Epidemiology: Tuberculosis and Its Transmission

Introduction

Tuberculosis is one of the most dangerous infectious diseases that affect people’s lungs and may lead to death. This disease can be observed among the citizens of high-income countries, as well as developing countries. The impact of migration on tuberculosis is frequently discussed in health and medical research (Pareek, Greenway, Noori, Munoz, & Zenner, 2016). About one­-fourth of the global population is currently infected with tuberculosis (Centers for Disease Control and Prevention, 2018).

Therefore, it is not enough to be aware of its epidemiological triangle, but to focus on the explanation of all contributing factors and its prevention regarding the guidelines developed by one of the most effective national agencies, the Centers for Disease Control and Prevention. This paper aims to investigate tuberculosis from a variety of perspectives, including its epidemiology, demographics, nurse participation, and global implication.

Disease Description

Causes and Transmission

Tuberculosis (TB) is a current public health concern around the whole globe. Though its development is characterized as slow, it remains regular and takes about 1.5 million lives annually (Centers for Disease Control and Prevention, 2018; Sulis, Roggi, Matteelli, & Raviglione, 2014). Mycobacterium tuberculosis is the main cause of TB. The prevalence of these multidrug-resistant strains can be high and lead to the inability to control TB despite a number of achievements being made in the field. As a rule, a person can live with latent or active TB in the lungs and put other people under threat through coughing and sneezing. It is easy for a healthy person to inhale droplets with TB bacteria. Still, this disease is not as contagious as it seems to be due to its air mode of transmission. People have to spend much time together in one place to catch it.

Signs and Symptoms

The peculiar feature of TB is that its symptoms may not be observed in case a person has a latent type of infection. However, in case of active TB, a patient may have similar to flue signs. They include a cough that may last more than several weeks, chest pain, weakness, and fever (Getahun et al., 2015). Venkatraman, Morris, and Wiselka (2013) also mention the importance of such symptoms as a headache, diarrhea, and joint pain. Unexplained weight loss can also be observed in people with TB (Getahun et al., 2015). Finally, if a person suffers from any of these symptoms, and night sweats began bothering, it is high time to see a doctor and take the necessary blood, sputum, and urine tests, as well as X-rays, to prove or disprove the diagnosis.

Complications

Patients with TB have to be diagnosed as soon as possible due to the existing complications of this disease. Without appropriate treatment, TB can be fatal for patients of different age. The bacterium may influence the work of the lungs, as well as other parts of the body, including the heart, liver, and kidney. This infection is characterized by such complications as back stiffness and arthritis. Mental health problems can be observed because of a lasting headache. Bloodstream may be affected by tuberculosis bacteria and promote liver, kidney, and heart problems with a poor ability to control an inflammation process in the body.

Treatment

As soon as the diagnosis is proved, a doctor has to develop a treatment plan and inform a patient. As a rule, it is suggested to take a six-months treatment in any case of TB with two main phases being developed: an initial phase is about the first two months, and a continuation phase includes the next four months (Venkatraman et al., 2013). The treatment offered during the initial stage aims at reducing the growth of bacteria and decreasing drug resistance risks (Venkatraman et al., 2013). Antibiotics such as isoniazid or rifampicin have to be prescribed and can be used until the end of treatment (Sulis et al., 2014). The combination of some antibiotics may cause side effects. Therefore, the first month of treatment should be thoroughly observed by medical workers to make sure that the choice of medications is appropriate for a patient.

Mortality and Morbidity

The discussion of mortality and morbidity associated with TB is an important step in research as it helps to understand what people know, what they are ready to do to avoid complications, and what results are achieved. In 2016, 9,272 new cases of TB were reported in the United States (Centers for Disease Control and Prevention, 2018). Though this number shows a decrease in morbidity rating compared to the previous year, such slow changes are not satisfactory for the US population and the government.

Regarding the global statistics, about 1.7 million TB-related deaths were identified (Centers for Disease Control and Prevention, 2018). Mortality and morbidity rates are higher among specific populations, including those who smoke, have alcohol abuse, and stay unemployed (Matteelli, Roggi, & Carvalho, 2014). These independent risk factors cannot be ignored by nurses and other stakeholders of TB research.

Prevalence and Incidence

Measurement of TB incidence and prevalence has to be evaluated. Compared to incidence that can hardly be measured at the national level, prevalence may be measured through surveys (Sulis et al., 2014). The decline in incidence is observed globally. The majority of cases is usually observed in Asian and African countries. At the beginning of the 2000s, its increase was observed in African due to a rising number of HIV-infected people (Sulis et al., 2014). New Zealand, the United States, and Canada are the counties with the lowest incidence rate.

The prevalence rate has been considerably decreased during the last several decades. The most affected countries are those located in the Eastern Europe and Central Asia Region (Sulis et al., 2014). The citizens of the Russian Federation, Belarus, and Moldova have to take special precautionary measures to avoid TB complications. The global perspective shows that about 450,000 cases of TB emerged in 2012 with 3.6% of new cases and 20.2% of already treated cases (Sulis et al., 2014). It is expected to decrease these numbers by 2020 through investigating and controlling risk factors and promoting new policies and programs.

Health Determinants

There are several factors that may contribute to the development of tuberculosis. They are divided into five main groups, including genetics, behavior, social environment, physical environment, and health services. Each of them plays an important role in TB epidemiology. For example, the genetic or biological factor is based on the presence of a special gene, NRAMP1, in the body of a person (Abel, El-Baghdadi, Bousfiha, Casanova, & Schurr, 2014). This gene may significantly change to the molecular progress of the disease. The presence of such diseases as diabetes, obesity, or cancer can promote the development of the disease as well.

Though gender and age are not direct contributors to the disease, a young age can be a threat because of the inability to strengthen the immune system in a short period of time. Individual behavior, including such habits as smoking and alcohol/drug usage may also increase the risk of getting the disease (Matteelli et al., 2014). The environmental (physical) factors like crowding housing, migration from different countries (or passion for traveling), and close contact with people with TB promote a possibility of transition a virus in the body.

Finally, the role of social factors and health care has to be identified. In case people are deprived of the opportunity to learn about TB, cannot access hospitals as soon as some signs are noticed because of low income or work schedules, or do not follow precautionary methods, they are under threat of having TB complications. Poverty, malnutrition, and medical service shortage are the factors that have to be solved by the government in order to reduce the spread of TB in their countries (Venkatraman et al., 2013). Negligence of theses determinates can lead to fatal results.

Epidemiological Triangle

Tuberculosis is a disease that may affect any person in the world. Therefore, the consideration of epidemiological data should help to clarify all risks and complications. Researchers offer to use the epidemiological triangle with the help of which the environment, host, and agent, all of them are also known as vertices, can be identified (Venkatraman et al., 2013). Regarding the findings made during this investigation, the following triangle can be developed:

  1. An agent is an infection that causes the disease (what?). In this case, Mycobacterium tuberculosis is the infectious agent.
  2. A host is an organism that may have the disease (who?). In this case, the bacterium usually affects the lungs of a human.
  3. An environment is the combination of external factors that may promote the disease transmission. In this case, TB predisposition is connected with chronic diseases, malnutrition, overcrowding living conditions, unstable/poor socioeconomic factors, and alcohol/drug/tobacco abuse.

This epidemiological triangle can be used by the community, schools, and the general population in their intentions to create favorable conditions to prevent TB. It is easy to learn what may cause tuberculosis. A description of what risk factors should be learned is given. Therefore, people must respect each others’ rights for health through smoking in specially created places, be regularly tested for tuberculosis, and inform about any change of the patient’s condition.

Community Health Nurse Role

The role of a community health nurse is extremely important in preventing and control of TB. This person can easily report and analyze all TB cases in their district and focus on the symptoms people may have. The nurse is in close contact with patients and their families. Therefore, the discussion of dangerous living and working conditions can help people recognize the risks they are exposed to. In addition to the possibility to collect data, the nurse is able to compare the results from different clinics and hospitals, investigate the outcomes of various treatment plans, and communicate with people who are involved in TB cases from various perspectives.

Nurses can help people in a variety of ways. Getahun et al. (2015) say about the possibility of nurse case management for the homeless people. Venkatraman et al. (2013) underline the necessity to manage all patients and their families. Finally, nurses have to inform the population about the importance of vaccination. For example, there are many migrant workers who have to begin cooperating with local people in a short period of time (Pareek et al., 2016). People have to know that vaccination is the best way to protect themselves about those who may have the bacteria.

National Agency and Tuberculosis

As well nurses who have to work hard and promote the prevention of tuberculosis, there are many local and national organizations that aim at discussing, preventing, and controlling diseases. The Centers for Disease Control and Prevention is one of such organizations the contributions of which are well-known around the whole globe. It is a federal agency that continues working under the Department of Health and Human Services in the United States.

The protection of public health and safety is the main goal of this organization. Among a variety of guidelines and statistical reports, the Centers for Disease Control and Prevention (2018) informs the population about the latest facts concerning TB and its growth among the Americans and in the world. People can easily find its official site and use the information offered.

TB stakeholders may use the results of this organization’s work in different ways. Its recent prevalence, incidence, mortality, and morbidity data can be helpful to healthcare researchers and nurses. Patients may learn how to reduce a possibility of having TB. Parents can find clear guidelines on how to protect their children. The discussion of social determinants to tuberculosis can be used by a citizen of any country. In general, the Centers for Disease Control and Prevention shows how to resolve and reduce the impact of TB through fair and up-to-date statistics.

Global Implications

The peculiar feature of tuberculosis is that this infectious disease is communicable, meaning that any person can easily catch it despite their age or gender. Today, tuberculosis may be defined as endemic as it is usually observed in such regions as Africa, Asia, and Western Europe. However, it is necessary to admit that the citizens of the United States and Canada are also exposed to this disease because people continue traveling and migrating all the time (Pareek et al., 2016). Therefore, the policymakers of different countries try to address this disease in the same way because the solution for TB remains the same for all people – avoidance of all possible risk factors, reduction of poverty, and the creation of favorable working and living conditions.

Conclusion

To conclude, it is necessary to say that though the citizens of some countries are not as exposed to tuberculosis, as the citizens of Africa and Asia, this disease is still a problem that bothers nations for a long period of time. The governments of certain countries are ready to spend much money to find a solution to tuberculosis and offer their citizens the best conditions for life and work. However, such processes and conditions as migration, traveling, and poverty cannot be stopped or neglected. Their impact on TB development is significant. Therefore, people have to improve their knowledge of signs, causes, and complications of TB in order to be ready to recognize it at its early stage and begin treating.

References

Abel, L., El-Baghdadi, J., Bousfiha, A. A., Casanova, J. L., & Schurr, E. (2014). Human genetics of tuberculosis: A long and winding road. Philosophical Transactions of the Royal Society B Biological Sciences, 369(1645). Web.

Centers for Disease Control and Prevention. (2018). Tuberculosis: Data and statistics. Web.

Getahun, H., Matteelli, A., Abubakar, I., Aziz, M. A., Baddeley, A., Barreira, D., … Raviglione, M. (2015). Management of latent mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries. European Respiratory Journal, 46(6), 1563-1576. Web.

Matteelli, A., Roggi, A., & Carvalho, A. C. C. (2014). Extensively drug-resistant tuberculosis: Epidemiology and management. Clinical Epidemiology, 6, 111-118. Web.

Pareek, M., Greenaway, C., Noori, T., Munoz, J., & Zenner, D. (2016). The impact of migration on tuberculosis epidemiology and control in high-income countries: A review. BMC Medicine, 14(1), 48-58.

Sulis, G., Roggi, A., Matteelli, A., & Raviglione, M. C. (2014). Tuberculosis: Epidemiology and control. Mediterranean Journal of Hematology and Infectious Diseases, 6(1). Web.

Venkatraman, N., Morris, T., & Wiselka, M. (2013). Current approaches to the management of tuberculosis. Prescribing in Practice, 24(18), 48-50.