Download What is TB?

IOSH Presentation
2012
Tuberculosis
Kim Cartlich 2012
Aims
• Basic awareness of Tuberculosis (TB)
• Gain knowledge of the disease process
• Be aware of local epidemiology / prevalence
• Recognise why TB is making a come back
•To understand the role of BCG vaccination and who requires it
• Know the role of the TB nurse
• Where to seek advice
What is TB?
•TB is an airborne communicable disease
•TB is caused by a bacteria called
mycobacterium tuberculosis
•It is spread by tiny airborne particles expelled
by individuals with infectious TB by cough,
sneeze or spit
•If another person inhales air containing these
bacteria transmission can occur
•TB bacteria prefer the lungs but can infect any
organ in the body
TB History
•Consumption
•Galloping consumption
•Scrofula
•Kings Evil
•White plague
•Phthisis
Famous people who had TB
•Bronte sisters
•Robert Burns
•George Formby
•Desmond Tutu
•Eleanor Roosevelt
•Vivian Leigh
•Tom Jones
•Nick Knowles
“It was the fashion
to suffer from the
lungs; poets
especially; it was
good form to spit
blood after any
emotion that was at
all sensational, and
to die before reaching
the age of
thirty.”Alexandre
Dumas
Past treatment for TB
2010/2011 TB Global facts
•
•
•
•
1.7 million people died from TB in 2009
This is equal to 4700 deaths per day
There were 9.4 million new TB cases in 2009
In 2010 the WHO reported the highest ever rates of MDR TB, with
peaks of 28% in some settings of the former soviet Union
• XDR TB cases have been confirmed in 58 countries
However !
• 2008 saw the highest level ever of people successfully treated at
86%
World Health Organisation 2012
Why the resurgence?
• Migration
• Poverty / war / civil unrest
• HIV
• Longevity
• Poor treatment and control in third world countries
Figure 1.4. Three-year
average tuberculosis case
rates by local areas*, UK,
2008-2010
*England – Local Authorities,Scotland –
NHS Boards, Wales – Local Health
Boards, NI – data not available.
Sources: Tuberculosis in the UK: Annual
report on tuberculosis surveillance in the
UK, 2011. London: Health Protection
Agency. December 2011.
Figure 1.3. Tuberculosis case reports and rates by region, England, 2010
Number of cases
3,500
50
Rate (per100,000) and 95% CI
45
41.9
40
2,500
35
30
2,000
25
1,500
1,000
20
16.0
11.9
15
12.0
11.1
8.8
500
10
8.2
5.4
0
5.3
5
0
Region
CI – Confidence interval
Sources: Enhanced Tuberculosis Surveillance (ETS), Office for National Statistics (ONS) midyear population estimates. Data shown in Appendix B; ii, iii.
Prepared by: TB Section - Health Protection Services, Colindale.
Rate (per 100, 000)
Number of cases
3,000
10,000
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
9,000
Number of cases
8,000
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
2000
2001
2002
2003
2004
Number of cases
2005
Year
2006
2007
2008
2009
Rate per 100,000 and 95% CI
CI - Confidence interval
Sources: Enhanced Tuberculosis Surveillance (ETS). Enhanced Surveillance of Mycobacterial
Infections (ESMI). Office for National Statistics (ONS) mid-year population estimates.
Prepared by: TB Section - Health Protection Services, Colindale.
2010
Rate (per 100, 000)
Figure 1.1. Tuberculosis case reports and rates, UK,
2000-2010
511
157
121
125
281
194
286
47
115
519
353
322
553
361
488
71
124
73
69
2,713
194
208
27
35
1,837
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
5,504
Percentage of cases*
Figure 1.6. Tuberculosis case reports by place of
birth and region/country, UK, 2010
Country/Region (% where place of birth known)
Non-UK-Born
UK-born
*Numbers of cases stated in bars
Sources: Enhanced Tuberculosis Surveillance (ETS). Enhanced Surveillance of Mycobacterial
Infections (ESMI), Office for National Statistics (ONS) mid-year population estimates.
Prepared by: TB Section - Health Protection Services, Colindale.
How is TB caught
• TB bacteria inhaled
• Most lodged in the upper
respiratory tract (70-90%)
• Some may reach the lungs and
multiply (10-30 %)
• 2-10 weeks after infection
immune system usually
intervenes and prevents
spread of infection (latent)
• Only 10 % will go on to
develop TB at some time in
their life time
Signs & Symptoms of TB
• Cough
• Weight loss
• Night sweats
• Chest pain
• Extreme tiredness and lethargy
• Coughing up blood
TB Treatment
•TB treatment in the UK is free
to the patient
•Medication is taken for
minimum of 6 months
•Key to cure is concordance
•Occasional side effects
•Closely monitored
•Poor concordance can result
in drug resistance
•Drug resistant TB is much
more difficult to treat and much
more expensive
Who is at risk of catching TB?
•Elderly
•The very young (under 2yrs)
•Those with weakened immune systems e.g. HIV
•Pre existing lung conditions
•Homeless / alcoholics / Drug addicts
•Travel to a high risk area i.e.. more than 3 months
•New entrants to the country from high risk areas are most at risk in the
first 3-5 years of settling in their chosen country of reactivating any latent
TB
MDR TB and XDR TB
Multi drug resistant TB
Extensively drug resistant TB
• Poor treatment compliance
• Single drug therapy
• Poor calculation or regimes
• Malabsorption of drugs
• Prescribing / dispensing errors
Map showing MDR TB 2010
Why the problem
• Gaps in TB control
• Extremely weak services
M/XDR-TB
• management and care
• Health workforce crisis
• Inadequate laboratories
• Quality of anti-TB drugs not
assured
• No restriction or regulation of
anti-TB drug use
• Absent infection control
• Insufficient research
• Major financial gaps
How to protect against TB
There is no 100% protection against TB
•
•
•
•
BCG vaccination affords some protection ,for high risk groups
Knowledge about the disease is the best defence
Knowing who to contact for advice
Seeking professional advice if you know you have come in contact with a
case of TB
• Promote general good cough hygiene
Remember ! TB is not as infectious as you think
The TB team
TB
Clinicians
TB
Nursing
Team
HPA
TB Incident , What to expect
Incident involving large numbers i.e. educational,
establishment, nursing residential home ,prison , factory
• Health protection agency lead
• Incident meeting is held , all relevant parties invited all
information is assessed.
• Plan of action –timetable, screening , communication ,
press statements,
• TB nurses screen, collate results inform HPA
• Further meeting to assess need for further screening
• Final outcome meeting
The role of the TB nurses
• To support and visit all newly notified TB patients
• To instigate TB contact tracing
• Hold TB screening clinics in the community and Hospital setting
• Provide nurse Led prophylaxis clinic
• To provide a BCG vaccination service
• To screen new entrants from high prevalence areas of TB
• To and act as a resource for information on TB
Useful contact numbers
North Yorkshire & Humber Health Protection
unit 01904 468900
TB Nursing Team CHCP 01482 617994