Author: Dr. Sukheshni Nand (BDS)
Tuberculosis (TB) is caused by the bacteria known as Mycobacterium tuberculosis which mostly affects the lungs [4][7]. Tuberculosis spreads from one person to another through the air via the cough, sneeze or spit of an infected person, thus propelling the TB germs into the air [4]. It takes only a few germs to become infected. Symptoms of active lung TB are cough with sputum and blood at times, chest pains, weakness or fatigue, weight loss, loss of appetite, fever, night sweats and a cough that lasts 3 weeks or longer [7]. The term “active” in this respect means the TB germs are multiplying and spreading in your body [1]. On the other hand, if an individual is infected with TB germs but they have not become active, it is known as latent TB [1]. The disease in latent phase is not contagious, however it is recommended to take appropriately prescribed medications to keep the germs from becoming active [1].
Tuberculosis frequently affects adults in their most productive years [1]. Older age groups were disproportionally affected. This finding is not surprising because the elderly strata of the population are more likely to have been infected and are more prone to reactivation of dormant mycobacteria [3]. However, all age groups are at risk. Over 95% of cases and deaths were in developing countries [7]. Individuals who are infected with HIV are 19 times more likely to develop active TB [7]. The risk of active TB is also greater in persons suffering from other conditions that impair the immune system [1][7]. People with undernutrition are 3 times more at risk [7]. There were globally 2.3 million new TB cases in 2018 that were attributable to undernutrition [7]. Babies, young children and individuals who became infected with TB bacteria in the last 2 years and those who were incorrectly treated for TB in the past are at high risk of being infected [1]. In addition, Alcohol-use disorder and tobacco smoking increase the risk of TB disease by a factor of 3.3 and 1.6, respectively. In 2018, 0.83 million new TB cases worldwide were attributable to alcohol-use disorder and 0.86 million were attributable to smoking [7].
Furthermore, from 2000 to 2013, the estimated TB incidence in the Pacific has remained high but stable; estimated frequency and mortality have fallen by 20% and 47%, respectively [2]. The TB case notification rate (CNR) increased by 58 (from 146 to 231) per 100 000 population in the same period. In 2013, 24 145 TB cases were notified, most (94% or 22 657) were from Papua New Guinea [2]. Kiribati had the highest TB case notification rate at 398 cases per 100 000 population. TB case notification rates were also high in Papua New Guinea, the Marshall Islands and Tuvalu (309, 283 and 182, respectively) [2]. During 2002–2013, an estimated 1,890 tuberculosis cases were recorded in Fiji alone. Notification rates per 100,000 population increased from 17.4 cases in 2002 to 28.4 in 2013 [3]. Older persons were most affected, but tuberculosis has also increased sharply in persons 25–44 years of age [3].
Most Pacific island countries have a dedicated national Tuberculosis programme responsible for prevention, diagnosis and care. Pacific island TB programmes aim for internationally recommended targets for TB eradication by 2050 as per the WHO Regional Strategic Plan to Stop TB in the Western Pacific: 2011–2015, the WHO Stop TB Partnership and the Millennium Development Goals (MDGs) [2]. Additional targets have been set for the global End TB Strategy designed for implementation after 2015 [2].
In 1995, WHO recommended the international TB control strategy and directly observed treatment short-course (DOTS), which was adopted by all Pacific island countries and areas in the subsequent years [2]. By the year 2000, most had officially adopted this strategy and the associated standardized recording and reporting system. The six United States-affiliated Pacific island countries (American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Guam, Palau, and Republic of the Marshall Islands) are also aligned with the TB policies of the United States Centers for Disease Control and Prevention (CDC) [2]. All Pacific island countries have a TB recording and reporting system using internationally accepted definitions [2].
For the diagnosis of Tuberculosis, many countries still rely on a long-used method called sputum smear microscopy. Trained laboratory technicians look at sputum samples under a microscope to see if TB bacteria are present [7]. Microscopy detects only half the number of TB cases and cannot detect drug-resistance [7]. Another method of diagnosing is the use of the rapid test Xpert MTB/RIF® [7]. Diagnosing multidrug-resistant and extensively drug-resistant TB along with HIV-associated TB can become complex and expensive. In 2016, four new diagnostic tests were recommended by WHO, these included – a rapid molecular test to detect TB at peripheral health centres where Xpert MTB/RIF cannot be used, and 3 tests to detect resistance to first- and second-line TB medicines [7]. However, Tuberculosis is mostly difficult to diagnose in children [7].
Fortunately, TB is a treatable and curable disease. Active, drug-susceptible TB disease is treated with a standard 6-12 month course of four antimicrobial drugs that are provided with information and support to the patient by a health-care professional. Without such support, treatment adherence is more difficult [5][7]. Between 2000 and 2018, an estimated 58 million lives were saved through TB diagnosis and treatment [7].
Therefore, if an individual is infected with TB he/she can prevent others from getting TB by taking medications as prescribed, covering their mouth when coughing or sneezing, washing their hands frequently, keeping a safe distance from others, staying home until they are no longer contagious and by avoiding public transportation [5]. It is important to act appropriately to prevent further spread and keep your community protected from large-scale spread of infections. Furthermore, WHO also promotes preventive action through early screening and treatment for active TB, by addressing co-morbidities, health risks as well as social determinants of the disease, and by promoting access to universal health care [6]. All in the efforts to keep the Pacific Island nations protected from such bacterial infections.
Centers for Disease Control and Prevention. Preventing Latent TB infection from progressing to TB Disease. 2016
Kerri Viney, Damian Hoy, Adam Roth, Paul Kelly, David Harley and Adrian Sleigh. World Health Organisation. The epidemiology of tuberculosis in the Pacific, 2000 to 2013. 2015
Lorenzo Pezzoli, Shakti Gounder, Talatoka Tamani, Mary Raori Daulako, Frank Underwood, Sakiusa Mainawalala, Vasiti Nawadra-Taylor, Eric Rafai, and Laura Gillini. National Center for Biotechnology Information. Tuberculosis, Fiji, 2002–2013. 2016
MedLinePlus. Tuberculosis. N/D
WebMD. Tuberculosis Prevention: What to Know. N/D
World Health Organisation. Preventing TB. 2020
World Health Organization. Tuberculosis. 2020