Andrea Eden-Shingleton Concordia University, Nebraska MPH 500
Introduction to Public Health Professor Rebecca Toland
10/21/2014
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Biomedical/ Biostatistical Principles Definition Cause Symptoms
Transmission Pathophysiology Treatment History
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What is Tuberculosis? Definition Tuberculosis, commonly known
as TB, is a contagious and potentially fatal airborne disease
caused by a bacterial infection. TB typically affects the lungs,
but it also may affect any other organ of the body. (cdc.gov, 2013)
Terms Latent TB infection- Persons with latent TB infection do not
feel sick and do not have any symptoms. They are infected with M.
tuberculosis, but do not have TB disease. The only sign of TB
infection is a positive reaction to the tuberculin skin test or TB
blood test. Persons with latent TB infection are not infectious and
cannot spread TB infection to others. (cdc.gov, 2013) Multi drug
resistant TB (MDR TB) is a form of drug-resistant TB in which TB
bacteria can no longer be killed by at least the two best
antibiotics, isoniazid (INH) and rifampin (RIF), commonly used to
cure TB. As a result, this form of the disease is more difficult to
treat than ordinary TB and requires up to 2 years of multidrug
treatment. (cdc.gov, 2013)
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What is Tuberculosis? Cause Mycobacterium tuberculosis is a
slow growing; aerobic, rod- shaped, acid fast bacterium that only
lives in humans. As shown below on an Acid Fast Bacilli smear.
(cdc.gov, 2013) Signs and Symptoms Cough with bloody sputum Fever
Weakness and fatigue Weight loss (loss of appetite) Positive
Tuberculin Skin Test Positive acid fast smear and cultures Chest
x-ray (see photo above, left x- ray image is TB, right is
normal)
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What is Tuberculosis? Transmission Spread by aerosol
Mycobacterium Tuberculosis is breathed in droplets expelled during
coughing Pathophysiology Inside the lungs the immune system will
kill off some bacilli and then wall off the rest into small,
calcified lesions which remain dormant(latent TB infection.)
Unknown to scientists, a small percentage of infected people
develop active TB soon after exposure. In an active case of
pulmonary TB, the bacilli grow in the lungs, causing breakdown of
lung tissues. (cdc.gov, 2013)
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What is Tuberculosis? Anti TB drugs for Latent TB 3 choices 1.
Isoniazid (INH) daily for 9 months 2. combination regimen of
isoniazid (INH) and rifapentine (RPT) given in 12 once- weekly
doses under directly observed therapy (DOT). 3. Rifampin (RIF)
given daily for 4 months(cdc.gov, 2013) Anti TB drugs for TB
Disease Isoniazid (INH) Rifampin (RIF) Pyrazinamide (PZA)
Ethambutol (EMB) TB disease must be treated for at least 6 to 9
months. In some cases, treatment can last 18 to 24 months or longer
to treat multidrug-resistant TB (MDR TB). (cdc.gov, 2013) Phases of
treatment 1. initial phase of 2 months, most tubercle bacilli are
killed 2. continuation phase of either 4 or 7 months. there are
still active bacilli in the body, to kill remaining bacilli
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History of Tuberculosis Found in spines of 4000 yr old Egyptian
mummies 460BCE consumption or phthisis described by Hippocrates
1679 Sylvius identifies pathological lung changes 1854 first
successful public health initiative, Isolation in Sanatoriums (see
photo) 1882 Robert Koch discovered Mycobacterium Tuberculosis 1906
Bacille Calmette-Guerin vaccine 1947 first anti-TB drug therapy
(Persson, 2010)
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Epidemiological Principle World wide incidence United States
incidence Risk Factors Social and Behavioral Environmental
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How prevalent is TB? The National Institute of Allergy and
Infectious Diseases reports, worldwide, a new person is infected
every second, killing between 2-3 million people globally each
year. (niaid.nih.gov, 2010) The WHO (2013) accounts around 1.3
million TB-related deaths worldwide in 2012; emphasizing that TB is
a leading killer of people who are HIV infected (320, 000 of the
total deaths.)
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How prevalent is TB?
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How prevalent is TB in the US? With 9,945 total cases,
representing a case rate of 3.2 cases per 100,000 persons, 2012 had
the lowest number of reported TB cases since reporting began in
1953. (84,304 cases/ 52.6) (cdc.gov, 2013). In 2013, the CDC
reported that foreign born Hispanics and Asians account for 79% of
the new cases and 50% of the national case total. In 2013, the CDC
estimated 6% of all TB cases and 10% of TB cases among people aged
2544 occurred among people who were HIV- positive.
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How prevalent is TB? United States: new cases reported in every
state in 2012
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How prevalent is TB? High Risk Groups Foreign-born Asian
Hispanic Native Hawaiian or Pacific Islander Black or African
American
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How prevalent is TB in the US? High risk Gender: Males, all
adult age groups Age 24-44 yrs. combined with 45-64 yrs. is 62% of
all reported cases in 2012
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How prevalent is TB? Social/Behavioral Factors Gender Race
Income Education Alcohol/Substance abuse HIV positive Poor
nutrition Lack of healthcare (cdc.gov, 2013) Social/Behavioral
Factors Gender Race Income Education Alcohol/Substance abuse HIV
positive Poor nutrition Lack of healthcare (cdc.gov, 2013)
Environmental Factors Crowding (prison) Crowding (prison) Urban
dwelling Urban dwelling Low Social Economic Status (Poverty) Low
Social Economic Status (Poverty) Unemployment Unemployment
Homelessness Homelessness Healthcare workers Healthcare workers
(cdc.gov, 2013)
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Policy and Infection control
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Stopping Tuberculosis TB Prevention laws are authorized by
various levels of government (typically state governments) to
regulate and establish TB control programs. (cdc.gov, 2009) Federal
agencies prevent infected individuals from traveling on commercial
aircraft; names of these individuals are placed on a Do Not Board
list. (Schneider, 2014, p. 165) A similar list, managed by the CDC
and Homeland Security, is distributed to border patrol authorities
in order to prevent diseased persons from entering the U.S. via
seaport or land border. (Schneider, 2014, p. 165)
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Stopping Tuberculosis The CDC (2013) TB infection control
program should be based on a three control measures: 1.
Administrative measures 2. Environmental controls 3. Use of
respiratory protective equipment For suspected exposure: The
Mantoux tuberculin skin test (TST) is the standard method of
determining whether a person is infected with Mycobacterium
tuberculosis. Reliable administration and reading of the TST
requires standardization of procedures, training, supervision, and
practice. (cdc.gov, 2013)
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cdc.gov. (2013, October). Retrieved September 10, 2014, from
cdc.gov:
http://www.cdc.gov/tb/statistics/reports/2012/pdf/report2012.pdf
http://www.cdc.gov/tb/statistics/reports/2012/pdf/report2012.pdf
niaid.nih.gov. (2010, August 10). Retrieved September 10, 2014,
from
http://www.niaid.nih.gov/topics/tuberculosis/Understanding/history/pages
/historical_killer.aspx
http://www.niaid.nih.gov/topics/tuberculosis/Understanding/history/pages
/historical_killer.aspx Persson, S. (2010). Smallpox, syphilis and
salvation: medical breakthroughs that changed the world. Auckland,
New Zealand: ReadHowYouWant. Schneider, M. J. (2014). Introduction
to public health. (4th ed.). Burlington, MA: Jones & Bartlett
Learning. WHO.int. (2013). Retrieved September 10, 2014, from
Global Tuberculosis Report 2013:
http://apps.who.int/iris/bitstream/10665/91355/1/9789241564656_eng.pdf?u
a=1