The Role of Public Health in Preventing and Managing Tuberculosis

Introduction:

Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis affecting the lungs. The disease is transmitted from person to person through air when the infected person coughs or sneezes. TB infection has shown its increased incidence rates in developing countries or (low-income countries) as a reason for a major economic burden. The huge concern for public health services is the fact that globally, a quarter of the population falls under the high-risk category of developing TB because of the increased incidence of immunosuppression. The WHO (World Health Organization) has come forward with a lot of preventive programs and is looking forward to reducing the incidence rates by 90 percent and mortality rates by 95 percent by 2035.

What Are the Measures Taken by Public Health Services (PHS) In Preventing and Managing Tuberculosis?

In order to prevent the infectious disease from spreading, the PHS has come up with three main strategies, which include:

1. Identify the patients with active TB disease and provide complete treatment to such people to make them non-infectious, thereby preventing further spreading of the disease in the community.

2. Identifying and screening people who are in close contact with TB patients involving,

• People who have already acquired active TB disease.

• People are infected with the bacteria, but are not spreading the disease.

• People and children who are at high risk of developing the infection can be indicated for window prophylaxis treatment, which happens to be the preventive treatment for presumed TB infection.

3. Identifying, screening, testing, and treating people who are suspected of having latent TB infection (LTBI) and other active TB patients who are otherwise resistant to conventional treatment benefit from the treatment for latent TB infection (LTBI).

What Are the Essential Components to Be Practiced to Carry Out Preventive TB Infection Programs?

1. Infection Control:

• The infection control programs should advocate suspicion of the infection among people who have TB symptoms during the assessment and should be able to arrive at a prompt early diagnosis.

• The patients diagnosed with TB should be therapeutically intervened immediately without further delay.

• Patients should be educated about the importance of periodic evaluation of infection and its control in preventing further spread.

• TB infection has more affinity towards immunocompromised patients who are already suffering from HIV or AIDS infection as the AIDS (acquired immunodeficiency syndrome) infection has already lowered the immune power, and the Mycobacterium tuberculosis (bacteria causing TB) can easily enter the patient’s body.

• Hence, strict measures should be taken to prevent the spread of TB infection in patients suffering from HIV (human immuno-virus) infection.

2. Adequate Staff for Conducting TB Preventive Programs:

• Various programs like record-keeping, planning of the programs, financial management, epidemiologic surveys, surveillance, social services, staff and patient training, and coordination of TB activities and other health department programs are charted out to conduct TB prevention programs and require adequate staff.

• A program manager is allocated for each and every TB control program. Such programs also include nurses, physicians, medical consultants, public health advisors, epidemiologists, outreach workers, and other staff to conduct the preventive TB programs.

• TB clinics should be encouraged as a part of TB prevention programs with adequate staffing patterns to keep a check on disease control.

• A well-qualified physician trained in TB diagnosis and management is made available in all TB clinics.

3. Providing Surveillance and Reporting the Cases of TB Infection:

• Surveillance of the TB control programs conducted plays an important role in initiating further public health awareness programs to eliminate TB.

• A drug susceptibility test (DST) is carried out to infer the effectiveness of a TB drug against the tuberculosis-causing bacteria, which forms a vital surveillance activity in containing the infection. Moreover, DSTs aid in devising proper treatment regimens.

• Drug-resistance surveillance involves genetic mutation analysis and DST.

• TB control programs used local drug resistance to assess the effectiveness of initial TB treatment regimens.

• Reporting of TB cases and suspected TB cases should be carried out in an electronic database. The reporting of data plays a key role in the following TB control activities:

a) Evaluation and treatment planning.

b) Effectiveness of the TB treatment regimens.

c) Identifying and preventing transmission of the infection.

d) Monitoring of drug-resistant cases and identifying populations at risk.

4. Should Abide by Laws and Policies for Conducting Hassle-Free TB Preventive Activities: TB control programs should abide by the laws and regulations that govern medical healthcare practices, which include:

• Prompt reporting of every confirmed and suspected TB case.

• Isolating the people infected from the rest of the public to prevent the spreading of the infection.

• Individuals who are currently non-infectious but are not willing to complete the treatment may end up becoming infectious again, and spreading the disease to others should be contained.

• Protecting patient confidentiality.

• Making the patients undergo complete treatment for elimination of TB and ensuring DOT (directly observed therapy) for TB patients. (DOT refers to ensuring that the patient completely undergoes treatment and takes all medications and the response to the treatment is monitored).

• Treating patients even if they are unable to pay.

5. Additional Strategies to Eliminate TB:

• Making the latent TB infection (LTBI) a reportable condition along with suspected and active TB cases.

• Providing directly observed therapy (DOT) to both active TB and LTBI cases.

• Periodic assessment of the surveillance and reporting data to monitor the effectiveness of treatment regimens and initiate new interventions as and when required.

• Creating awareness among the public regarding the incidence and prevalence rates of TB and LTBI cases through news releases on social media and publishing case reports and presentations by experts in the field.

• Having a collaborative approach by tying up with various local, state, tribal, and federal institutions to conduct collaborative TB control programs.

Conclusion:

Although tuberculosis is a preventable and curable disease, millions of people die globally, making it the world’s highest infectious killer disease. The state and local health departments and other public health services have an important role in the early diagnosis, screening, and treatment of TB disease. This highly infectious disease can be tackled by eliminating the spread of the infection in the community by organizing worldwide preventive and eradication programs for TB.