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James A. Haley Veterans’ Hospital - Tampa, Florida
Clock is ticking to end TB
By Ed Drohan
Monday, March 22, 2021Note: March 24 is World Tuberculosis Day. Occupational Health and Infection Control will be hosting an inaugural World TB Day event at James A. Haley Veterans’ Hospital. There will be an informational table for Veterans and staff located in the lot between COVID-19 staff testing trailer (Trailer 49) and Building 41 from 8:30 a.m. to 3 p.m. Wednesday, March 24.
While the world has been concentrating on the COVID-19 pandemic, another disease killed more than 1.5 million people around the world in 2019 alone.
A World Health Organization (WHO) report stated that tuberculosis (TB), a bacterial infection that affected an estimated 10 million people worldwide in 2019, can be found in most countries of the world but is most prevalent in the Southeast Asia, Africa and Western Pacific regions. While the infection rate in the United States is lower than many other countries, the Florida Department of Health still reported 413 cases of TB infection in the state in 2020.
According to James A. Haley Veterans’ Hospital Infectious Disease Specialist Dr. Richard Oehler, TB has affected people in what is now the United States for thousands of years. The biggest problem for medical professionals and those infected with TB is the rate of infection growth with the disease.
“It’s a different type of bacterium called TB mycobacterium,” Oehler said. “These bacteria grow very slowly and over time can become less responsive to treatment. Treatment is often prolonged. Currently, most people with the susceptible, non-resistant type of tuberculosis are treated for usually about six months.”
TB is transmitted from person to person, usually through inhalation, when an infected person is in tight, poorly ventilated settings with others. Once the bacteria are in the lungs, the body usually mounts a defense to help prevent an active infection.
“Your body mounts an initial defense, which basically walls off the bacillus that causes tuberculosis,” Oehler said. “If you have a normal immune system, your body will contain the infection. If you have a healthy immune system, that may be the end of the infection. The infection may not come back and reactivate.”
When that happens, the individual is considered to have a latent tuberculosis infection, which also means they cannot pass the disease along to others. Doctors recommend that people with a latent infection receive treatment to ensure the infection doesn’t eventually turn into active TB. The treatment usually consists of taking a single medication for anywhere from four to nine months. One of the problems, though, is when a person with a latent infection doesn’t complete their course of treatment, this can cause the disease to become resistant to the medications currently used against TB.
Khayr is one person who was affected in this way. He detailed his experiences with multidrug resistant TB to the Centers for Disease Control and Prevention.
He was a student when he was diagnosed with a latent TB infection. While he was prescribed medication to treat the latent infection, he never completed the course of treatment. Two years later he was diagnosed with active TB which became drug resistant because of his incomplete initial treatment. Because of this, his active TB treatment lasted two years and he had to be isolated for seven months of that treatment while he was still infectious.
Another problem with Latent infections is that some can go undetected for decades. That can become a problem for patients who may require treatments for other diseases that can suppress the immune system and cause the latent infection to become active.
“A lot of patients who have chronic diseases like rheumatoid arthritis, Crohns Disease receive therapies that suppress their immune system to prevent their disease,” Oehler said. “Unfortunately (those therapies) also suppress the portion of their immune system that contains the TB and keeps it at bay.”
People with HIV have a higher risk for complications from TB because of the disease’s tendency to suppress the immune system of those affected with it.
He added that some Veterans can have a higher risk of TB because of the travel sometimes involved with the military lifestyle.
“The Pacific area is a big area for tuberculosis,” Oehler said. “In some of our wartime populations, like Afghanistan and Iraq, and in those communities, there’s a certain amount of tuberculosis in those theaters. Travel and other considerations that exist for serving in a combat situation or going to a foreign theater can put you at higher risk. That’s why it’s so important for the VA to identify these individuals and provide them treatment.”
Other risk factors for developing TB infection include long-term hospitalization, incarceration, and a history of substance abuse or homelessness, or travel to places like Mexico, Asia, China, India and the African continent. While people with latent TB infection show no symptoms, those with active TB can experience fever, night sweats, chills, weight loss and coughing. Left untreated, TB can be fatal.
TB Infection rates had been steadily decreasing in the U.S. and around the world, but those numbers have plateaued in the last few years. While the WHO is actively campaigning to eradicate TB around the world, Oehler said more needs to be done to identify and treat individuals with latent or active TB.
“It’s clear that there’s a lot more to be done in our targets of eliminating TB at some point in the next several decades.”