Free Essay. Epidemiology of Tuberculosis and Its Global Implication

Tuberculosis or TB is a contagious and bacterial disease that affects the respiratory system. This health condition is airborne, and it is caused by Mycobacterium tuberculosis (CDC, 2020). Often, the causative agent enters into the air when an individual with lung TB spit, sneeze, or cough, releasing droplets containing the bacteria. In this regard, Mycobacterium tuberculosis (M. tuberculosis) enters the body by inhalation of droplets having the infectious agent. According to the World Health Organization (2019), a person only needs to inhale a few of Mycobacterium tuberculosis to develop TB. The immune system, however, can contain these pathogens so that they do not cause the illness or replicate to other parts of the body. In such instances, an individual would not have an active TB disease but rather a Latent Tuberculosis (LT) (CDC, 2020). LT infection, notably, develops to active tuberculosis disease when the immune system is weakened by illnesses and not able to fight M. tuberculosis (CDC, 2020). While there is no risk of passing on the latent infection, people with active TB can easily spread it. The bacteria, often, is transmitted to other people through direct contact. Although immunization helps reduce the incidence of tuberculosis, the federal government and the community should address environmental risk factors like overcrowding, malnutrition, and indoor air pollution because it facilitates the spread of M. tuberculosis bacteria.

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Description of the Disease

Symptoms and the Demographic of Interest

Symptoms of this illness depend on the part of the body where M. tuberculosis is growing (CDC, 2019). The causative agent, nonetheless, usually replicates in the lungs, causing pulmonary TB. The signs of tuberculosis in the respiratory system are pain in the chest, coughing up blood, and a prolonged cough (CDC, 2018). Other symptoms of this health condition are sweating at night, chills, fever, lack of appetite, fatigue or weakness, and loss of weight (CDC, 2018). People with LT infection, however, neither have symptoms of tuberculosis nor feel sick (CDC, 2018).

Tuberculosis is a matter of concern in many jurisdictions, and it is among the leading causes of death globally (World Health Organization, 2019). In 2018, more than 251,000 adults with HIV died from TB, while another 1.5 million perished directly from the disease (mortality) (World Health Organization, 2019). About 10 million people across the world, also fell ill with TB in the same year (World Health Organization, 2019). The statistics further show that two-thirds of the total tuberculosis cases reported globally in 2018 were in 30 high TB-burden nations (World Health Organization, 2019). The countries leading the count were China, Indonesia, and India. However, the incidence of this communicable disease is falling at about 2% per annum (World Health Organization, 2019).

In the US, approximately 13 million persons were living with LT infection in 2018 (morbidity) (CDC, 2018). The prevalence of the disease in the same year was 2.8 cases per 0.1 million persons (CDC, 2018). The proportion of tuberculosis cases in 2018, according to CDC (2018), decreased by 1.3% from 2017. The prevalence of the disease, notably, has continuously decreased over the last two decades. New cases or incidence of TB infections in the United States, however, is higher in the African-American community (CDC, 2018).

Tuberculosis among children below 15 years has been a public health concern for many years (CDC, 2019). Notably, infants tend to develop chronic forms of TB compared to adults and older children (CDC, 2019). Other populations where tuberculosis is a public health issue are the homeless, pregnant women, and inmates. Government statistics indicate that about 4 to 6% of new manifestations (incidence) of TB are reported in incarcerated persons in US prisons (CDC, 2019).

Complications Associated with Tuberculosis

TB, according to Shah and Reed (2014(, is a challenging disease to control and diagnose. The process of diagnosing this condition, according to Shah and Reed (2014), is complicated because of the heterogeneity of disease presentations. Even with effective treatment, tuberculosis can lead to long-term health consequences (Shah & Reed, 2014). Research by Shah and Reed (2014) attributed TB complications with a host of inflammatory responses to M. tuberculosis, metabolic abnormalities, vascular compromise, and structural damage caused by the pathogens. An example of a life-threatening complication associated with the disease is sepsis (Shah & Reed, 2014). Other issues impaired pulmonary function and Mycetoma (Shah & Reed, 2014).

Treatment and the Reporting Time

Active tuberculosis disease can be treated using nine first-line anti-TB agents, such as pyrazinamide (PZA) and rifampin (RIF) (CDC, 2018). These drugs are effective because they form optimum treatment regimens. According to the CDC (2018), individuals with active TB should take the prescribed medications for 6 to 9 months. The treatment regimens for LT infections, on the other hand, use rifapentine (RPT) and isoniazid (INH) (CDC, 2018). However, doctors should modify treatment procedures if a person has drug-resistant TB. The treatment for both illnesses, notably, has special considerations for teens, pregnant women, and persons with HIV.

Tuberculosis is a reportable disease in many jurisdictions, including the US. Currently, the United States is using the reporting guidelines that were issued by the national Department of Health in 2010 (CDC, 2010). The timeframe to report suspected cases of tuberculosis infections in the country is 24 hours (CDC, 2010). Anyone having a reason to believe that a person has M. tuberculosis should convey such information to local departments of health or health officers within 24 hours (CDC, 2010). For healthcare provides, the law requires them to notify the TB program in the facility of clinically suspected cases. In this case, the reporting time for healthcare providers is also 24 hours (CDC, 2010). Professionals in charge of clinical laboratories, as well, are required to promptly notify the official state department or local health department of such findings.

Social Determinants of Health (SDOH)

Green (2018) defined SDOH as the conditions hindering or contributing to people's well-being. These elements influence access to quality care within a population, and it includes conditions where people age, work, worship, and learn (Green, 2018). Also, SDOH covers aspects of places where individuals play, live, and grow. These factors are intertwined and consist of the biological, economic, social, and environmental variables that affect the ability of a group of people to maintain and even have good health (Green, 2018). SDOH explains the existence of health disparities within populations. Here, variations in the quality of health arise from environmental, economic, social, and biological disadvantages. Determinants that increase the risk factors of illnesses are inadequate health systems, poor healthcare access, contaminated water, and inadequate sanitation (Green, 2018). Other factors are social exclusion, poor housing, and insufficient healthy food sources.

Socioeconomic deprivation, according to Hargreaves et al. (2011), is responsible for a high prevalence of TB in specific populations. This aspect is a combination of factors like unemployment, overcrowding, low income, and inadequate education. In the US, homelessness and social exclusion have contributed to a high incidence of tuberculosis. As mentioned earlier, the incarcerated population is at a high risk of getting M. tuberculosis because of social and environmental conditions. Inmate population accounts for 4 -6% of new tuberculosis reported in the country (CDC, 2019). Duarte et al. (2018) noted that several studies had found an association between homelessness and tuberculosis. The situation not only increases the risk of getting TB but also reduces the success rate for treatment. The main predictors of unsuccessful treatment of TB, according to Duarte et al. (2018), are HIV co-infection, intravenous druse use, and age. Americans that live in overcrowded areas, as well, are at a higher risk of exposure to M. tuberculosis than their counterparts living in better conditions. Overcrowding and poor housing, in this regard, adversely impact the quality of the indoor air quality because of poor ventilation.

Shelby et al. (2018), found an association between the incidence of tuberculosis and per capita domestic product. Precisely, people with low-income experience socioeconomic deprivation, which, in turn, gives rise to multiple SDOH. Such persons face undernutrition, overcrowding, and poor living conditions, which increase the risk of exposure to M. tuberculosis. Persons living or working in high TB burden areas are at a high risk of getting M. tuberculosis, as the disease is airborne, and it is transmitted through direct contact. People's economic status, as well, affects access to quality TB treatment. Specifically, the catastrophic economic burden associated with the treatment of tuberculosis limits the ability of low-income families to get proper treatment.

Tuberculosis Epidemiologic Triangle

Epidemiologists use this model to explain pathogens causing infectious diseases, conditions that allow them to spread and reproduce in the human body (Green, 2018). Also, it helps understand the symptoms, signs, causes of diseases, and how the causative agents are transmitted. The key components of an epidemiological triangle are environmental factors, agents, and host factors.

Agent Factors: The causative agent of TB is Mycobacterium tuberculosis, which affects the respiratory system. Whereas these bacteria reproduce slowly, they are hypersensitive to ultraviolet light and heat (Wong & Jacobs, 2016). M. tuberculosis can also affect the kidneys, lymph nodes, joints, and intestines. The body, however, can fight BT bacteria unless the immune system is weak and cannot respond to the infection. Tuberculosis is communicated through direct contact and inhalation of infected droplets that enter the air through coughing, spitting, and speaking.

Host Factors: Human being becomes the potential host of M. tuberculosis when they inhale droplets containing infectious disease agents. Since TB pathogens are airborne, it can spread to susceptible persons who, in turn, become the host of the bacteria. A large number of people can easily become the host of tuberculosis pathogens through respiratory exposure in public gatherings.

Environmental Factors: Warm conditions facilitate the replication of M. tuberculosis, and its ability to thrive and spread (Wong & Jacobs, 2016). Air pollution, overcrowding, and poor housing also increase exposure to TB pathogens. Besides, socioeconomic factors, such as poverty, limit access to treatment, suggesting that it discourages individuals from seeking care services.

However, there is a need for special considerations in public gatherings and community settings, since such environments can facilitate the replication of M. tuberculosis. Such social places should have proper ventilation to enhance the quality of indoor air. Also, they ought to have proper lighting since TB pathogens can easily multiply in damp, dark settings.

The Role of the Community Health Nurses (CHNs)

Nurses play vital roles in treating persons with tuberculosis, as well as creating awareness on how to prevent the spread of the disease. These professionals make follow-ups to ensure TB patients receive quality and successful treatment that enhances full recovery.