The Perspective
 
SPRING 2011

TB? Not me.

“Hello, this is the Southern Nevada Health District’s Tuberculosis Treatment and Control Clinic. You’ve been identified as a contact of a TB patient and you need to be tested.”

For anyone who has been involved in a TB outbreak investigation, these words were most likely greeted with apprehension and anxiety.

TB was once one of the world’s most dreaded diseases - today it is treatable and more importantly, it is curable.

Despite advancements made in TB treatment and control, many misconceptions still exist. While treating more than 80-100 new patients annually and conducting just about as many contact investigations, the health district continually addresses the many myths associated with TB disease.

Diet Myth 1

Nobody gets TB anymore.

1/3 of the world is infected with TB

We wish. In 2010, 2 billion people worldwide were affected by tuberculosis; 97 locally. In 2009, there were more than 11,000 cases in the United States; 106 in Nevada.

At any given time, about 80 people are undergoing treatment in Southern Nevada. Treatment can last six to 24 months and is conducted under the strict supervision of the health district’s TB nursing staff.

“People are afraid when we contact them. We get resistance from some, reluctance to provide contacts, denial from others. Each patient and their contacts require our time to educate them and assure them that we will be there through the course of their treatment,” said Laurie Hickstein, senior public health nurse. “It is like the movie ’50 First Dates’ every day, but that’s what we do.”

Each new TB case results in a contact investigation. A contact investigation is when people with close contact to the patient are tested for TB.

Contact investigations help keep down the number of new cases and are an example of a successful public health intervention which focuses not just on treating the patient but on stopping the spread of disease within a community.

Diet Myth 2

TB infection means TB disease.

“One of the most common misconceptions is that if you test positive, you have an active case of TB,” said Bonnie Sorenson, director of clinics & nursing services.

TB infection is NOT necessarily TB disease. A positive TB test simply means you were exposed to TB at some point in your life. This is known as “latent” TB infection.

Latent TB cannot be spread to others. About 90-95 percent of people with latent TB infection never develop active TB disease.

TB Symptoms

“The good news is that we offer treatment to people with latent TB to prevent them from developing an active case,” said Sorenson.

An “active” case of TB – someone who is symptomatic and infectious – triggers a contact investigation.

During a contact investigation, people close to the patient are tested for TB, and anyone who tests positive receives an X-ray. If a contact tests positive for TB after the first round of testing, the infection may not be the result of contact with the patient who triggered the investigation.

Eight to 10 weeks later, the patient’s contacts are retested. If a formerly negative contact now tests positive, it is likely the infection is the result of contact with the original patient.

“It is a big undertaking. We rely on the cooperation of patients, family members, employers or other institutions. We want to help people who are sick, and we want to keep people from getting sick,” said Sage Nagai, disease investigation intervention specialist. “People don’t like to hear from us but it’s important to understand that it is in your best interest and the best interest of the community to participate.”

Diet Myth 3

TB infects only the lungs.

Pulmonary (lung) TB is the most well-known type of infection. Extrapulmonary TB affects other parts of the body such as the brain, kidneys, or the spine and the treatment is similar to pulmonary TB treatment.

Myth 4

TB is a disease of poverty.

TB can infect anyone, regardless of where they live or their socioeconomic status. TB disease is much more common in most countries in Latin America, the Caribbean, Africa, Asia, Eastern Europe and Russia. Nearly 55 percent of local TB patients are foreign born, many from countries where TB infection is widespread. In the US, the number of TB cases continues to decline, however, among foreign born residents, the rate of decline has been slower.

“We encounter this myth all the time. In some countries, TB is still associated with poverty or poor living conditions and we get push back from patients because of this,” said Nagai. “It can make it more challenging for us during our investigations.”

TB can also spread more easily in communal settings such as prisons or jails, homeless shelters and some nursing homes.

Myth 5

TB is easy to catch and can be spread through casual contact.

Man coughing

You have to be in close contact for a long time with someone who has TB to “catch” it. TB is spread through the air when a person with active pulmonary TB coughs, sneezes, speaks or sings.

You cannot get TB by:

  • shaking someone’s hand
  • sharing food or drink
  • touching bed linens or toilet seats
  • sharing toothbrushes
  • kissing

“Patients have also told us that sometimes even health care workers are afraid to come into close contact with them out of fear and misunderstanding. They have said that some of their loneliest times were during a hospital stay. We continue to educate families, friends and health care workers about how TB is spread and what they should and shouldn’t do,” said Hickstein.

Myth 6

Once you get TB, you have lifelong immunity.

Unfortunately, this too is a myth. Although it’s rare, you can be infected from a different strain of TB.

For more information, access the TB section of the health district’s website. To subscribe to "The Perspective," complete our online form.

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