Published 13 July 2016
On 24 March we celebrate World TB Day, the day in 1882, that Robert Koch made the announcement of the discovery of the bacillus that caused TB at the meeting of the Berlin Physiological Society. Today, more than hundred years later, approximately 9 million people suffer from TB yearly and approximately 1.5 million will die of TB each year.
Presently South Africa is rated fifth (5) of the countries with the highest burden of TB, ranking amongst countries such as India and China. This is greatly attributed to the “terrible twins” phenomenon – in the face of HIV, TB has increased dramatically. HIV affects a person’s immune system and this opens the door for TB to emerge as health threat. There is also a concern that the inconsistent treatment of TB might lead to drug resistance. For every South African, as most of us have been exposed to TB early in life, there is a 10% chance of developing TB in one’s lifetime. For those infected with HIV the chances of developing TB is 10 times higher per year. For the diabetics, children, the elderly and in mining communities the chances of developing TB disease are also increased.
TB is transmitted in air through very small Mycobacterium tuberculosis-infected droplets which are spread from an infected person via sneezing, coughing, talking and singing. The droplets can remain suspended in the air for longer periods of time. A healthy person then inhales these infected droplets.
Living in closed, overcrowded settings with poor ventilation provides the ideal transmission vehicle for the spread of TB. Some people with chronic conditions like diabetes, cancer and PLWH are also more prone to tuberculosis due to a weakened immune system. As a child most South Africans are exposed to TB, but only a small proportion of children will develop TB disease. Most of the time the immune system takes care of the infection, but as some tests will now show up as “positive” it is termed Latent TB. Only when circumstances are favorable for TB disease, (e.g. PLHW, diabetes) will the dormant bacillus become active. The most common form of TB is TB of the lungs, but in fact TB can affect any organ in the body.
In South Africa we only test people who have TB symptoms. The symptoms that warrants a check for TB include:
The most common test for diagnosing TB is providing a sputum sample that is then analyzed for the presence of TB bacilli. BCG, the TB vaccine, is given to babies at birth as protection against severe forms of the disease, e.g. TB meningitis. As a general rule, TB treatment has to be taken for 6 months. Children under 5 years who were exposed to active TB from an adult, will receive prophylactic (protective) treatment with Isoniazid.
Once a person is diagnosed with TB, a course of treatment will be prescribed and the person will have to take the treatment for 6 months uninterrupted. The treatment will be strictly monitored. Medical staff will assist you to deal with any challenges whilst on treatment. Before travelling you need to inform your treatment provider of your trip so that necessary arrangements may be made to avoid interrupting the treatment. TB treatment can be combined with other medication, such as ARVs or any other treatment. Make your family or friends aware that you are on TB treatment and advise them to seek help should they experience symptoms. It is better and safer to make sure that you are cured the first time on treatment by taking the right dose, at the right time for the right duration. Any interruption of the treatment may lead to developing drug resistant TB which is more difficult to treat and to cure.
Let us join hands!!
Firstly we all have to strive to stay healthy by staying on a balanced diet, with regular exercises, moderate alcohol consumption and staying outside in the sun as much as possible as sunlight is the natural killer of the bacteria. STOP smoking and say NO to drugs! Always open windows in church, schoolrooms, offices, homes and any shared spaces. Educate friends and family about the importance of healthy living. Get tested for HIV yearly if not yet infected and take precautions to stay negative. Cover your cough with a tissue or cough in your elbow. Dispose used tissues safely. Wash hands regularly. Know the symptoms and go for medical check-ups regularly. Advise friends and family with symptoms to go for check-ups.
And lastly, should a friend or family be diagnosed with TB, support them and help them complete the treatment by being a supportive “treatment buddy”.