Epidemiology – Tuberculosis

Communicable diseases occurs in every country regardless of urban, rural, or with socio economical diversities. In order to help in prevention and control of communicable diseases, locally, nationally and globally, nurses who are working with the public health system , must have basic understanding of epidemiology, microbiology, treatments, and knowledge about public health system and the legal system.

Although, the United states attained a significant success in attaining the control over the communicable diseases, compared to the other parts of the world since 1940s, communicable diseases are still leading cause of death in the United States. (Maurer &Smith, 2012). Tuberculosis(TB) is a air bourn infectious disease which is caused by Mycobacterium Tuberculosis. People who are living in poor socioeconomic background and who are living in medically underserved communities are more prone to this deadly , but preventable and curable disease. This disease continue to be as an indicator of poverty and low socio-economic background.

Most of the time people affected with this deadly disease are undiagnosed early and affected with malnutrition or immunologically compromised. Tuberculosis can affect several organs of human body, including brain, bones, kidney. Mostly it affects the lungs and spreads through the infected droplets of saliva when the infected person talks, coughs or sneezes. According WHO fact sheets, “Tuberculosis is next to HIV/AIDS in causing death of human worldwide. In 2012, 8. 6 million people got sick with TB and 1. 3 million people died due to TB infection”(WHO, 2013).

Identification and treatment of all active TB cases, and the estimated of 2 billion people who are latently infected with Mycobacterium tuberculosis, can lead to a global eradication of tuberculosis.. (Mwaba et. al 2011). Tuberculosis may be considered as active TB,or latent TB. Active TB ussually seen as pulmonary tuberculosis. It may enter into other organs which is referred as “extra-pulmonary tuberculosis”. Common signs and symptoms of active pulmonary TB are cough associated with sputum,bloody sputum at times, fever, chest pain, weight loss and weakness, night sweats.

”Miliary TB” is uncommon type of TB which is lethal enters the blood stream and the multiplication of the bacteria in different organs and glands occurs. Multi drug therapy on all active TB cases under the supervision of health care personnel, which is called as “Directly Obseved Therapy”(DOT) is intended to prevent noncompliance, which may result in increase in spread of infection or increase in acquired resistance to the medication. In latent TB, the person may not show any signs and symptoms of tuberculosis. The chest X-Ray may be negative.

They may present with a positive “tuberculin skin test”(TST), or “interferone-gamma release assay. ”(IGRA). Latent TB can become active with other disease like HIV/AIDS. In The United States latent TB is treated with preventative therapy. (Ismen,M,2013). According to WHO reports, every second, someone in the world is infected with Tuberculos infection. One third of the population of the world is infected with TB. Implementation of ”Directly Observed Therapy-Short course”(DOTS) ,which is one of most cost effective strategy in TB Prevention globally, has considerably reduced the mortality and morbidity rate.

The main determinants in tuberculosis are many. Global socio economic inequalities, huge volume of people moving around nationally and internationally,unplanned urbanization resulting in overcrowded living and work places, increased population growth,poor ventillation in houses and work places, resulting in, exposure of uninfected people to TB infected people. Poverty and malnutrition and diseases like HIV /AIDS increases the suseptibility to TB. (Hargreves et. al 2011) “Epidemiology” is the “study of the distribution and determinates of health related states in specified population and application of the study to controll health problems. ”(WHO).

Scientists developed a model of study called “epidemiological triangle”,focusing on the agent, host and the environment favoring the disease. Preventing communicable disease depend on the understanding of the relationship of the chain of infection. The agent (causative organism), The environment (physical,Biological, socio economical) and the host (defensive mechanism,immmunity) are the three main factors of this chain. (Maurer& Smith 2012. ) In tuberculosis the agent is Mycobacterium Tuberculosis, and occassionally from mycobacterium bovine, which is normally seen in cattles.

The bovine type enters the human body through injestion of unpasteurized milk which is infected with mycobacterium bovine. This can be prevented with pasturization and proper boiling of milk before consuming. Promoting breast feeding can reduce the incidence from this type of TB infection infants. Mothers who are not able to breast feed or if there is no adequate milk production, the community health worker should emphasize on the importance of proper boiling of cow’s milk, if the choice of milk is cow or sheep’s origin. Mycobacterium Tuberculosis transmits from an infected person to un infected person through droplet infection.

This airborne particles which are called as droplet nuclie are one to five microns in diameter and able to suvive for several hours in air under favorable environments. Persons who are diagnosed with active pulmonary tuberculosis should be treated with multi drug therapy under “Direct Observational Therapy”(DOT). Respiratory hygiene should be in practice to prevent spreading. A surgical mask should be worn by the patient to prevent spreading of droplet infection. (CDC) The host factors for tuberculosis includes poor nutrition, coexisting diseases, poor immunity.

Compremised population are at high risk for communicable diseases. Infants, children who are longer time in schools, older adults are prone to get infected with communcable diseases like TB. According to WHO, vaccination for TB, in countries where the disease is common, is recommended. Bacille Calmette – Guerin (BCG) is effective in protecting small children from TB. BCG is not in use in The United States (NIH). Health care workers, police officers, para medics, ambulance personnels, are at high risk for contracting communicable diseases like TB.

The environmental factors includes overcrowding, improper waste disposal leading to bad environmental and personal sanitation, poor ventilation which leads to cross contamination of uninfected people to TB infected people. Planned communities and housings with adequate ventllation prevents cross contaminatoin. Use of high efficiency air filters purify the air with droplet nuclie. Educating the community about hygiene to prevent diseases is important. Simple hand washing can prevent the spread of many communicable diseases. Tuberculosis spreads with droplet infection.

Encouraging the community and people to cover the cough while sneezing and coughing is part community health education. This simple precautions can prevent spread of disease. People who are infected with TB should be encouraged to participate in “DOT’ method of treatment to prevent developing multi drug resistant TB. People with latent TB should be followed up periodically for active signs of TB. Screening programs for communicable diseases like TB,Hepatitis B, are included as part of school,college and pre-employment screening. This benefits to protct the public and early treatment. (Maurer& Smith 2009).

Data collection, analysis and follow up in TB is important. Data collection can be in different ways. Reports from health care settings, of all diagnosed TB cases to the infection contoll department is mandatory. Direct interviews, surveys, observation and record review, are methods of data collcetion. Community health nurses who are culturally competant are able to collect adequate information and can provide appropriate teaching instructions. Use of translators, or printed material in the language of the patient is necessary to get correct information, if the patint’s primary language is not English or can not understand English.

Information Should be colleceted by the community health nurse at each visit of the patient to the health center or each community visit of the nurse. Age, gender, race, country of birth, sign and symptoms onset duration should be documented . All diagnosed TB population should be followed up regularly for assessment and treatment by the community nurse. Folllow up results of “Tuberclin Skin Test”(TST), chest Xrays, Sputum smear, and cultures indicating negative results are indicative of compliance to treatment. “Stop TB USA” is a national organization foamed in 1992.

This organization’s goal is primarly to eliminate tuberculosis and address failure of TB contoll in the United States. It serve as a guide to public and policy makers on the position of elimination of tuberculosis nationally and globally. More information about this organization is available ro the public through the web site, www. stopusa. org In conclusion tuberculosis is a disease, preventable and cureable, if diagnosed early and treated appropriately. The prevalance of tuberculosis is low in the United States.

Active community participation and awareness is needed to prevent and eliminate tuberculosis from the United States and globally.

References Hargreves, J. R. , Baccai, D. , Evans, C. A. , Adatto, M. , Petticrew, M. , & Porter, J. D. ( April 2011). The social determinants of Tuberculosis ; from evidence to action. Am j public Health, vol 101(4), 654-662. Retrieved November 6th,2013 from http://www. ncbi. nlm. nih. gov/pmc/articles/PMC3052350/ . Ismen, M. (2013). Tuberculosis:Types . National Jewish Health. /Retrieved November6th 2013, from http://www. nationaljewish.

org/ Maurer, F. A. , & Smith, C. M. (2012). Community/Public health nursing practice: Health for families populations (5th ed. ). St. Louis, MO: Saunders Elsevier. ISBN-13: 9781455707621 Mwaba, P. , Macnerney, R,Grobusch, M. P. , O’ Grady, J. , Bates, M. , Kapta, NZimla, A. (July 2011). Achieving STOP TB partnership goals; perspective on diagnostics, drugs and vaccine for tuberculosis. /Retrieved November 5th 2013 from http://www. ncbi. nlm. nih. gov/pubmed/21489070 Tuberculosis ( october2013). WHO. /Retrieved November6th,2013 from http://www. who. int/topics/tuberculosis/en/.

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