IOSH Presentation 2012

Kim Cartlich 2012 Tuberculosis

Aims Basic awareness of Tuberculosis (TB) Gain knowledge of the disease process Be aware of local epidemiology / prevalence Recognise why TB is making a come back To understand the role of BCG vaccination and who requires it Know the role of the TB nurse Where to seek advice

What is TB? TB is an airborne communicable disease TB is caused by a bacteria called mycobacterium tuberculosis It is spread by tiny airborne particles expelled by individuals with infectious TB by cough, sneeze or spit If another person inhales air containing these bacteria transmission can occur TB bacteria prefer the lungs but can infect any organ in the body

Consumption Galloping consumption Scrofula Kings Evil White plague Phthisis Famous people who had TB Bronte sisters Robert Burns George Formby Desmond Tutu Eleanor Roosevelt Vivian Leigh Tom Jones Nick Knowles TB History “ It was the fashion to suffer from the lungs; poets especially; it was good form to spit blood after any emotion that was at all sensational, and to die before reaching the age of thirty.” Alexandre Dumas

Past treatment for TB

2010/2011 TB Global facts 1.7 million people died from TB in 2009 This is equal to 4700 deaths per day There were 9.4 million new TB cases in 2009 In 2010 the WHO reported the highest ever rates of MDR TB, with peaks of 28% in some settings of the former soviet Union XDR TB cases have been confirmed in 58 countries However ! 2008 saw the highest level ever of people successfully treated at 86% World Health Organisation 2012

Why the resurgence? Migration Poverty / war / civil unrest HIV Longevity Poor treatment and control in third world countries

Figure 1.4. Three-year average tuberculosis case rates by local areas*, UK, Sources: Tuberculosis in the UK: Annual report on tuberculosis surveillance in the UK, London: Health Protection Agency. December *England – Local Authorities,Scotland – NHS Boards, Wales – Local Health Boards, NI – data not available.

Figure 1.3. Tuberculosis case reports and rates by region, England, 2010 Sources: Enhanced Tuberculosis Surveillance (ETS), Office for National Statistics (ONS) mid- year population estimates. Data shown in Appendix B; ii, iii. Prepared by: TB Section - Health Protection Services, Colindale. CI – Confidence interval

Figure 1.1. Tuberculosis case reports and rates, UK, CI - Confidence interval Sources: Enhanced Tuberculosis Surveillance (ETS). Enhanced Surveillance of Mycobacterial Infections (ESMI). Office for National Statistics (ONS) mid-year population estimates. Prepared by: TB Section - Health Protection Services, Colindale.

Figure 1.6. Tuberculosis case reports by place of birth and region/country, UK, 2010 *Numbers of cases stated in bars Sources: Enhanced Tuberculosis Surveillance (ETS). Enhanced Surveillance of Mycobacterial Infections (ESMI), Office for National Statistics (ONS) mid-year population estimates. Prepared by: TB Section - Health Protection Services, Colindale.

How is TB caught TB bacteria inhaled Most lodged in the upper respiratory tract (70-90%) Some may reach the lungs and multiply (10-30 %) 2-10 weeks after infection immune system usually intervenes and prevents spread of infection (latent) Only 10 % will go on to develop TB at some time in their life time

Signs & Symptoms of TB Cough Weight loss Night sweats Chest pain Extreme tiredness and lethargy Coughing up blood

TB Treatment TB treatment in the UK is free to the patient Medication is taken for minimum of 6 months Key to cure is concordance Occasional side effects Closely monitored Poor concordance can result in drug resistance Drug resistant TB is much more difficult to treat and much more expensive

Who is at risk of catching TB? Elderly The very young (under 2yrs) Those with weakened immune systems e.g. HIV Pre existing lung conditions Homeless / alcoholics / Drug addicts Travel to a high risk area i.e.. more than 3 months New entrants to the country from high risk areas are most at risk in the first 3-5 years of settling in their chosen country of reactivating any latent TB

MDR TB and XDR TB Multi drug resistant TB Extensively drug resistant TB Poor treatment compliance Single drug therapy Poor calculation or regimes Malabsorption of drugs Prescribing / dispensing errors

Map showing MDR TB 2010

Why the problem Gaps in TB control Extremely weak services M/XDR-TB management and care Health workforce crisis Inadequate laboratories Quality of anti-TB drugs not assured No restriction or regulation of anti-TB drug use Absent infection control Insufficient research Major financial gaps

How to protect against TB There is no 100% protection against TB BCG vaccination affords some protection,for high risk groups Knowledge about the disease is the best defence Knowing who to contact for advice Seeking professional advice if you know you have come in contact with a case of TB Promote general good cough hygiene Remember ! TB is not as infectious as you think

The TB team TB Clinicians HPA TB Nursing Team

TB Incident, What to expect Incident involving large numbers i.e. educational, establishment, nursing residential home,prison, factory Health protection agency lead Incident meeting is held, all relevant parties invited all information is assessed. Plan of action –timetable, screening, communication, press statements, TB nurses screen, collate results inform HPA Further meeting to assess need for further screening Final outcome meeting

The role of the TB nurses To support and visit all newly notified TB patients To instigate TB contact tracing Hold TB screening clinics in the community and Hospital setting Provide nurse Led prophylaxis clinic To provide a BCG vaccination service To screen new entrants from high prevalence areas of TB To and act as a resource for information on TB

Useful contact numbers North Yorkshire & Humber Health Protection unit TB Nursing Team CHCP