Happy World TB Day! Each year, March 24th is designed to build public awareness that tuberculosis remains an epidemic in much of the world, causing the deaths of nearly one-and-a-half million people each year, mostly in developing countries. This annual event commemorates the date in 1882 when Dr. Robert Koch announced his discovery of Mycobacterium tuberculosis, the bacillus that causes tuberculosis (TB).
Still today, up to 13 million people in the United States are infected with latent TB, which happens when a person breathes in TB bacteria, but his body is able to fight off the infection. This person has no symptoms, doesn’t feel sick, and cannot spread TB bacteria to others, but will usually have a positive TB test. Without treatment, a person with latent TB has a 5 to 10 percent chance of developing full-blown TB disease. Active TB happens when a person’s immune system cannot fight off the TB bacteria, and this person usually feels sick, and has symptoms that may include: a bad cough that lasts three weeks or longer, pain in the chest, coughing up blood or sputum, weakness or fatigue, weight loss, no appetite, chills, fever and sweating at night. It is important to note the one thing that both latent TB and active TB have in common is they both require treatment.
Both latent TB and exposure to active TB are identified through testing. The Mantoux tuberculin skin test is the test of which most are familiar. This type of testing was offered for many years through the Meigs County TB Clinic levy, operated under the Meigs County Commissioners. This levy was a completely separate levy from the Meigs County Health Department (MCHD) levy. Many assumed this TB Clinic was part of the health department because both businesses were housed under the same roof. This clinic was closed by the County Commissioners on Dec. 31, 2016, due to the specific language of the levy being for treatment of patients with tuberculosis and not for the educational and preventive services that were being offered.
Our public health system and private providers play a crucial role in the effort to identify and control and eliminate TB in the United States. As it is our mission to preserve, promote, and protect the health and well-being of Meigs County, the MCHD is currently considering becoming designated as the TB Control Unit within Meigs County. This appointment, should it occur, will come from the Meigs County Commissioners as is designated by Ohio Revised Code (ORC) 339.72.
So, you may ask, who should be tested for TB? You will find that some colleges and some professions do require a person to be tested. These rules are set at the discretion of each place of business. Often, healthcare workers are required to be tested. TB testing is usually a covered service by private insurance and Medicaid. You’ll recall that it used to be all students entering kindergarten had to have a TB test. Because this was no longer method of detecting or preventing cases of childhood TB, Ohio Administrative Code (OAC) 3701-15-04 “Tuberculin testing and examination in schools” was rescinded effective September 1, 2008; thus, schools no longer require TB testing in teachers, school bus drivers or students. A strong recommendation, however, to be tested would be for any student or staff who have lived outside the US five years or longer and whom have never been tested. Restaurant owners, food service workers and fair booth volunteers often ask if they need tested for TB, as this has been a long-standing practice. State of Ohio Uniform Food Safety Code (OAC 3717-1) does not address this; thus this decision is left up to the owner/management of the establishment.
Meigs County has had no confirmed case of TB since 2009. Ohio had 151 cases in 2017 while the US had 9,105 new cases diagnosed in that same period. Generally, persons at high risk of developing TB disease include those have been recently infected with TB bacteria, including: close contacts of a person with infectious TB disease; persons who have immigrated from areas of the world with high rates of TB; children less than 5 years of age who have a positive TB test; groups with high rates of TB transmission, such as homeless persons, injection drug users, and persons with HIV infection; persons who work or reside with people who are at high risk for TB in facilities or institutions such as hospitals, homeless shelters, correctional facilities, nursing homes, and residential homes for those with HIV. Also at risk of developing TB disease include persons with medical conditions that weaken the immune system, such as: HIV infection (the virus that causes AIDS), substance abuse, silicosis, diabetes, severe kidney disease, low body weight, organ transplants, head and neck cancer, medical treatments such as corticosteroids, and specialized treatment for rheumatoid arthritis or Crohn’s disease (CDC, 2016). If you, a family member, or someone you know fall within any of these high-risk areas, I encourage you to be tested for TB. Presently, the MCHD refers residents to their primary care provider or other local health department for testing. A public announcement will be made should the MCHD be designated as the County’s TB Control Unit.
For questions about TB, please visit https://www.cdc.gov/tb/ or https://odh.ohio.gov/wps/portal/gov/odh/know-our—programs/tuberculosis/TB_Welcome or call me at 740-992-6626 Ext. 1032.
Leanne Cunningham is the Director Nursing at the Meigs County Health Department.