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Role of the Health Department in Tuberculosis Prevention

by Wilson

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Due to tuberculosis being caused by an infectious organism capable of spreading from person to person through the air, public health measures were set into motion. Three strategies have been created for tuberculosis prevention and control in the United States. The first is to identify and treat persons who have contracted the tuberculosis disease. Secondly, locating persons exposed to infectious tuberculosis patients, evaluating them for Mycobacterium tuberculosis infections and disease, and providing them with appropriate treatment. And lastly, testing the population at high risk for undiscovered tuberculosis infection and treating those individuals who are infected to prevent the spread of the disease. 

The strategies for prevention and control behind tuberculosis are touched upon in a framework containing several important topics. Historical and epidemiological context of tuberculosis control, Organization for public health tuberculosis control programs, legal action for public authority, conducting overall planning and development of policy, assessing individuals who have clinically active tuberculosis, evaluation if immigrants, managing individuals who have or are suspected of containing the disease, medical consultation, inter-jurisdictional referrals, assessing and managing the individuals infected with mycobacterium tuberculosis, providing laboratory and diagnostic services, collecting and analyzing data, and lastly providing important training and education. 

Tuberculosis (TB) is an airborne, communicable disease caused by infection with the bacterium, mycobacterium tuberculosis. Infection can usually happen when a person manages to inhale a microscopic droplet nuclei filled with viable bacteria, typically acquired as a result of the droplet nuclei spread due to coughing or sneezing by persons who have tuberculosis. An undiagnosed, untreated individual with active TB disease can infect an estimated 10-14 people in a single year. Although, with Mycobacterium tuberculosis (M. TB) doesn’t normally result in TB disease. Around 5-10% of those infected with Mycobacterium tuberculosis (M. TB) eventually develop active disease, of those, only 5% develop active TB within the first two years after becoming infected. 

Those who are infected with TB but in whom the bacteria is not reproducing or able to spread have what is known as latent TB infection (LTBI). For certain population subgroups, discussed below, the risks of TB infection and progression from LTBI and active TB disease are much higher. While some believe that TB has managed to diminish over the decades, it reality, TB still remains a major global health problem. Approximately two billion people around the world are infected with mycobacterium tuberculosis (M. TB) and about nine million of those have developed TB disease each year. 

While TB is not heavily prevalent in the general U.S population as it was in recent decades, its incidence among certain high-risk populations is consistently unreasonable. TB disease rates for the U.S. declined steadily between 1953 and 1986. Although, between 1986-1992 TB disease rates began to increase annually, because of the increase of HIV/AIDs, immigration from countries with higher problems of TB, nosocomial transmission of mycobacterium tuberculosis (M. TB), multi drug-resistant TB, and lastly deterioration of U.S. infrastructure for TB. While improved public health strategies and prevention resources have managed to reduce TB rates, as of 1993, the rate decline slowed by 2000. Between 1993-2000, the average annual percentage decline for TB incidence rate was 7%. By 2000-2007 the average rate was 3%

Basic public health strategies in response to TB normally concentrated on testing, surveillance, prevention, and control, each of which has multiple factors. By 2005, the American Thoracic Society, CDC, and the Infectious Diseases Society of America came up with four basic principles vital to TB Control in the U.S., which state:

1. Promptly detect and report persons who have contracted TB.

2. Protect close contacts of patients with contagious TB from contracting TB infection and disease.

3. Take concerted action to prevent TB among the population of U.S. residents with LTBI by identifying those at highest risk for progression to TB disease through targeted testing and administration of a curative course of treatment.

4. Reduce the rising burden of TB from recent transmission of M. tuberculosis by identifying settings at high risk for transmission and applying effective infection-control measures to reduce the risk.

Each of these strategies are the main objective for TB control efforts by tribal, state, and local public health departments in collaboration with federal authorities and private sector partners. Although, the implementation of  this strategy is difficult due to the complication TB presents. For instance, the variable latency period between infection and the progression to active TB disease can impede control efforts. Furthermore, testing and screening programs must distinguish LTBI, which is asymptomatic and non-contagious, from active TB. These potentially contagious people with LTBI can benefit from treatment to prevent the disease from progressing.

While the field of medicine is crucial for the detection, prevention, and treatment of TB, communication disease control policies in the U.S. are founded by public health principles and governed by public health law. Public health law can be defined as “those laws” or legal processes for every level of government, that are mainly made to assure the conditions for people to remain healthy.