Top Banner
Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals for Legislators
29

Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Mar 27, 2015

Download

Documents

Aaron Armstrong
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: April 4, 2004

Division of Tuberculosis Control

Virginia Department of Health

Richmond, Virginia

Tuberculosis Infection & Disease: Fundamentals for Legislators

Page 2: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

Tuberculosis (TB): A Disease ofPublic Health Significance

Potentially fatal disease transmitted by close contactLong, multidrug treatment regimens increase potential risk of nonadherenceSerious impact on community if TB treatment is improper and/or inadequateDisproportionate impact on persons with inadequate access to health care

Page 3: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

Current TB Challenges in Virginia

Increasing proportion of TB patients born outside the US 48 different countries of origin in 2003 At least 20 primary languages, other than English,

spoken in 2003

High incidence of drug-resistant TB cases

21 deaths from TB in 2003 TB is a curable disease

Page 4: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

The Public Health Department’s Role

Recognized expert in TB control for the local communityResource for the latest on testing and treatment standardsHas access to medical experts at CDC for consultation on complicated TB casesProvides follow-up care to persons diagnosed with TBHas ultimate responsibility for TB control in VirginiaHas authority to legally enforce the VA Health Code Requires compliance to TB treatment,

www.vdh.state.va.us/epi/tb/guidebook.htm Assists in interjurisdictional referrals for patients who move residences

Page 5: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

VA Division of TB Control (DTC)Role of the Central Office in Richmond

Mission of the DTC Provide leadership in overcoming barriers

to protect the people of Virginia from tuberculosis

Objectives of the DTC Detect all cases of TB disease Treat all cases of active TB disease Complete treatment of all cases of active

TB disease and their infected contacts

Page 6: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

Virginia TB Control Laws: Key Points

Require reporting of TB disease

Require treatment and adherence to TB treatment

Allow isolation of infectious TB disease patients who refuse treatment and/or put the public at risk for TB infection

Page 7: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

How TB is Transmitted

TB is caused by Mycobacterium tuberculosis (tubercle bacillus)

When a person with active, infectious TB disease coughs, sneezes, laughs, sings, etc., s/he expels the TB bacteria into the air TB spreads when another person breathes in

the air that contains the TB bacteria Prolonged contact with an infectious TB

disease patient is needed for TB transmission to occur

Page 8: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

Factors That Determine theTransmission of TB

Infectiousness of the person with TB disease The more infectious a person, the more likely the

TB will be transmitted to others who are in close contact with this individual

Environment in which exposure to TB occurs Room size and ventilation -- Transmission of TB is

likely to occur in rooms that are small and with poor ventilation

Continues on the next slide…

Page 9: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

Factors That Determine theTransmission of TB (2)

Length of time spent with the infectious TB patient The longer the time spent with an infectious TB

patient, the more likely TB transmission will occur

Virulence (strength) of the TB bacteria The stronger the TB bacteria, the more likely the

transmission of TB infection will occur

Page 10: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

Pathogenesis of TB

TB occurs most commonly in lungs (85% of the time), but can occur in other parts of the body TB in the lungs = pulmonary TB TB outside the lungs = extrapulmonary TB

A person with TB infection and a normal immune system has a 10% chance of developing active TB disease in his/her lifetime This risk is greatest within the first 2 years after

acquiring TB infection

Page 11: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

TB Infection - Latent TB Infection (LTBI)

Occurs when TB bacteria are in the body, but are inactive

Does not result in any clinical symptoms of active TB disease

Is not infectious to others

Produces a “positive” reaction to the TB Skin test

Presents a normal chest X-ray

Page 12: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

Active TB Disease

Occurs when the inactive TB bacteria in the body (LTBI) become active

May be infectious

Has clinical symptoms (see next slide)

Page 13: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

Symptoms of Active TB Disease

Prolonged cough(may produce sputum)*Chest pain*Hemoptysis*FeverChills

*Symptoms commonly seen in cases of pulmonary (lung) TB

Night sweatsFatigueLoss of appetiteWeight loss orfailure to gain weight

Page 14: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

Persons at Higher Risk forBecoming Infected with TB

Close contacts of persons known or suspected to have active, infectious TB disease

Foreign-born persons from areas in the world where TB is common

Residents and employees of high-risk congregate settings

Health care workers (HCWs) who serve high-risk clients

Medically underserved, low-income populations

High-risk racial or ethnic minority populations

Children exposed to adults in high-risk categories

Persons who inject illicit drugs

Page 15: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

If Infected with TB, Factors That Could Increase the Risk for Developing TB Disease

These high-risk persons should be tested for TB infection, and if positive, treated.

HIV infection

Substance abuse

Recent TB infection

Low body weight (10% or more below the ideal)

Diabetes mellitus

Silicosis

Prolonged corticosteroid therapy

Other immunosuppressive therapy

End-stage renal disease

Cancer of the head or neck

Page 16: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

TB and HIV Coinfection: A Concern

For persons infected with TB, HIV positive status is the strongest risk factor for developing active TB disease

In persons who are HIV positive and have TB infection, the chances of developing TB disease increases from 10% in a lifetime to 7% to 10% each year!

Page 17: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

Role of Epidemiology in TB Control

Epidemiology is the study of the distribution and determinants of disease in human populations

Epidemiological data tell us: who in the population is most at risk for

developing TB disease what risk factors these individuals possess where TB disease is most prevalent how to best protect the public from the spread

of TB disease

Page 18: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

TB Cases Reported in Virginia, 1992-2003

See Notes pages for an explanation of this graph. [In the menu bar, click “View,” then “Notes Pages.”]

332 in 2003

Page 19: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

Percent of TB Cases by Age and SexVirginia, 2003 Click on “View” and “Notes Pages” to read the

explanation of the graph.

0

10

20

30

40

50

60

70

Num

ber

of C

ases

0-14 15-24 25-44 45-64 65+

Age Group in Years

Male

Female

Page 20: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

Percent of TB Cases in Virginia, by Region2002 and 2003

Southwest8%

Northwest5%

Central14%

Eastern17%

Northern56%

Central20%

Eastern18%

Northern46%

Northwest9%

Southwest7%

2002 2003

Page 21: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

Goal of Screening for LTBI

Find persons with LTBI who would benefit from treatment to prevent the development of TB disease

Find persons with TB disease who would benefit from treatment

[Persons at no risk for TB infection should not be tested for TB]

Page 22: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

Mantoux Tuberculin Skin Test (TST)

A test for TB infection only Preferred test for TB infection

Clinician performs procedure An injection

TB skin test result (positive, negative) based on: Size of the induration (swelling) and, Person’s risk factors for TB

Page 23: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

Basic Principles of TB Treatment

Goals of treatment for TB disease are: Provide the safest, most effective therapy

in the shortest possible time Give multiple drugs to which the TB

bacteria are susceptible Ensure patient adherence to therapy

Page 24: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

Treatment of LTBI

Treating LTBI prevents the development of TB disease, especially for persons at high risk for developing TB disease if infected with TB

Usual medication regimen for treating TB infection Isoniazid (INH) for 9 months is optimal

6 months of INH is acceptable Rifampin for 4 months is alternative in certain

circumstances

Page 25: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

Treatment of TB Disease

Usual medication regimen Minimum of 6 months of therapy, sometimes

longer Initial 4 drug therapy standard, and they are:

Isoniazid (INH) Rifampin Pyrazinamide (PZA) Ethambutol

Medications may need to be changed if the TB is drug resistant to any medication listed above

Page 26: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

Causes of Drug Resistance

Physician prescribes an inappropriate drug regimen

Patients do not take their TB medications exactly as instructed

If you become infected with TB that is already drug-resistant

Page 27: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

Directly Observed Therapy (DOT)

What is DOT? DOT is when a health care worker watches

a TB patient swallow each dose of the prescribed drugs

DOT is recommended for all persons who have TB disease Health care worker will conduct DOT at a

time and place convenient for the patient

Page 28: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

Benefits of DOT

DOT prevents drug resistance by eliminating opportunities for non-adherence to TB therapy among patients with TB disease

DOT allows for the rapid identification of problems patients may experience with their TB medications Allows early interventions to assure accurate and

correct TB therapy and patient adherence to TB therapy

Page 29: Last Update: April 4, 2004 Division of Tuberculosis Control Virginia Department of Health Richmond, Virginia Tuberculosis Infection & Disease: Fundamentals.

Last Update: May 28, 2004

For More Information…

Division of TB ControlVirginia Department of HealthMadison Building, First Floor109 Governor StreetRichmond, VA 23219804-864-7906 (Telephone)804-371-0248 (Fax)http://www.vdh.virginia.gov/epi/tb

Centers for Disease Control and Prevention Division of TB Eliminationhttp://www.cdc.gov/nchstp/tb/default.htm