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Disease Awareness December 2015 • Facts Tuberculosis Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis. It occurs most often in people with weakened immune systems and in people who weren’t born in the United States. It primarily affects the lungs, in which case it’s usually infectious. But it can also affect other parts of the body such as the brain, kidneys, or spine. In these cases it’s usually not infectious. Not everyone infected with TB bacteria gets sick. There are two types of TB infection: latent TB infection and TB disease. Latent Tuberculosis Infection In the first weeks or months after exposure, most people mount an immune response that keeps the bacteria under control. Immune cells form a barrier around the bacteria. Live bacteria are present, but they are contained. This results in latent TB infection. People with latent TB infection: • Don’t have symptoms • Aren’t contagious • Usually test positive with a TB skin test or blood test • Usually have a normal chest x-ray and negative sputum smear or culture • Can be treated to prevent them from developing active disease Tuberculosis Disease TB bacteria are active in TB disease. They grow and attack the body and make the person sick. Active TB bacteria in the lungs can be passed to others. Bacteria can enter the air when an infected person coughs or sneezes and infect other people. Tuberculosis Facts In the United States: • M ore than 11 million people have latent TB infection.1 • 9 ,421 TB cases were reported in 2014. 2 • 555 TB deaths occurred in 2013. 2 • 2 out of every 3 TB cases occur in foreign-born people. 2 TB case rates are2: • 2 9 times higher for Asians than for whites. • 8 times higher for both African Americans and Hispanics than for whites. Tuberculosis and National Origin • Loss of appetite The country a person was born in has a lot to do with their risk for having TB disease. People who live in the United States but who weren’t born here have a much higher incidence of TB. In fact, it’s about 13 times higher.3 The majority of people in this group who have TB disease were born in 5 countries. These are4: • Chills or fever • Mexico • Night sweats • The Philippines Symptoms of Tuberculosis Disease Most people with TB disease have 1 or more of these general symptoms: • Feeling weak or tired • Weight loss • India • Vietnam • China 1 Tuberculosis Facts Symptoms of TB disease in the lungs include: • Coughing for 3 weeks or longer • Chest pain • Coughing up blood Sometimes TB affects other parts of the body. In these cases, the symptoms depend on where the infection is. Risk for Tuberculosis Disease Many people with latent TB infection never develop TB disease. But some people aren’t able to fight the TB bacteria. The bacteria become active and cause TB disease. People have a higher chance of getting TB disease if they5: • Have HIV infection • Were infected with TB bacteria in the last 2 years • Are a child younger than 5 years of age • Are elderly • Take some types of medicines • H ave other health problems that make it hard for the body to fight disease (eg, diabetes and certain types of cancer) • Are underweight • Smoke cigarettes • Abuse alcohol and/or drugs People Who Should Get Tested Tuberculosis and HIV Coinfection HIV infection is the greatest risk factor for progression of latent TB infection to TB disease. • I n people with latent TB infection and untreated HIV, the risk of developing TB disease is 7% to 10% each year.7 • I n people with latent TB infection and a healthy immune system, the risk of developing TB disease is 10% over their lifetime.7 Tuberculosis and BCG Vaccination Bacille Calmette-Guerin (BCG) is a TB vaccine. It: • I s used in many countries where TB is common • Isn’t used in the United States • D oesn’t always prevent people from getting TB • M ay cause a false-positive TB skin test but will not affect a TB blood test Not everyone should be tested for TB. Testing is appropriate for people who are at increased risk of infection or progression to active disease. In addition to the people listed above, this includes people who5,6: • Have had close contact with someone who has TB disease • Have symptoms of TB disease • Are from a country where TB disease is very commona • L ive or work where TB disease is more common (eg, homeless shelter, jail, nursing home) • A re in healthcare and work closely with those who are at increased risk of TB disease • A re infants, children, or adolescents exposed to adults who are at increased risk of TB. Includes most countries in Latin America, the Caribbean, Africa, Asia, Eastern Europe, and Russia. a 2 Tuberculosis Facts Tuberculosis Testing References There is no gold standard test for TB. Two tests in common use are: 1. • TB skin test • Interferon-gamma release assay (IGRA) blood test In the TB skin test, a small amount of test fluid is injected into the skin on the lower part of the arm. A return visit to a trained healthcare worker 2 to 3 days later is needed. He/she will ‘read’ the test by looking for a small bump on the arm. It’s a sign of a positive reaction. An IGRA test uses a blood sample. It measures the immune system’s reaction to TB bacteria. No return visit is needed. Both tests can detect latent TB infection and TB disease. A positive result means TB bacteria may be present. Further testing is needed to know for sure. A negative result means that TB bacteria are probably not present. But some people with TB might have a negative result. This is true with either test. Neither test can be used to: • Tell the difference between latent TB infection and TB disease • Tell if a person will develop TB disease IGRAs are preferred for people who6: • H ave received the bacille Calmette-Guerin (BCG) vaccination (see sidebar on page 2) • C an’t or aren’t likely to return 2 to 3 days later to have a skin test read by a trained healthcare worker The skin test is preferred for testing children younger than 5 years of age. enters for Disease Control and C Prevention. New, simpler way to treat latent TB infection. cdc.gov/Features/ TuberculosisTreatment/. Updated December 12, 2011. Reviewed August 13, 2014. Accessed October 20, 2015. 2. C enters for Disease Control and Prevention. Take on tuberculosis. cdc.gov/ tb/publications/infographic/default.htm. Updated September 28, 2015. Accessed October 20, 2015. 3. C enters for Disease Control and Prevention. Fact Sheet. Trends in tuberculosis, 2014. cdc.gov/tb/ publications/factsheets/statistics/ tbtrends.htm. Accessed October 20, 2015. 4. C enter for Strategic and International Studies. Tackling tuberculosis abroad. csis.org/files/publication/140604_ Moore_TacklingTBAbroad_Web.pdf. Published June 2014. Accessed October 20, 2015. 5. M orbidity and Mortality Weekly Report. Updated guidelines for using interferon gamma release assays to detect Mycobacterium tuberculosis infection— United States, 2010. cdc.gov/mmwr/ PDF/rr/rr5905.pdf. Published June 2010. Accessed October 20, 2015. 6. C enters for Disease Control and Prevention. Testing for tuberculosis (TB). cdc.gov/tb/publications/factsheets/ testing/tb_testing.htm. Updated December 19, 2014. Accessed October 20, 2015. 7. C enters for Disease Control and Prevention. Core curriculum on tuberculosis: what the clinician should know. Chapter 2. Transmission and pathogenesis of tuberculosis. cdc.gov/ tb/education/corecurr/pdf/chapter2.pdf. Updated June 21, 2013. Accessed October 20, 2015. 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