Tuberculosis - Assignment Example

Introduction Tuberculosis is in the forefront of infectious disorder epidemiology and has highest rate of mortality in Hong Kong. Though tuberculosiswas contemplated not a serious health problem, the disease is not yet virtually died out. As the global environment is changing at fast pace, the paths of disease transmission are also varying and therefore, offering more challenges when international eradication is concerned. To control tuberculosis two important tools are: knowledge of epidemiology, and good management. The control of tuberculosis has posed varied problems in the past decades. In commissioning and contracting for this contagious disease, several management issues have to be considered. Technical and financial amenities should be used to prevent resurgence of this infectious disease. The people who do not want to follow preventive education are the most vulnerable to risk factors. To reduce the enormous global burden and long-term goal of better control of this communicable disease, there is a need for international surveillance. The pathogen Mycobacterium tuberculosis is responsible for tuberculosis (TB). The person carrying the dormant tuberculosis germs (latent TB infection) is prone to tuberculosis, if they become active and multiply. Then, the infection can be easily transferred to the other person in contact with the individual carrying the disease. This is an airborne disease and people exposed to infected droplet nuclei get easily infected. It spreads through activities like cough, sneeze, laugh, sing etc. of the disease carrying person. It has been estimated that around 33% of world population is infected with tuberculosis germs. It has been reported that about 9 million people can suffer from tuberculosis disease in a year. The disease is most prevalent in resource-limited countries like Africa followed with 50% new cases in 6 Asian countries (Bangladesh, China, India, Indonesia, Pakistan and the Philippines) (WHO 2009). When the tuberculosis infection in the person gets successfully treated, it is referred as ‘primary tuberculosis’. This cured person still contains noninfectious, but live mycobacterium. This ‘primary inactive tuberculosis’ could follow one of the three paths in the future. It might remain inactive throughout the life span of the infected person, or it might develop into ‘active tuberculosis’ from its own infection, or the same person might get exposed to new infection called ‘reinfection tuberculosis’ which would have again above two possibilities (Jekel, Katz & Elmore 2001). HIV infected individuals not only have high chances of developing TB infection, but also are the most vulnerable people to develop active TB disease, making TB and HIV a deadly combination (WHO 2009). State of knowledge: Chinese/Hong Kong epidemiological information The disease Tuberculosis has undergone many transformations in Hong Kong (HK) in a century from deadly major killer disease to less contemplated serious health issue. It was observed as a notifiable disease in 1939 with a death rate equivalent to 250 per 100,000 (Tuberculosis and Chest Service 2006). TB death rate as well as TB notification rate are drastically decreased due to HK’s government positive step to combat this pandemic disease (Centre for Health Protection 2008). The current scenario in HK is such that TB does not belong to top 10 high risk disorders leading to mortality due to various TB control methods adopted including BCG vaccines, anti-TB drugs, new policies and various treatments (Tuberculosis and Chest Service Annual Report 2007, p.22). TB has shown characteristic pattern of age and gender distribution in the country. Males are more prone to TB than female among all age groups and show significant differences in clinical manifestations. It was found that the aged population over 60 years also has higher probability of TB infection. (Chan-Yeung, Noertjojo, Chan & Tam 2002, p. 11). It was reported that longevity of elderly population has given rise to not only higher TB incidence rates in aged groups, but continuously high rate of TB in HK from 1992 to 2002 (Chan-Yeung, Noertjojo, Chan & Tam 2002, p. 771). It was also observed that TB incidence rates are disproportionately related to increase in elderly population among different aged groups. The people suffering from pulmonary TB come under highest risk factor category and show highest death rates. HIV infected individuals and smokers not only have high chances of developing TB infection, but also are the most vulnerable people to develop active TB disease than non HIV people and nonsmokers (Leung et al. 2004). These results could help to identify and focus high risk group population for targeting prevention programmes (Chan-Yeung, Noertjojo, Chan & Tam 2002). Chinese/ Hong Kong Government’s response A timeline of major events in the history of TB control in HK is broadly divided into three developmental phases (Lee 2008). Widespread TB Phase I (1948-60s) had following major events (Lee 2008). The first public service for TB at Harcourt Health Centre was set up in 1947. The Hong Kong Tuberculosis, Chest and Heart Diseases Association were established in 1948. Anti-TB drugs were developed in a decade from 1940 to 1950. From 1952, BCG vaccination was started to newborn babies and school children. Anti-TB treatment regimens were used and DOT (Direct Observation Treatment) was considered in 1962. Longevity in aged population led to increase in chronic diseases in Phase II (1970s-80s). In 1970, fully supervised treatment (DOT) was used on a service basis (to enhance adherence to the treatment regimen). In 1979, short course service programme (6 months) for TB patients was implemented. Current Phase III (1990s-present) is recognized for double burden of diseases (chronic noncommunicable diseases and new infectious diseases) where the number of new cases and deaths has dropped dramatically due to committed efforts (Lee 2008). The three new Chinese medicine clinics were set up in 2005-06 (HKTACMC 2007). Hong Kong community based services Community based services in HK are divided into primary and secondary level of care. Primary health services are the responsibility of The Department of Health (DH) who serves through their 18 chest clinics; while secondary level work involves inpatient hospital management taken care by Hospital Authority in 5 chest hospitals (HKSAR, 2000). DH also plays significant role in the surveillance of TB, case finding, supervised chemotherapy, defaulter tracing, contact tracing, BCG vaccination, health education and research (HKSAR, 2000). TB control programs are based on comprehensive system of treatment and prevention methods to stop and eliminate TB. Treatment approach consists of case finding, effective chemotherapy, treatment of latent TB infection and use of drugs (e.g. isoniazid and rifampicin); while prevention methods include BCG vaccination for neonates and school children, health education, UAS (Unlinked anonymous screening) (HKSAR, 2000). Promotion Strategies to reduce the impact of TB Hospitals are following certain practices like isolation of patients with active TB to chest hospitals, reduce concentration of airborne tubercle bacilli. Staffs are trained to pay attention to patients’ condition (e.g. respiratory status) through routinely sent circulars and emails, should wear N95 masks while caring TB patients etc. Public awareness is spread through educational talks, and distribution of pamphlets having information on location and contact information of all chest clinics in HK, reminder of regular check-ups and strict adherence to treatment programmes, explanation of different drugs used for TB, prevention approaches of TB etc (HKSAR, 2000). Preventive measures for tuberculosis in community Cost effective BCG is administered to infants and children (aged below 15 years) for primary prevention of TB in HK). In the secondary prevention method, screening methods are employed and then diagnostic tests are executed to check the TB infection. Here, preventive therapies are employed mainly to prohibit inactive TB infection to turn into active TB disease. Early contact examination like tuberculin skin testing and chest x-ray examination have been carried out among household contacts. The tertiary methods of prevention consist of combination therapy, Directly observed prevention therapy called DOPT therapy (to trace the non-compliance client, to check adverse drug reactions in patients) and use of negative pressure rooms in 18 chest clinic distributed in HK (HKSAR 2000; Jekel, Katz, & Elmore 2001). The objective of prevention technique is reducing an individuals susceptibility to disease by teaching people, vulnerable groups and health care providers about the TB disease and transmission. Early symptoms awareness have been created through health education promoting activities like anti-TB campaigns, mass media, internet, pamphlets, poster, slide etc. Health talks have been given to public about adequate exercise, enough rest and sleep, balanced diet, avoidance of smoking and alcohol, breathing fresh air and maintaining good indoor ventilation, good personal hygiene in order to improve and enjoy the positive health and psychological benefits throughout their lives. The commitment from HK government to control TB is further pushed by setting policies to control environmental pollution, discourage smoking, clean HK campaign, research on tuberculosis and other chest diseases to look for better measures in the fight against these diseases, support client within the course of treatment (HK Conclusion TB control programs are designed to arrest and prevent spread of TB, prohibit emergence of drug resistant TB; and reduce mortality rate, disability, illness, distress, emotional trauma, family disruption, and social discrimination. The treatment has multimodal approach which includes curing the TB patient, preventing mortality from active TB or latent infection, preventing relapse of TB, reducing the chances of transmission, and preventing the development of resistance. Drug-resistant tuberculosis and virulent strains has offered unmet challenges with little assistance from the recent drugs. The coordinated efforts and commitment of government resources with synergistic national strategy contributions from non-governmental organizations, academic institutions, public-spirited individuals, the community and the devotion and dedication of the staff and availability of ample resources have furnished positive control in tuberculosis. In order to be better prepared for the future, there must be continuous commitment from the government to develop an effective health care system, to give greater emphasis to health promotion and disease prevention, and to strengthen partnerships at regional and international levels, particularly in the Pearl River Delta Region, in a global effort to stop TB and other infectious diseases. In order to deliver dramatic reduction in tuberculosis cases at the end of this century in Hong Kong, it is necessary to follow persistently effective healthcare system, health promotion and disease prevention approaches, rrecognition of the critical delay factors for adoption and implantation of new tools for immediate effect. WHO’s new Stop TB Strategy based on DOTS, Stop TB Partnerships and the International Standards for quality tuberculosis care are new strategies in direction of hope to fight TB globally. References Centre for Health Protection (2008). Tuberculosis notifications (all forms) and rate by age group and sex. Retrieved from Chan-Yeung, M., Noertjojo, K., Chan, S. L., Tam, C.M. (2002). Sex differences in tuberculosis in Hong Kong. International Journal of Tuberculosis and Lung Diseases, 6, 11-18. Chan-Yeung, M., Noertjojo, K., Tan, J., Chan, S. L., Tam, C.M. (2002).Tuberculosis in the elderly in Hong Kong. International Journal of Tuberculosis and Lung Diseases, 6, 771-779. Jekel, J. F. Katz, D. L. & Elmore J. G. (2001). Epidemiology, biostatistics, and preventive medicine, 2nd edition, illustrated, Elsevier Health Sciences, 2001. Lee, S. H. (2008). The 60-year battle against tuberculosis in Hong Kong—a review of the past and a projection into the 21st century. Respiroloy, 13, S49-S55. Leung, C. C., et al. (2004). Smoking and tuberculosis among the elderly in Hong Kong. American Journal of Respiratory and Critical Care Medicine, 170, 1027-1033. HKSAR (2000). Tuberculosis control in Hong Kong. Retrieved from Hong Kong Tuberculosis Association Chinese Medicine Clinic (2007). Background. Retrieved from Tuberculosis and Chest Service (2006). Historical summary of TB and services in Hong Kong. Retrieved from Tuberculosis and Chest Service of the Department of Health Annual Report (2007). Retrieved from http://www.info.gov.hk/tb_chest/doc/Annual%20Report%202007.pdf World Health Organization (2009). Tuberculosis. Retrieved from http://www.who.int/topics/tuberculosis/en/ World Health Organization (2009). 10 facts about tuberculosis. Retrieved from www.who.int/features/factfiles/tuberculosis/en/index.html Read More