TB: What you should know

June 20, 2007 09:11 PM CDT
TB: What you should know

STATEWIDE (WIS) - Tuberculosis has been in the news recently, and there are some things you
should know about the disease. The Institute for Families in Society has released facts and
research on the disease, which follows:

South  Carolina  Data

TB remains a major public health threat with an average of about 300 new cases each year.

South Carolina has consistently ranked among the top 10 states nationally in the number of new
cases per 100,000 people. TB, if left untreated, can result in a 50 percent mortality rate.

Approximately 150,000 South Carolinians are infected with the tuberculosis bacteria.

Over sixty percent of new cases in South Carolina occur among African Americans born in the
United States.

US  Data

There are an estimated 9 to 14 million people in the United States infected with TB. About 10
percent of these people will develop active TB disease in their lifetimes.

In  2006, the number of active TB cases reported in the US fell to an all-time low of 13,767
cases, with a rate of 4.6 cases per 100,000 in the population. While this is the lowest US TB
case rate ever recorded, the decline in 2006 (3.2%) was one of the smallest in more than a
decade.

Despite a downward trend nationally, TB continues to affect many US communities
disproportionately.

Eighty-two percent of all TB cases in the United States occurred in racial and ethnic
minorities.

Over half of new TB cases in the US occur among individuals born outside of the country. The
TB rate in foreign-born persons was nearly 9 times that of those US born. Seven countries
accounted for 62% of the total of foreign-born persons with TB in 2006: Mexico; Philippines;
Vietnam; India; China; Haiti, and Guatemala.
Global  Data

TB is an airborne disease that is spread much like the common cold or flu - the spread of which
is not contained by the borders of any country.

At least one person is infected with TB each second, and someone dies of TB every ten seconds.
One-third of the world's population is infected with TB (two billion people).
TB accounts for more than one-quarter of all preventable adult deaths in developing countries.
How  does  one  become  exposed  to  TB?

Tuberculosis (TB) is a bacterial disease found primarily in the lungs. It is spread from person
to person through the air. Persons who have tuberculosis in their lungs cough the bacteria into
the air and others become infected by breathing in the bacteria. These persons now have latent
TB. Without treatment for latent TB  infection, approximately 10 percent of the persons who
become infected will develop tuberculosis disease sometime in their lifetime. The remaining 90
percent of the people with latent TB carry the bacteria for a lifetime without developing the
disease. Persons with HIV, however, are at the highest risk of developing the disease. If they
do not receive preventive medication they have a 10 percent chance per year (rather than a
lifetime) of developing disease.

What  tests  determine  TB?

The tuberculin skin test is most commonly used to determine if a person has TB infection. A
substance, called tuberculin, is injected into the skin.  Tuberculin is purified protein and
not a vaccine or contains any germ cells. The immune system of most people who have TB
infection recognizes tuberculin and this will cause a reaction in the skin. The skin is
examined 48 to 72 hours after the tuberculin injection in order to evaluate the reaction. Any
swelling that can be felt around the site of the injection is measured. The diagnosis of TB
infection depends on the size of the measured swelling and the patient's individual risk
factors. If TB infection or disease is suspected, a chest x-ray should be taken. The chest
x-ray helps the clinician determine any presence of TB or old healed TB disease.  Secretions
from the lungs (sputum) are observed directly under a microscope or by culture to determine the
presence of tuberculosis disease.

How  is  TB  treated?

The treatment for TB disease usually lasts six months and requires four or more medications.
Most of the bacilli are killed during the first eight weeks of treatment.  If the entire
treatment course is not completed, some bacilli may survive and cause TB disease later or
develop into a strain of drug-resistant TB.  The purpose of treating latent TB infection is to
prevent future disease from developing. Taking the complete course to treat TB infection will
provide lifetime protection against TB disease.

Is  TB  curable?

Yes. People can be cured of TB if they take medicine every day for as long as it's prescribed.
TB is still a problem because in order to get treated, people with TB need to be found. People
who are infected with TB but aren't sick need to be tested and treated. When people don't feel
sick they don't usually seek medical attention, so it takes a lot of work to find the people
who are infected.

What  is  "drug  resistant"  TB?

"Drug resistant" TB is tuberculosis that does not respond to the first choice medications. With
multidrug-resistant TB (MDRTB), doctors are forced to use different drugs, which can be more
expensive and less effective. The second choice drugs are much more expensive, much less
effective, take longer to work when they do work, and have more side effects.

How  do  people  work  to  control  TB?

People work to control TB by identifying people who have TB or have been exposed to those who
have TB and making sure they are treated. Various health workers in all parts of the system
work to fight TB. At a public health department, there are front-line workers, who do the
footwork to locate infected people and connect them with the necessary resources. Additionally,
doctors and nurses in hospitals and private practices, researchers, and other people work to
control the spread of TB.

How  is  the  Institute  for  Families  in  Society  involved  in  the  work  to  eliminate
TB?

The Institute for Families in Society at USC in partnership with the SC DHEC has been working
with CDC to identify and understand sociocultural, racial, and health system barriers for
African Americans in South Carolina with or at risk for TB. The emphasis on the African
American population is a result of the 60% prevalence of TB among that population in South
Carolina.
What  has  the  Institute's  research  revealed?

Our research has been very valuable in identifying the reasons for increase rates in the
Southeast. We have found that there are many reasons for this increase, particularly in our
region.

Lack of knowledge of TB is a significant barrier to stopping TB in South Carolina.
Fear  and  the  stigma  associated  with  a  TB  diagnosis  results  in  late  identification
of  the  disease,  failure  to  contact  others  exposed  to  TB,  and  the  completion  of
treatment. Misinformation  about  the  causes  of  TB  increases  the  stigma  feeding  the
fear  and  nonresponse.

Improving TB service is hindered by lack of resources and effective strategies to reach African
Americans.
Individuals  with  identified  cases  of  TB  often  do  not  have  insurance  or  workers
compensation,  which  severely  limits  their  ability  to  remain  economically  solvent
through  treatment. A  lack  of  resources  to  enhance  contact  and  communication  between
individuals  and  health  care  providers  exists.  There  is  a  substantial  need  to
develop,  implement,  refine,  and  evaluate  culturally  sensitive,  community-based  models
to  enhance  African  American  participation  in  early  detection  and  follow-up  services.

This research is led by Dr. Ana Lòpez-De Fede, Research Associate Professor at the Institute
for Families in Society.  She currently serves on the Advisory Council for the Elimination of
Tuberculosis for the Centers for Disease Control and Prevention (CDC) working on both national
and global issues to eliminate tuberculosis.

Posted by Chantelle Janelle