Biological Hazard - Mycobacterium Infection: Tuberculosis Prevention and Cure - Essay Example

Biological Hazard - Mycrobacterium infection: Tuberculosis (TB) Prevention and Cure Introduction: The Centre for Disease Control and Prevention (CDC)identifies TB as the second most common cause of death from infectious disease in the world, preceded by HIV/ AIDS (CDC, 2013). Approximately one-third of the worlds total population is affected by Tuberculosis (TB) killing as many as two million people every year (U.S. Department of Labour, 2013). Considering the vast outreach and rapid rise in the total number of people affected by the disease, analyzing and understanding of various factors associated with the disease such as prevention and cure as well as its wider implications on the society, is imperative. This essay aims to discuss TB as a biological hazard and suggest various means in which it can be prevented. Definition: NHS Choices (2012) Tuberculosis (TB) is a bacterial infection spread through inhaling tiny droplets from coughs or sneezes of an infected person. It is a serious condition but can be cured with proper treatment. TB mainly affects the lungs. However, it can affect any part of the body, including the bones and nervous system. Other definitions: It can be spread when someone with the infection coughs, sneeze or talks and the other person breathe in the bacteria WHO (1993) According to the National Institute of Allergy and Infectious Diseases TB is defined as "a contagious and an often severe airborne disease caused by a bacterial infection. TB typically affects the lungs, but it also may affect any other organ of the body. It is usually treated with a regimen of drugs taken for 6 months to 2 years, depending on the type of infection" (NIAD, 2013) Lynn et al (2002) defines TB as "a chronic systematic bacterial infection that may involve the lungs, meninges, bones, joints, kidneys, and skin" (p. 743) TB infection is defined as “"an asymptomatic individual with a positive TB skin test, a normal physical examination, and a normal chest radiograph" (Lynn et al., 2002: 743). TB disease is defined as “a symptomatic patient with definitive evidence (usually radiographic) of TB.” (Lynn et al., 2002: 743) Types of TB There are two types of TB namely – pulmonary or respiratory TB and extra-pulmonary or non-respiratory TB. Pulmonary TB is the most common form of disease out of the two. It is known to affect the lungs as opposed to extra-pulmonary TB which occurs outside the lungs (NHS, 2013; Miller, Walsh, and Hoyt, 2005). Symptoms of tuberculosis (TB): Common symptoms of respiratory TB include weight loss, cough, fever, and night sweats. These symptoms can be identified over a period of time indicating the progress or stage of TB which is generally identified as the primary and post-primary stages. Coughing for instance is one of the most commonly observed symptoms of the post-primary respiratory TB, followed by chest pain. According to a study conducted in Sudan to study the clinical features of the disease it was observed that various chest symptoms were directly related with the sputum smear tests. Also it was observed that the symptoms tend to increase with the duration of the TB among the patients (National Collaborating Centre for Chronic Conditions, 2005). Figure: Classic symptoms of Tuberculosis Source: National Collaborating Centre for Chronic Conditions (2005: 33) Other symptoms include weight loss, loss of appetite, tiredness and fatigue (Bupa Health Information Team, 2012) Causes of TB: TB is an often referred to the disease of poverty and hence it is often associated with poverty. It is an airborne illness which is caused by a bacterium called mycobacterium tuberculosis. Since the disease is airborne it spreads easily due to actions such as sneezing or coughing. Those in the vicinity of a TB patient are hence highly vulnerable and at great risk of attracting the disease (Holtz, 2012; Floyd, Mimms, and Yeldiing, 2007). Respiratory TB that affects the lungs is the only form of the disease that is contagious. Hence it is known to spread easily among people living under the same roof, such as families. Generally in healthy individuals the immune system (i.e. the body’s natural defence system) acts a defence against the disease and protects the body by preventing the spreading of the bacteria in the body. Hence the symptoms may not be easily detected but living in the proximity of TB patients causes the bacteria to spread among others. This stage is known as latent TB (Dyer, 2010). However it is highly likely that the disease may transform from its latent stage to an active one, if the body’s immune system is weakened, due to various reasons, since weakening of the immune system leads to its failure to kill the bacteria and prevent the spreading of the infection in the body. The symptoms can be usually seen within the first few weeks or months. This is known as active TB, as it has now transferred from a dormant state to a full blown infection. Associations to TB Health impacts of migration: Tuberculosis in Britain Migration is identified as one of the key factors which pose a significant health risk. According to the Health Protection Agency (HPA) immigration is identified as the key factor resulting in heightened cases of tuberculosis in the Britain. Migrants from Asia and sub-Saharan Africa were associated with the increased incidences of TB in the country. Statistics suggest that post the great immigration wave which brought about migrants from these regions during the 1970s the number of TB cases in the country rose to 9266 in the year 1979 (HPA, 2013). According to a recent cohort study carried out in the UK between the years 2008 - 2010, it was observed that the current procedures to detect and screen cases of TB among the immigrants fail to detect the disease in more than 70 per cent of cases, most of which are latent infections (Pareek et al., 2011) Link between bovine TB and human infections: There is overwhelming historical evidence which indicates a strong and positive relationship between TB in humans and bovine TB (Davis, 2006). According to White and Thompson (2000) most of the TB cases found among humans were detected to be derived from animal sources, and particularly cows milk. Currently there is a heated debate among scientists and researchers concerning the validity of the argument that bovines and badgers are responsible for the spread of TB in the country (The Guardian, 2012). Link between poverty and TB: There is strong evidence which links poverty with increased incidences of TB. Research suggests that poverty forces individuals to live in impoverished and unhealthy living environments. Furthermore poverty is also known to cause malnutrition and contribute to increased stress. Such adverse factors significantly affect the human immune system making them highly vulnerable to TB (WHO, 2013b). The incidences of TB in industrialized countries are rapidly rising especially among the impoverished populations which further indicate a strong relationship between the two variables (Davies and Grange, 2001). According to a study conducted by Clark, Riben, and Nowgesic (2002) in low income households in Canada it was observed that the incidence rates of TB among the poor households was higher than those who were economically well off. Link between environment and ill health associated with infectious disease Ill health is caused by a triad of factors known as the epidemiological model, which includes the host, the agent, and the environment. Environment with reference to diseases comprises of both - the physical as well as socio-cultural environment (Lundy and Janes, 2009). Germ theory was used to describe the impact of environment on ill health. The theory indicated that the physical and natural environments in which individuals live, significantly affect their overall health. Fresh air (or rather the lack of it) was proposed to be one of the key reasons behind the TB epidemic during a major part of the twentieth century (Connolly, 2008). Prevalence of TB outbreak Global National Sub-groups outbreak According to the WHO (2013), one third of the world’s population is infected with (TB) bacteria. A person living with HIV is about 20 to 30 times more likely to develop active TB (WHO, 2013). In 2011, 8.7 million people fell ill with TB. A total of 1.4 million people died from TB in 2011 (including 430 000 people with HIV). TB remains one of the worlds top infectious killers. About 95% of TB deaths occur in low- and middle-income countries. About 80% of reported TB cases occurred in 22 countries in 2011. Up to 70 000 children died due to TB globally in 2011. Around 9,000 cases of TB are currently reported each year in the United Kingdom and most cases occur in major cities mainly in London. In 2011, a total of 8,963 cases of (TB) were reported. Of these, over 6,000 cases affected people who were born outside the UK. Lastly, the majority of these cases were notified from urban centres, amongst young adults, those from countries with high TB burdens, and those with social risk factors for TB. It has been said that over half of reported TB cases had pulmonary TB (Health Protection Agency, 2012). Tests There are two kinds of tests that are used to detect TB bacteria in the body: the TB skin test (TST) and TB blood tests. These tests can be given by a health care provider or local health department. If you have a positive reaction to either of the tests, you will be given other tests to see if you have latent TB infection or TB disease. (NHS, 2012) Relationship between TB and HIV World Health Organisation (WHO, 1993); (Bakari et al. 2008) stated: TB is a very common co infection disease with HIV, especially in endemic countries. The HIV/AIDS weakens the human immune system, a fact that makes the individual more vulnerable to diseases such as the Tuberculosis. For this reason patients are treated for presumptive TB. Someone who is HIV-positive and infected with TB is many times more likely to become ill with TB, than someone infected with TB who is HIV-negative. TB is the main factor that kills most of the HIV infected patients, coming up to 11% of AIDS deaths worldwide. In Africa, HIV is the single most important factor determining the increased incidence of TB in the past 10 years. Treatments According to WHO (2013) TB is preventable and curable with treatment, TB infection can usually be cured. Most people will need a course of antibiotics, usually for six months. Several different antibiotics are used. This is because some forms of TB are resistant to certain antibiotics. If a patient is infected with a drug-resistant form of TB, treatment can last up to 18 months. This is because if a patient stops taking their antibiotics before they complete the course, or if the patients skip a dose, the TB infection may become resistant to the antibiotics. In the case a person gets close contact with a TB infected patient, tests may be carried out for trace of infection, these includes chest X-ray and blood test and a skin test called Monteux test. Treatment for TB is carried out for free in the UK, regardless of your immigration status. Vaccines The current available vaccine is Bacillus Calmette–Guérin  (BCG). It is the most widely used vaccine worldwide, more than 90% of all children are being vaccinated, however, the immunity decreases after about ten years, as tuberculosis is rare in most part of Canada, United Kingdom and United States, BCG is only administered to people at high risk.  This is because the use of the vaccine makes the tuberculin skin test falsely positive, and therefore, of no use in screening. A number of new vaccines are currently in development. (World Health Organisation, 2013) Strengths: The BCG vaccine has been used for almost a hundred years. It was first developed in 1921 and it is widely used throughout the world, particularly in the developing world, where it’s given at birth. The BCG has been shown to give 70% - 80% protection against TB. When BCG is given at birth it can protect against further forms of diseases such as TB meningitis and other forms of TB outside the lungs. This vaccine is known to be safe as well as quick and simple to administrate. Limitations On the other hand, the BCG vaccines do not assure 100% protection against lung disease, either in children, adolescents or adults. Treatment for TB can be expensive. Currently, the BCG vaccinations are only recommended for groups of people who are at a higher risk of developing TB. Prevention and infection control BCG vaccine is offered to infants under 12 months of age born or living in areas where the yearly rate of new cases are high. In order to stop TB from spreading it is important that people take some basic precautions to stop TB spreading to families and friends. These precautions include: Covering your mouth when coughing and sneezing; appropriate disposal of used tissues in a sealed plastic bag; open windows if possible to ensure a good supply of fresh air; stay off work, school or college until the disease if fully treated; get advise from Health Professional that you can return etc. It is advisable that a person should not sleep in the same room to minimize the spread of the infection. Furthermore other factors such as early diagnosis and screening, isolating the patient, contact tracing, using face masks, and ensuring proper ventilation in houses can help in preventing occurrences as well as spread of the disease (Warell, Cox and Firth, 2012). Initiative in public health intervention: What has been done? A TB summit was formed in the North West of England as a response to safeguard public health from the rapidly spreading epidemic. As a part of this initiative various policy measures were introduced and implemented. This includes (Health Protection Agency Report, 2012): Formation and implementation of a cohort review which was carried out across the North Western region of England, during the year 2011; Strengthening TB Nursing workforce; Improving coverage of BCG Vaccination and Preventing TB in children (among others) Source: Health Protection Agency (HPA) Report (2012) Recently in February 2012, the Chatham House in association with the London School of Hygiene and Tropical Medicine introduced and promoted an expert consultation on "Social protection intervention for Tuberculosis control" to address the impact and challenges posed by the disease and recommendations to overcome the same. The event was co-sponsored by several reputed international organizations such as WHO, the Bill & Melinda Gates Foundation, the UN Development Program, as well as the UK Health Protection Agency (Chatham House Report, 2012). TB Health surveillance : How the disease is surveyed Organisations Campaigns Government policies Strength (success) Weakness (limitations) Stop TB Partnership (2013), WHO (2013) The WHO has developed a new Stop TB Strategy which builds on the successes of Directly Observed Treatment (DOT) and also addresses the key challenges facing TB. The DOT’s have identified the following six key components 1. To pursue high-quality DOTS expansion and enhancement. 2. To address TB-HIV, Multidrug-resistant (DR-TB), and the needs of low and middle income countries 3. To contribute to a health system to strengthen primary health care 4. Engage all care providers 5. Empower people with TB, and communities through partnership 6. Enable and promote research. This supports the development of new and effective tools to prevent, detect and treat TB. However, the proportion of eligible patients reported to have received Directly Observed Therapy (DOT) remains low Effectiveness: There have been impressive achievements to date because the number of cases per capita is falling by around 1% per year, and death rates have fallen by about one third since 1990. The world health organisation has achieved some success with the improved treatment regimens, and a small decrease in case numbers. Since 1990 the mortality incidence is declining, For example, Brazil and China have showed a sustained decline in TB cases over the past 20 years. In this period China, had an 80% decline in deaths. 20 million lives saved through TB care and control. On 17th October 2012, Washington DC estimated that 20 million people are alive today as a direct result of tuberculosis (TB) care and control, according to the WHO Global tuberculosis report 2012. The World TB day has been affective because the WHO 2012 reported that the activities saved around 1.3 million lives between 2005 and to the end of 2011. The Coalition has been formed to increase the level of awareness, commitment and political that will stop TB through a integrated voice and coordinated actions to fight against tuberculosis. Organisations and partnerships (Lloyd et al, 2007 p.147) The world TB day falls on 24th of March each year in remembrance of Dr. R. Koch who discovered the causes of TB in 1882. It was built to create aware ness of the risk factors associated with TB infection, mostly in developing countries. The campaign is an opportunity to mobilise political and social commitment for further progress to stop this disease. This year the World TB Day campaign reaches the end of a two years target with the slogan ‘Stop TB in a lifetime world TB Day. The WHO (2012) reported that scale up of collaborative TB activities saved 1.3 million lives between 2005 and the end of 2011. Although huge effort have be implemented by the World TB Day Campaign to control and cure, TB remains a problem which requires additional strategies to eliminate. Programs such as these provide an opportunity to mobilise political and social commitment for further progress to stop this disease. This year the World TB Day campaign reaches the end of a two years target with the slogan ‘Stop TB in a lifetime ’ The Target For Tuberculosis The Target For Tuberculosis has an mission to help stop vulnerable people in Africa and Asia dying from the disease. They are helping to improve residents access to information, treatment, care and support. They stated that from now-2015, 90.000 people with TB symptoms will be referred for testing 27.500 people with TB will be supported through treatment. 20.000 local health workers and volunteers will be trained in TB control. 4.6 million people will be reached with TB health information This organisation uses holistic approach to address the health, social and economic issue that may have an impact on the disease. However this organisation is saying all this but they have not say anything about how many people they have helped for the past years and what were their difficulties and barriers. Barriers accessing healthcare Access to treatment and diagnosis in poorer countries is an on-going problem. Multi-drug resistant TB (MDR-TB) does not respond to standard treatments and is difficult and costly to treat. The HIV pandemic complicates attempts to eradicate TB HIV is considered the single most important factor in the increase of TB in Africa since 1990. Emerging drug-resistant strains of TB are also hampering efforts to stamp out both diseases Link between Bio psychosocial factors and TB Studies indicate a positive relationship between psychosocial factors such as social and environmental conditions of households and the prevalence of TB. Various psychosocial and behavioural factors such as substance abuse, antisocial behaviour, psychopathology, as well as strong negative reactions to certain significant life events are known to drastically increase the incidence of TB particularly among the youth and adolescents (Rabin et al., 1999; Marsland et al., 2002; Ehrlich and Myer, 2008). References: Centers for Disease Control and Prevention (CDC) (2013) Tuberculosis :World TB Day 2013. available at: http://www.cdc.gov/tb/events/worldtbday/default.htm (12TH MARCH 2013 Chatham House Report (2012). Social protection interventions for Tuberculosis control: The impact, the challenges, the way forward. 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