Tuberculosis

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Tuberculosis

• Facts for Health Care Workers
• November 2008

STuberculosis PowerPoint1108.ppt
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TB Facts

• Tuberculosis (TB) is one of the worlds most
  deadliest diseases.
• One third of the worlds population is infected
  with TB.
• The World Health Organization estimates that if
  TB control is not strengthened, nearly one
  billion people will be newly infected with TB
  worldwide, over 150 million will become sick and
  36 million will die from the disease between now
  and 2020.

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TB Control

• Public health surveillance and epidemiology
  reveal disease patterns and statistical trends to
  target affected populations for prevention,
  control, and treatment.

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United States TB Statistics

• The United States has seen a steady decline in
  the number of reported TB cases since 1992.
• The Center for Disease Control (CDC) reported
  13,299 new cases of TB in the United States in
  2007. This represents a 3.3 decrease from 2006.
  

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Reported TB Cases United States, 19822007
No. of Cases
Year
Updated as of April 23, 2008.
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TB Case Rates, United States, 2007
D.C.
lt 3.5 (year 2000 target)
3.64.4
gt 4.4 (national average)
Cases per 100,000.
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TB in the State of Michigan

• There were 266 cases of TB reported in the State
  of Michigan in 2007.
• The Detroit Metropolitan area including Oakland,
  Macomb, Washtenaw, and a portion of Wayne County
  represents 63.7 of the State's tuberculosis (TB)
  cases in 2007.

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What is Tuberculosis?

• Mycobacterium tuberculosis (TB) is a bacteria
  spread through the air from one person to
  another.
• TB bacteria are expelled into the air when a
  person who has active TB disease, coughs,
  sneezes, laughs or sings.
• TB most commonly affects the lungs, but can
  affect other organs in the body.

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Common Sites of TB Disease
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Factors Affecting TB Transmission

• The number of bacteria expelled into the air.
  (The more bacteria the person emits, the more
  infectious the person is)
  
• Environment in which exposure occurred open well
  ventilated room versus enclosed space
• Duration of exposure and distance between you and
  the other person
• Virulence of the bacteria

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Symptoms of TB Disease

• Cough lasting 3 weeks or more
• Unexplained weight loss
• Loss of appetite
• Chills
• Fever
• Night sweats
• Weakness or fatigue

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Who should have a TB Test

• You should have a TB test if
• You have spent time with a person who has TB
  disease.
• You have HIV infection or other condition that
  makes it harder for your body to fight infection.
• You inject illegal drugs.
• Your employer or physician says you need a test.
• You are from a place where TB disease is more
  common or spend a lot of time where TB is
  prevalent.

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Tuberculin Skin Testing (TST)

• The Mantoux tuberculin skin test (TST) is the
  standard method of identifying persons infected
  with M. tuberculosis.
• Purified protein derivative (PPD) of killed
  tubercle bacilli is injected under the skin.
  Persons must then return for TST reading within
  48 to 72 hours. Positive reactions are
  classified as follows
• 5mm induration or gt for highest-risk groups
• 10mm induration or gt for other high-risk groups
• 15 mm induration with no risk factors

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Mantoux Test
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TB Diagnosis

• Chest X-ray
• Presence of infiltrates and/or cavities in the
  lung tissue

• Sputum smear
• Mycobacterium Tuberculosis, acid-fast bacilli
  (AFB) growth on a slide

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Two Step Testing

• Health care workers and residents and employees
  of certain facilities receive a baseline TST when
  they start their job or enter a facility. This
  test may be negative.
• The test is repeated in 1 to 3 weeks, to assess
  for booster phenomenon. The second test
  boosts the immune system to react to the
  tuberculin.

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TB Treatment

• Treating (LTBI) and TB disease benefits the
  person and the community by preventing and
  controlling TB.
• Treatment of (LTBI) significantly reduces a
  persons risk of developing TB disease.
• (LTBI) treatment consists of a 9 month medication
  regimen of the drug Isoniazid (INH) which kills
  the bacteria that are in the body to prevent
  progression of infection.

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TB Treatment

• Drug susceptibility drives the treatment of TB
  disease. The majority of people are treated for
  6 to 9 months with the following first line
  drugs
• Isoniazid (INH)
• Rifampin (RIF)
• Pyrazinamide (PZA)
• and either
• Ethambutol (EMB) or Streptomycin (SM)

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TB Infection Control Programs

• Effective infection control programs allow for
• Prompt identification, isolation and treatment of
  potentially infectious persons with TB disease.
• Locating and evaluating TB contacts and treating
  them appropriately.
• TST testing of high risk persons to identify
  (LTBI) candidates and ensure completion of
  treatment.
• Provide education on TB to the public as well as
  medical professionals.

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TB Infection Control Measures

• Administrative controls reduce the risk of TB
  exposure by
• Developing policies and protocols to ensure rapid
  id, isolation, evaluation and treatment of
  persons with TB
• Implement effective work practices among health
  care workers (HCW)
• Provide TB training and education
• Screening HCW for TB infection and disease
• Engineering controls prevent the spread of TB by
• Use of adequate ventilation and filtering systems
  to reduce concentration of infectious droplet
  nuclei in the air (i.e. negative pressure rooms)
• Personal respiratory protection (i.e. N-95 mask)

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Respiratory Protection

• N95 respirators must be worn by trained staff
  when active TB is suspected.
• Fit testing is done annually for individuals who
  are at risk for direct exposure to clients with
  TB.
• Suspect TB clients are educated on mask use and
  are asked to wear them to protect others from
  potential exposure.

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• Questions?

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References

• Guidelines for Preventing the Transmission of
  Mycobacterium tuberculosis in Health-Care
  Facilities, 1994 CDC MMWR October 28,
  1994/Vol.43/No. RR-13
• Core Curriculum on Tuberculosis, What the
  Clinicinian should know. Fourth Edition, 2000
• OSHA, Employee Workplace Rights, US Dept. of
  Labor OSHA, 3021-2000, TB Fact sheet in OSHA 451
• World Health Organization. Global Tuberculosis
  Control Report, 2007.