Tuberculosis: Epidemiology, Prevention, and Control

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Table of Contents

Introduction
Tuberculosis Infection
Prevention and Control
Surveillance
Epidemiology
Special Topics and Significant Events
Conclusion
References

Introduction

It has been changing for years, making it difficult to have a single method of curing the disease. In recent years, tuberculosis has been associated with multiple deaths worldwide, with developing countries facing a significant problem in handling the disease. The United States has several infections, and the Center for Control and Prevention (CDC) has been identifying various ways of handling the infection. This essay focuses on tuberculosis infection, prevention and control, surveillance, epidemiology, and significant events.

Tuberculosis Infection

According to the CDC, there were more than 10 million TB cases globally in 2017, with a rate of 133 per 100,000 individuals (MacNeil et al., 2017). In comparison to the previous years data, there was an estimated 1.8% decline in cases observed from 2016 to 2017. On average, TB cases have declined by approximately 1.5% annually since the year 2000. A similar trend was observed in TB deaths, with a decline of 3.9% from 2016 to 2017 (MacNeil et al., 2017). Approximately 920,000 cases of TB and HIV coinfection were accounted for in 2017, representing 9% of the total TB cases observed (MacNeil et al., 2017, p. 263). Additionally, 300,000 deaths were observed among TB patients coinfected with HIV, indicating a case fatality rate of 32.6% (MacNeil et al., 2017). Rifampicin-resistant TB (RR-TB) cases and multi-drug resistant TB (MDR-TB) cases accounted for 558,000 incident cases and 230,000 deaths (MacNeil et al., 2017, p. 263). The case fatality rate among resistant forms of TB was 41% (MacNeil et al., 2017).

Tuberculosis is an airborne infection that implies that the disease is transmitted through airborne particles. When an infected individual coughs, shouts, sneezes or sings, the generated particles get suspended in the air for various hours. When these particles get in contact with a person through inhalation or swallowing, they are transferred to the alveoli of the lungs. When in the lungs, the incubation period for the bacteria is about twelve weeks (Behr et al., 2018). An infected individual becomes contagious during this period and remains contagious as long as the bacteria is in the sputum. Individuals are usually contagious for about two to three weeks after the incubation period.

Tuberculosis treatment involves patients taking a combination of medications based on patient circumstances considering if they have had the disease before or not, which goes up to 6 months with no interruption. These patients have to take a minimum of three drugs as part of the first treatment. This is because fewer drugs can lead to drug-resistant Tb development (Al-Saeedi & Al-Hajoj, 2017). If the patient has never received treatment before, the doctor will have to prescribe Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol (Mase & Chorba, 2019). This follows the probability that the bacteria will be sensitive to all medication and it will not respond to the patients body. The skin test method involves the injection of tuberculin into the lower arms skin. The blood test is done by interferon-gamma release assays (IGRAs).

Prevention and Control

The population-level disease control measure is usually implemented to prevent the further spread of the infection. At this level, the infected individuals are identified, and those with active tuberculosis are treated, making the infection non-contagious. The individuals who have had contact with TB patients are screened to ensure that they do not have active TB (Li et al., 2017). Individuals that are identified to be at risk are then subjected to treatments. Various awareness procedures are set up to enable public members to avoid certain activities that may lead to the spread of TB.

TB patients pose a significant threat to others as the bacteria are airborne. The infected individuals are usually isolated while receiving treatment and removed from isolation within a few weeks of receiving treatments (Xin et al., 2021). The post-exposure prophylaxis for individuals developing active TB can be a supplement in controlling TB. Individuals from places with higher rates of TB infection require post-exposure prophylaxis to help control the TB. However, there are significant challenges to post-exposure prophylaxis, such as exposure gradient, the balance between the benefits and the risks, and post-exposure prophylaxis efficacy (Xin et al., 2021).

Currently, chemoprophylaxis is the most used method in TB Post-exposure prophylaxis. This preventive treatment has significant efficacy in managing the disease.

Surveillance

Case definitions tend to vary from one health organization to another. The World Health Organization (WHO) provides various case definitions and classifications for TB. In Nevada, TB cases are reported within 24 hours timeframe once the healthcare provider has identified them. The health authority then investigates the cases that are either active tuberculosis or suspected cases. Necessary measures are taken to prevent the spread of the infection. Screening of individuals in contact with active TB is done from 8 to 10 weeks (Nac, 2021). Active and suspected cases are then required to follow TB regulations administered by the State Board of Health. It is crucial to have TB surveillance to prevent an epidemic because the disease is contagious. Furthermore, it helps identify substantial gaps between people and the health systems. This includes X-ray diagnosis areas that reveal abnormalities and extrapulmonary cases that the laboratory has not yet confirmed. TB is a nationally notifiable disease by law in the United States, and it is reportable in the state of Nevada.

Epidemiology

From a global perspective, tuberculosis is a significant problem that affects a large population. In 2020, approximately 1.5 million people died from the infection, including 214,000 people already infected with HIV (Tuberculosis (TB), 2022). TB is identified as the 13th leading cause of death, and on the infectious level, it is second after COVID-19. Africa is the region with the highest prevalence, reporting 226 cases per 100,000 population, followed by Southeast Asia with 217 cases per 100,000 population and the Eastern Mediterranean with 114 cases per 100,000 population (Statista, 2021). The Western Pacific reported 93 cases per 100,000 population, whereas the United States reported only 29 cases per 100,000 population. Europe reported the lowest number of cases of the six regions, with only 26 cases per 100,000 population (Statista, 2021).

During this period, the US had more than 84,000 cases of TB(CDC, 2019). From 1953 to 1984, the number of TB infections decreased significantly, with an average rate of 6% every year (CDC, 2019). In 1985, the total cases of TB were at their lowest, with 22,201 cases (CDC, 2019). TB cases began to rise in 1986 after a significant period since 1953. From 1985 to 1992, the number of TB cases increased from 22,201 to 26,673, representing an increase of approximately 20% (CDC, 2019). However, in 1993, the number of infections decreased, which was experienced for 21 years until 2014 (CDC, 2019). A slight increase in the number of cases was noted in 2015. In 2017, the United States reported a significantly low number of TB cases since it began reporting in 1953.

Special Topics and Significant Events

The major tuberculosis outbreak happened between 1800 and 1990 in North America and Europe. 70%-90% of North American and Europe urban populations contracted the disease by the late 19th century (Barberis et al., 2022). In the United States alone, there were 84,304 cases in 1953 and 79,775 in 1954. In Western Europe, TB was a significant problem during the 18th century as it had a mortality rate of 900 deaths per 100,000 people. Detection of TB that is resistant to the antibiotics such as rifampicin and isoniazid has been enhanced by the development of automated Nucleic Acid Amplification Tests (NAATs) (WHO, 2021). It was discovered that the use of doxycycline, together with Tb medication treatment, resulted in the reduction of the lung cavity size and accelerated lung recovery markers (Miow et al., 2021).

Conclusion

It is a contagious disease that affects a significant portion of the US population and the global community. Currently, the infection hugely affects Asian and African countries. Despite its reduction in infection rates, there are areas where individuals are hugely affected by this condition. Identification of patients infected by TB is an essential measure in curbing its spread. Isolation is an important step in the fight against TB since the disease is airborne and highly contagious. The history of TB shows that it is necessary for the condition to be given maximum attention as it leads to multiple deaths when not treated. It is not selective, as it affects individuals of all age groups. However, various antibiotics have been developed which help treat the infection.

References

Al-Saeedi, M., & Al-Hajoj, S. (2017). Diversity and evolution of drug resistance mechanisms in Mycobacterium tuberculosis. Infection and Drug Resistance, 10, 333-342.

Barberis, L., Braggazi, N., Galluzo, L., & Martini, M. (2022). The history of tuberculosis: From the first historical records to the isolation of Kochs bacillus.Journal of Preventive Medicine and Hygiene, 58(9), 9-12. Web.

Behr, M., Edelstein, P., & Ramakrishnan, L. (2018). Revisiting the timetable of tuberculosis.BMJ, 1-8. Web.

Li, J., Chung, P., Leung, C., Nishikiori, N., Chan, E., & Yeoh, E. (2017). The strategic framework of tuberculosis control and prevention in the elderly: A scoping review towards End TB targets.Infectious Diseases of Poverty, 6(1), 1-9. Web.

MacNeil, A., Glaziou, P., Sismanidis, C., Maloney, S., & Floyd, K. (2017). Global Epidemiology of Tuberculosis and Progress Toward Achieving Global Targets,68(11), 263266. Web.

Mase, S., & Chorba, T. (2019). Treatment of Drug-Resistant Tuberculosis. Clinics in Chest Medicine, 40(4), 775-795.

Nac: Chapter 441A- Infectious Disease; Toxic agents. Leg.state.nv.us. (2021). Web.

Statista. (2021). Tuberculosis incidence worldwide by region 2019 | Statista. Statista. Web.

Tuberculosis (TB). Who.int. (2022). Web.

WHO announces updates on new molecular assays for the diagnosis of tuberculosis (TB) and drug resistance. Who.int. (2021). Web.

WHO. (2020). Definitions and reporting framework for tuberculosis (pp. 1-47). Web.

Xin, H., Jin, Q., & Gao, L. (2021). Conditional expanding post-exposure prophylaxis: a potential new tool for tuberculosis control. ERJ Open Research, 7(1), 1-6.

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