World Tuberculosis Day - March 24
World Tuberculosis Day is an awareness day aimed at educating the public about the impact of TB around the world. CDC, along with our partners and colleagues around the world share successes in TB prevention and control and raise awareness of the challenges that hinder our progress toward the elimination of this devastating disease.
The CDC and its domestic and international partners, including the National TB Controllers Association, Stop TB USA, We Are TB, the TB Elimination Alliance, and the global Stop TB Partnership are working together to eliminate this deadly disease.
The theme of World TB Day 2022 - ‘Invest to End TB. Save Lives.’ –conveys the urgent need to invest resources to ramp up the fight against TB and achieve the commitments to end TB made by global leaders. This is especially critical in the context of the COVID-19 pandemic that has put End TB progress at risk, and to ensure equitable access to prevention and care in line with WHO’s drive towards achieving Universal Health Coverage.
Tuberculosis today remains an epidemic in much of the world, causing the deaths of nearly one and a half million people each year, mostly in developing countries. It commemorates the day in 1882 when Dr. Robert Koch astounded the scientific community by announcing that he had discovered the cause of tuberculosis, the TB bacillus. At the time of Koch’s announcement in Berlin, Tuberculosis was raging through Europe and the Americas, causing the death of one out of seven people. Koch’s discovery paved the way towards diagnosing and curing TB.
On March 24, 1882, Robert Koch announced his discovery that TB was caused by a bacteria in his presentation “Die Aetiologie der Tuberculose” at the Berlin Physiological Society conference. The discovery of the bacteria proved that TB was an infectious disease, not hereditary. In 1905, Koch won the Nobel Prize for Medicine and Physiology.
Why World Tuberculosis Day is Important
While Tuberculosis may seem like an outdated disease, it remains one of the world’s deadliest infectious killers. Each day, over 4100 people lose their lives to TB and close to 28,000 people fall ill with this preventable and curable disease. Global efforts to combat TB have saved an estimated 66 million lives since the year 2000. However, the COVID-19 pandemic has reversed years of progress made in the fight to end TB. For the first time in over a decade, TB deaths increased in 2020.
Who Should Be Tested for TB
TB is an airborne infectious disease, that spreads when a person with TB disease coughs, speaks, or sings. When a person is diagnosed with TB disease, a contact investigation is done to find and test people (like family members) who may have been exposed to TB. People diagnosed with TB disease or latent TB Infection are then treated.
Certain people should be tested for TB infection because they are at higher risk for being infected with TB bacteria, including:
- People who have spent time with someone who has TB disease
- People from a country where TB disease is common (most countries in Latin America, the Caribbean, Africa, Asia, Eastern Europe, and Russia)
- People who live or work in high-risk settings (for example: correctional facilities, long-term care facilities or nursing homes, and homeless shelters)
- Health-care workers who care for patients at increased risk for TB disease
- Infants, children, and adolescents exposed to adults who are at increased risk for latent tuberculosis infection or TB disease
Many people who have latent TB infection never develop TB disease. But some people who have latent TB infection are more likely to develop TB disease than others. Those at high risk for developing TB disease include:
- People with HIV infection
- People who became infected with TB bacteria in the last 2 years
- Babies and young children
- People who inject illegal drugs
- People who are sick with other diseases that weaken the immune system
- Elderly people
- People who were not treated correctly for TB in the past
TB tests are generally not needed for people with a low risk of infection with TB bacteria. New technologies like whole genome sequencing help public health professionals see patterns of TB transmission. This tool can help focus public health efforts to find and treat persons with TB disease and latent TB infection.
How is TB diagnosed?
A person who suspects that they may have TB should get tested by their doctor or the health department as soon as possible.
Your doctor will start by collecting a patient history to determine if you may have been exposed. During a physical exam, they will use a stethoscope to listen to your lungs and check the lymph nodes in your neck for swelling. If your doctor suspects TB, they may order a skin or blood test.
The skin test is done by injecting a small amount of fluid called tuberculin into the skin in the arm. You will be told to return to the office within 48 to 72 hours to have a healthcare worker check the arm to see if a bump or an induration (thickening) of the skin has developed. It may be difficult to feel so an experienced healthcare worker should examine the reaction. The healthcare worker will measure the bump or induration and tell you if your reaction to the test is positive or negative. If it's positive, it usually means you have been infected with the TB germ. It does not tell whether you have developed clinically active TB disease. The skin test isn’t 100% accurate, meaning you may have a false-positive or a false-negative, so your doctor may order further testing regardless of the result.
The TB blood test measures how your immune system reacts to the germs that cause TB. This information will be used to more precisely confirm or rule out latent or active TB. It requires only one office visit.
If the skin or blood tests indicate the need for further analysis, your doctor may order a chest X-ray or CT scan to look for visible signs of TB in your lungs. They may also check your sputum (coughed-up mucus) for bacteria, to see whether you have clinically active TB disease and if so, which strain of TB you have. These tests can take one to two months before results are available.
Vaccine
Albert Calmette and Jean-Marie Camille Guerin developed the Bacille Calmette-Guérin (BCG) vaccine in 1921. Prior to developing the BCG vaccine, Calmette developed the first antivenom to treat snake venom.
The BCG vaccine is not widely used in the United States, but it is often given to infants and small children to prevent TB meningitis in countries where TB is common. BCG does not always protect people from getting TB. TB blood tests are the preferred TB test for people who have received the BCG vaccine.
Vaccine research continues into the future. When a more effective TB vaccine is developed and deployed, it could reduce disease and death around the world.
Treatment and Managing Tuberculosis
Latent TB
If you have become infected with TB, but do not have the active TB disease you should get preventive therapy. This treatment kills germs that could cause problems if the disease becomes active. The most common preventive therapy is a daily dose of the antibiotic isoniazid (INH) taken as a single daily pill for six to nine months. You are not contagious if you have latent TB.
Active TB
If you have an active TB disease you will probably be treated with a combination of antibacterial medications for a period of six to 12 months. The most common treatment for active TB is isoniazid INH in combination with three other drugs—rifampin, pyrazinamide and ethambutol. You may begin to feel better only a few weeks after starting to take the drugs but treating TB takes much longer than other bacterial infections. You must continue taking your medication as prescribed for the entire time your doctor indicates or you could get sick again, have a harder time fighting the disease in the future and spread the disease to others. Not completing your entire course of medication could also contribute to drug-resistant TB.
Drug-resistant TB
Drug-resistant TB means that some drugs initially used to treat TB will no longer be able to fight the TB germs in your body. TB that is resistant to more than one drug, called multidrug-resistant TB (MDR TB) is very dangerous. The treatment for this type of TB takes much longer, 20 to 30 months to complete, and you may experience more side effects.
Managing Tuberculosis
You must finish your medicine and take the drugs exactly as prescribed. If you stop taking the drugs too soon you can become sick again and potentially spread the disease to others. Additionally, by taking the drugs incorrectly, TB germs that are still alive may become drug-resistant, making it harder for you to get better next time.
While you are in treatment for active TB disease, you will need regular checkups to make sure your treatment is working. Everyone is different, but there are side effects associated with taking the medications, including:
- Upset stomach, nausea and vomiting or loss of appetite
- Tingling or numbness in the hands or feet
- Itchy skin, rashes, or bruising
- Changes in your eyesight or blurred visions
- Yellowish skin or eyes
- Dark-colored urine
- Weakness, fatigue or fever that for three or more days
It is important to tell your doctor or TB nurse immediately if you begin having any unusual symptoms while taking medicine for either preventive therapy or for active TB disease. TB drugs can be toxic to your liver, and your side effects may be a warning sign of liver damage. If you are having trouble with tingling and numbness, your doctor may prescribe a vitamin B6 supplement while you are in treatment. It may also be possible to change TB medications if your side effects are serious.
Tips for Taking TB Medicine
If you are taking TB medicine on your own, it's important to get into a routine. Here are some ways to help you remember to take your TB medicine:
- Take your medicine at the same time every day.
- Each day when you take your medicine mark it off on a calendar.
- Get a weekly pill dispenser that has a section for each day of the week. Put your pills in it.
- Ask someone close to you to check in daily to make sure you have taken your medicine.
- Ask your healthcare provider what you should do if you forget to take your pills.
- Sometimes it is helpful to have support in sticking to the long treatment timeline. You may be offered assistance through a program called Directly Observed Therapy (DOT). This means a healthcare worker will come to you to administer your medication and eliminate the concern of forgetting to take the treatment.
Preventing the Spread of Tuberculosis
If you have active TB disease, it will take a few weeks of treatment before you can't spread TB bacteria to others. Until your healthcare provider tells you to go back to your daily routine, here are ways to protect yourself and others near you:
- Take your medicine exactly as the healthcare provider directed.
- When you cough, sneeze or laugh, cover your mouth with a tissue. Put the tissue in a closed bag and throw it away.
- Do not go to work or school until your healthcare provider says it's okay.
- Avoid close contact with anyone. Sleep in a bedroom alone.
- Air out your room often so the TB germs don't stay in the room and infect someone else.
How to Observe World Tuberculosis Day
Get tested
Disease prevention always starts with you. Testing for tuberculosis is simple and is sometimes required for travel or job applications. It’s always a good thing to have on your medical records and not in your lungs.
Spread awareness
Many people with TB don’t even know they have it. Latent tuberculosis can lie dormant for years without a single symptom. This is why it’s important to spread awareness about how to get tested and treated. With any disease, prevention is the best cure.
Sources:
https://www.cdc.gov/tb/worldtbday/default.htm
https://www.paho.org/en/campaigns/world-tuberculosis-day-2022