Tb and Leprosy

8/13/2019 Tb and Leprosy

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Tuberculosis


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Infectious Agent

Mycobacterium tuberculosisandM. Africanumprimarily from humans, andM. bovisprimarily fromcattle.


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Mode of Transmission

Airborne droplet method through coughing, singingor sneezing.

Direct invasion through mucous membrane or

breaks in the skin may occur, but is extremely rare. Bovine tuberculosis result from exposure to

tuberculosis cattle, usually by ingestion ofunpasteurized milk or dairy products. Extra-

pulmonary tuberculosis, other than laryngeal, isgenerally not communicable, even if there is adraining sinus.


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Period of Communicability


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Susceptibility and Resistance


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Method of Control


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Preventive Measures

Prompt diagnosis and treatment of infectious cases BCG vaccination of newborn, infants and grade 1/ school

entrants Educate the public in mode of spread and methods of control

and the importance of early diagnosis. Improve social conditions, which increase the risk of

becoming infected. Such as overcrowding. Make available medical, laboratory and x- ray facilities for

eamination of patients, contacts and suspects, and facilitiesfor early treatment of cases and persons at high risk of

infection and beds for those needing hospitalization. Provide public health nursing and outreach services for home

supervision of patients to supervise therapy directly and toarrange for examination and prevent treatment of contacts.


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The National TuberculosisProgram


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Vision: A country where TB is no longer a public healthproblem

Mission: Ensure that TB DOTS services are available,accessible, and affordable to the communities in

collaboration with the LGUs and other partners

Goal: To reduce prevalence and mortality from TB byhalf by the year 2015 (Millennium Developmental

Goal)


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Targets:

Cure at least 85% of the sputum smear- positive TBpatient discovered

Detect at least 70% of the estimated new sputumsmear- positive TB cases


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NTP Objectives and Strategies

The NTPs four- pronged set of objectives calls

for improvement of access to and quality of services,enhancement of stakeholders health- seeking

behavior, sustainability of support for TB controlactivities, and strengthening management of TB

control services at all levels.


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Objective A: improve access to and quality of serviesprovided to TB patients, TB symptomatics, andcommunities by health care institutions and providers


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Strategies:

1. Enhance quality of TB diagnosis

2. Ensure TB patients treatment compliance

3. Ensure public and private health care providersadherence to the implementation of nationalstandards of care for TB patients.

4. Improve access to services through innovativeservice delivery mechanisms for patients living inchallenging areas (geographically isolatedcommunities with peace and order problem,culturally- different, and those in institutions likeprisons)


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Objective B: Enhance the health- seeking behaviors onTB by communities, especially the TB symptomatics


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Strategies:

Develop effective, appropriate, and culturally-responsive IEC/ communication materials.

Organize barangay advocacy groups


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Objective C: Increase and sustain support andfinancing for TB control activities


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Strategies:

Facilitate implementation of TB- DOTS Centercertification and accrediatation.

Build TB coalitions among different sectors.

Advocate for counterpart input from localgovernment units.

Mobilize/extend other resources to address programlimitations


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Objective D: Strengthen management (technical andoperational) of TB control services at all levels.


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Strategies:

Enhance managerial capability of all NTP programmanagers at all levels.

Establish an efficient data management system for

both public and private sectors. Implement a standardized recording and reporting

system.

Conduct regular monitoring and evaluation at all

levels. Advocate for political support through effective local

governance.


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Key Policies

Category Type of TB patient Treatment Regimen


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Category Type of TB patient Treatment RegimenIntensive phase Continuation Phase

I New smear- positive PTB New smear- negative PTB

with extensive parenchymallesions on CXR as assessed

by th TBDC EPTB Severe concomitant HIV

disease

2HRZE 4 HR

II Treatment failure Relapse Return after Default Other

2HRZE/ 1HRZE 5HRE

III New smear- negative PTBwith minimal parenchymallesions on CXR as assessedby the TBDC

2HRZE 4HR

IV Chronic (still smear- positiveafter supervised treatment) Refer to specialized facility or DOTS PlusCenter

Refer to provincial/ City NTP coordinator


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Body weight (kg) No. of tablets per dayIntensive Phase

(2 months)FDA (HRZE)

No. of tablets per dayContinuation Phase

(4 months)FDC- B (HR)

30- 37 2 238- 54 3 355- 70 4 4

>70 5 5


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Bodyweight

(kg)Intensive Phase Continuation Phase

First two months Third mo. FDC- B(HR) E400mg

FDC- A(HRZE) Streptomycin FDC- A(HRZE)

30- 37 2 0.75 g 2 2 138-54 3 0.75 g 3 3 255- 70 4 0.75 g 4 4 3

>70 5 0.75 g 5 5 3


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Anti- TB Drugs No. of tablets per dayIntensive Phase

(3 months)No. of tablets per dayContinuation Phase

(4 months)

Isoniazid (H) 1 1Rifampicin 1 1

Pyrazinamide (Z) 2Ethambutol (E) 2


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Anti- TB Drugs No. of tablets/vial perday

Intensive Phase

(3 months)

No. of tablets per dayContinuation Phase

(5 months)

First 2months 3

rdmonths

Isoniazid (H) 1 1 1Rifampicin (R) 1 1 1Pyrazinamide (Z) 2 2Ethambutol (E) 2 2 2Streptomycin (S) 1 vial/day*


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DOTS Strategy

DOTS is the internationally- recommended TB controlstrategy and combines five elements. The five elements arethe following: Sustained political commitment Access to quality- assured sputum microscopy Standardized short- course chemotherapy for all cases of

TB under proper case management conditions, includingdirect observation of treatment

Uninterrupted supply of quality- assured drugs

Recording and reporting system enabling outcomeassessment of all patients and assessment of overallprogram performance.


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Public Health Nursing Responsibility (Adult TB)

Together with other NTP staffworker, manage the procedures for case-finding activities

Assign and supervise a treatment partner for patient whi will undergoDOTS.

Supervise rural health midwives (RHMs) to ensure proper implementationof DOTS.

Maintain and update the TB Register Facilitate requisition and distribution of drugs and other NTP supplies. Provide continuous health education to all TB patients placed under

treatment and encourage family and community participation in TBcontrol.

In coordination with the physician, conduct training of health workers.

Prepare, analyse, and submit the quarterly reports to the Provincial HealthOffice or City Health Office.


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Leprosy


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Signs and Symptoms

1. Early Signs and Symptoms Change in skin color- either reddish or white

Loss of sensation on the skin lesion

Decrease/ loss of sweating and hair growth over thelesion

Thickened and/ or painful nerves

Muscle weakness or paralysis of extremities

Pain and redness of the eyes Nasal obstruction or bleeding

Ulcers that do not heal


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2. Late Signs and Symptoms

Loss of eyebrow- madarosis

Inability to close eyelids- lagophthalmos

Clawing of fingers and toes Contractures

Shrinking of the nose bridge

Enlargement of the breast in males or gynecomastia Chronic ulcers


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Infectious Agent

Mycobacterium leprae an acid fast, rod- shapedbacillus which can be detected by Silt Skin Smear(SSS)


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Method of Transmission

Airborne- inhalation of droplet spray from coughinand sneezing of untreated leprosy patient

Prolonged skin-to-skin contact


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Diagnosis of leprosy is currently based on clinical signsand symptoms especially if there is history of contact

with person with leprosy (PWL). Only in rare instances isthere really a need to use laboratory and otherinvestigation to confirm a diagnosis.

Silt Skin Smear (SSS) examination is an optionalprocedure. It is done only when clinical diagnosis isdoubtful. The main objective is to preventmisclassification and wrong treatment. A ready referralfacility must be recognized in the conduct of SSS

procedures. Susceptibility- Children especially twelve years and below are moresusceptible


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Prevention

Avoidance of prolonged skin-to-skin contactespecially with a lepromatous case

Children should avoid close contact with active,untreated leprosy case

BCG vaccination

Good Personal Hygiene

Adequate Nutrition

Health Education


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Leprosy Control Program

Vision: Empowered primary stakeholders inleprosy and eliminated leprosy as a public healthproblem by 2020

Mission: To ensure the provision of acomprehensive, integrated quality leprosy services atall levels of health care

Goal: To maintain and sustain the elimination

status


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The National Leprosy Control Program aims to:

Ensure the availability of adequate anti-leprosy drugs ormultiple drug therapy (MDT).

Prevent and reduce disabilities from leprosy by 35% throughRehabilitation and Prevention of Impairments andDisabilities (RPIOD) and Self Care.

Improve case detection and post-elimination surveillancesystem using the WHO protocol in selected LGUs. Integration of leprosy control with other health services at the

local level. Active participation of person affected by leprosy in leprosy

control and human dignity program in collaboration with theNational Program for Persons with Disability. Strengthen the collaboration with partners and other

stakeholders in the provision of quality leprosy services forsocio-economic mobilization and advocacy activities forleprosy.


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Public Health Responsibilities

a. Prevention

Health education of patients, families and thecommunity on the nature of the disease,

symptomatology and its transmission. Children whoare more susceptible to the disease should not beexposed to untreated lepromatous cases.

Advocate healthful living through proper nutrition,

adequate rest, sleep and good personal hygiene. BCG vaccination especially of infants and children.


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b. Casefinding Recognize early signs and symptoms of leprosy and refers

suspects to the RHU physician or skin clinic for diagnosis andtreatmen

Takes patient and family history and files up patient records Conducts epidemiological investigation and report findings to

MHO

Assists physician in physical examination of patients in theclinic/ home.

Assesses health of the family members and other householdcontacts. Performs/assists in examination of contacts

Integrates casefinding of leprosy case in other activities suchas MCH, EPI, inspection, examination of school children andother programs

Tb and Leprosy

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