/World TB Day

Drug resistant TB infection and disease is an increasing public health threat locally, nationally, and globally. Patients can be on therapy to treat drug resistant TB for 18 to 24 months. TB can be a challenging disease to treat which requires strict compliance and the use of multiple medications to prevent resistance. TB can remain in the body dormant for years, it is important to treat individuals that may not exhibit signs and symptoms of active disease but still harbor the organism to prevent the progression of the infection and possibly death. TB awareness is important not only on World TB Day but every day so we can protect our community from this possibly deadly highly but curable disease.

March 24, 2010

The Southern Nevada Health District’s TB Treatment and Control Clinic conducted 82 contact investigations in 2009. At any given time, there are approximately 80 people undergoing treatment for active TB in Clark County under the supervision of the health district. Adherence to treatment is key to eliminating the risk of spreading TB to a patient’s close contacts and the community as a whole. In recent years, drug resistant strains of TB have developed, limiting treatment options with several cases of drug resistant cases identified locally. “Directly observed” therapy protocols require the TB Treatment and Control Clinic to utilize a number of resources to monitor patient compliance with therapy. Health district clinicians coordinate care for patients, many of whom voluntarily remain in quarantine until adherence to an effective treatment plan renders them no longer infectious. Treatment can take six to 24 months and requires supervision, which is burdensome on the patient and health care systems.

Incomplete treatment has led to a surge in multiple drug-resistant TB strains around the world. In some locations, more than 20 percent of newly diagnosed TB cases are drug resistant. There have been no new classes of TB drugs developed since the 1960s.

Public health nurses from the health district visit or speak with every active TB patient five times each week to ensure treatment compliance and to verify that other needs such as food and shelter are being met. These visits are also part of the “directly observed” therapy protocol; the attending physician examines adult patients weekly and pediatric patients monthly.

“While TB is highly curable, it is unfortunate that people still place a stigma on this disease. As TB continues to spread in many parts of the world it is critical that communities, like Clark County, continue to maintain effective programs to identify and treat active TB cases and screen their contacts,” said Dr. Lawrence Sands, the health district’s chief health officer. In 2009, nearly 55 percent of Clark County TB patients were foreign-born; however, as many as one in 10 people no matter their country of birth tested positive for exposure to the bacterium, although they may not have been sick or infectious.”

“People who test positive for what is called ‘latent’ TB are asymptomatic and are not capable of spreading the disease. It means that they have been exposed to the bacterium at some point in their lives. The good news is we can offer them treatment to prevent them from developing into an active case of TB which could spread disease within our community,” Sands added.

Nationwide, there were more than 12,500 cases of TB in 2008. According to the CDC, the 2008 TB rate in the United States is 4.2 cases per 100,000 people, a 3.8 percent decline from 2007. The majority of cases nationwide and in Nevada are among the foreign born in whose home countries latent TB infection rates are high. Between 1993 and 2007, TB case rates in the United States decreased for American-born and foreign-born people, however, the decrease among the foreign-born remained less substantial.

Additionally, the CDC reports that the “essential elements for controlling TB in the United States include sufficient resources, interventions targeted to populations at high risk for TB, and collaborative efforts with the international community to reduce the burden of TB globally.”

TB affects millions annually:

  • Approximately one in three people worldwide have latent TB infection
  • Approximately 4,500 people each day die from tuberculosis; approximately two million annually
  • TB is the leading cause of death in HIV co-infected individuals

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The Southern Nevada Health District serves as the local public health authority for Clark County, Boulder City, Henderson, Las Vegas, Mesquite and North Las Vegas. The agency safeguards the public health of the community’s residents and visitors through innovative programs, regulations, and initiatives focused on protecting and promoting their health and well-being. More information about the Health District, its programs, services, and the regulatory oversight it provides is available at www.SNHD.info.