Epidemiology of Tuberculosis

Since ancient times tuberculosis has been present, it was also known as Consumption. Despite current advanced medical screenings, diagnostics, and treatment methods, approximately one-third of the world’s population has been exposed and is infected with the organism (Mandal, 2014, para. 2). Becoming infected with TB usually occurs following close proximity with an infected person for a long period of time. Causes Tuberculosis (TB) is caused by an infectious bacteria known as Mycobacterium tuberculosis. M. tuberculosis is a rod-shaped slow growing bacteria that is hydrophobic.

It was first isolated in 1882 by Robert Koch and identified as an infectious disease (Mandal, 2014, para. 8). Symptoms In active TB, any, all, or none of the following symptoms may be present: persistent cough, fatigue, weight loss, decreased appetite, fever, hemoptysis, and night sweats. In latent tuberculosis infections, the patient is not contagious and cannot spread the bacteria. Latent TB infection occurs when there is exposure but an immune response occurs which manages the bacteria by walling it off and causing it to be dormant in the body. If a LTBI is treated at this stage, a subsequent active TB infection can be prevented (Murphy & Bernardo, 2013, para. 5).

Mode of Transmission Tuberculosis is transmitted via droplet contact, when someone with an active TB coughs, sneezes, talks, or laughs, very small droplets of saliva or mucous are expelled into the air. People in the vicinity of this infected person inhale these particles which can remain suspended in the air for several hours (Centers for Disease Control and Prevention, 2013, p. 21). Infection occurs in the host when these inhaled micro-particles reach alveoli in the lungs.

Complications Left undiagnosed and untreated, TB can spread to other areas via the bloodstream ultimately impairing liver and kidney function. It can also cause swelling and stiffness in joints, typically the hips and knees and occasionally the spine. In extreme cases, TB can affect the EPIDEMIOLOGY OF TUBERCULOSIS 3 brain’s membrane and the tissues surrounding the heart, risking fatality (Mayo Clinic, 2014). Tuberculosis is treatable and preventable, yet can be fatal if untreated. Treatment A major treatment concern is adherence to treatment protocols.

Patient education is paramount regarding medication compliance, adverse side effects of medications, timeliness seeking medical attention, isolation potential, and TB infection control measures. Currently, ten drugs are approved by the Food and Drug Administration for tuberculosis treatment. Demographics Tuberculosis is a worldwide disease, mainly acquired by young adults, yet all age groups are at risk. In 2013, over 500,000 children contracted TB. In 2013, fifty-six percent of new cases occurred in Southeast Asia and Western Pacific regions (WHO, 2015b).

The estimated number of new cases annually is declining and the death rate decreased forty-five percent from 1990-2013. Approximately thirty-seven million lives were spared due to diagnosis and treatment during that same time (WHO, 2015b). Determinants of Health There are many factors that increase risks of infection like a person’s location of residence and travelling habits.

India, China, Russia, and Africa all have high rates of drug- resistant forms of TB. Situations where people live in close proximity such as nursing homes, prisons, and homeless camps, contain high incidences of TB infections due to close living quarters, poor health and nutrition all increase risk. Low income populations and those who live in remote areas, lack medical care needed to diagnosis and treat TB. Substance abuse increases the risk of contracting TB.

Epidemiologic Triangle EPIDEMIOLOGY OF TUBERCULOSIS 4 The epidemiologic triangle is a model describing disease causation. Understanding the function and relationship between factors enables communicable disease prevention. The three main factors are host, agent, and environmental. The image below is an example. (UOttawa, 2014) Host Factors The host factors are affected by characteristics including age, health status, susceptibility, natural and artificial immunities, and other disease.

These influence a pathogen’s success at creating an infection. People with HIV are twenty-six to thirty-one times more likely to develop active TB than those not HIV positive (WHO, 2015b). Natural, passive and artificial immunities are ways the body protects the host. Agent Factors An agent is the pathogen or the cause of the infection. Each pathogen has characteristics which enable it to successfully infect a host. Some of these characteristics include the ability to survive outside the body, susceptibility to antibiotics, transmission ability, degree of invasiveness, and the infective dose.

Agents that are less infectious such as TB require host EPIDEMIOLOGY OF TUBERCULOSIS 5 exposure to larger numbers of TB bacilli for longer periods for disease transmission (Maurer & Smith, 2013, p. 205). Environmental Factors Environment altering can affect a pathogen’s ability to spread disease. Infectious disease transmission can be decreased by changing temperature, humidity, and ventilation. Crowding, famine, and mobility of people increase the possibility of spreading infections. Population density can contribute to environmental problems as it provides agents’ access to many victims rather than a few in a confined area (Maurer & Smith, 2013, p. 206).

Role of the Community Health Nurse Community health nurses work to prevent infection and spread of communicable diseases. They are often first to diagnose communicable disease and are tasked with interviewing the infected person. This identifies further community members at risk due to infected patient contact. They perform home visits to assess patients under treatment and safeguard compliance (Maurer & Smith, 2013, p. 204). Primary, Secondary, and Tertiary Prevention Preventions are risk reduction activities to the population’s health.

Primary prevention actions prevent disease establishment and focus on risk reduction, health education, and vaccination. Secondary prevention focuses on reducing a disease’s impact by detecting further disease cases and treating known cases to slow or stop disease progression, at the earliest stages so people can return to their normal health and functional levels as soon as possible. Tertiary prevention involves actions to manage diseases’ long-term effects and accompanying health problems, and the creation of programs and plans to improve the function, quality of life of those infected with disease.

EPIDEMIOLOGY OF TUBERCULOSIS 6 Case Finding Case finding identifies every case of possible disease. When new cases are identified, rapid treatment occurs to minimize further transmission. Community health nurses often function as case finders. Nurses identify individuals with the most intimate contact, referred to as Level One contacts. The search continues to spread outward in a circular fashion to others in close contact known as Level Two contacts. In cases where no further infections are found in Level One, there is no reason to proceed to Level Two (Maurer & Smith, 2013, p. 227).

Reporting In the United States, some diseases are required to be reported by state and local health departments. State public health departments are legally responsible for controlling communicable diseases within their state and reporting approximately ninety notifiable communicable diseases to the CDC. Most states electronically report their cases to the CDC (Maurer & Smith, 2013, p. 208). Data Collection and Analysis Data collection enables the CDC and individual states to decide which health concerns should have priority.

This data collection shows seasonal fluctuations and geographic distributions or higher incidences in selected risk groups of the disease being tracked. Trends are noted while programs are formulated to prevent or reduce a disease’s impact. An example involves measles’ resurgence as researchers discovered combined measles-mumps-rubella vaccine was not as long-acting as previously believed. New immunization standards were developed as a result (Maurer & Smith, 2013, p. 209).

Follow Up EPIDEMIOLOGY OF TUBERCULOSIS 7 The community health nurse is responsible for follow-up with patients who have a communicable disease to see if they are continuing their medications, health is improving, and if there are any areas needing education. Follow-up is especially important with tuberculosis patients that are not compliant taking medications because there is increased risk of antibiotic resistant TB.

Organization and Contribution The World Health Organization (WHO) has developed multiple programs over the years to decrease the number of TB cases and hopefully to end TB worldwide. One initiative of the WHO was to expand high quality Directly Observed Treatment Short-course (DOTS) therapy for TB cases. DOTS is treatment regimen directly observed by a community health worker for at least the first two months.

Other TB objectives of WHO include high-quality care for all with TB, reduce suffering and socioeconomic burden associated with TB, protecting vulnerable populations from TB, TB/HIV and multidrug-resistant TB, and to protect and promote human rights in TB prevention, care and control (WHO, 2015c). Conclusion Worldwide tuberculosis deaths each year are second only to HIV in number. There is an estimated need for eight million dollars annually to fund a full response to TB in low and middle income countries.

More than fifty companies are involved in the development of improved TB diagnostics and there are fifteen vaccines currently in trials (World Health Organization Press [WHO Press], 2014). While the number of TB cases is decreasing, there is more work to be done.

EPIDEMIOLOGY OF TUBERCULOSIS 8 References Centers for Disease Control and Prevention. (2013). Introduction to the Core Curriculum on Tuberculosis: What the Clinician Should Know. Retrieved from http://www. cdc. gov/tb/education/corecurr/default. htm Department of Epidemiology and Community Medicine, University of Ottawa. (Cartographer). (2014). Epidemiologic Triad. Retrieved from http://www.med. uottawa. ca/sim/data/Infectious_Diseases_e. htm Mandal, A. (2014).

History of Tuberculosis. Retrieved from http://www. news- medical. net/health/History-of-Tuberculosis. aspx Maurer, F. , & Smith, C. (2013). Community/Public Health Nursing Practice: Health for Families and Populations (5th ed. ). St. Louis, Missouri: Saunders Elsevier. Mayo Clinic. (2014). Tuberculosis. Retrieved from http://www. mayoclinic. org/diseases- conditions/tuberculosis/basics/definition/con-20021761 Murphy, C. , & Bernardo, J. (2013). Patient information: Tuberculosis (Beyond the Basics).

Retrieved from http://www. uptodate. com/contents/tuberculosis-beyond-the-basics? view=print# World Health Organization – Media Centre – Tuberculosis. (2015a). Retrieved from http://www. who. int/mediacentre/factsheets/fs104/en/ World Health Organization – The Stop TB Strategy – Vision, goal, objectives and targets. (2015b). Retrieved from http://www. who. int/tb/strategy/stop_tb_strategy/en/# World Health Organization Press. (2014). Global tuberculosis report 2014. Retrieved from World Health Organization: http://www. who. int/tb/publications/global_report/gtbr14_main_text. pdf? ua=1.

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