March is TB Awareness month, but despite being the no 1 killer in South Africa (pneumonia is 2nd and HIV is 3rd), it’s still not getting nearly as much attention it probably should. It is treatable and curable, but so many are still falling victim to this bacterial infection.
The prevalence of TB in Cape Town today is equivalent to what it used to be in London in the 1800s. TB is a concern around the world, but it is particularly prevalent in South Africa.
I’m not sure if it’s due to stigma, assumption or just plain ignorance, but most people I chat to about Tuberculosis (TB) don’t seem even remotely phased by the global pandemic, even though someone dies from it every 20 seconds (nearly 1.5 million people in 2014 alone). Of the people who die from TB-related illness, more than 70% of them are HIV-positive. HIV and TB coinfection is a massive problem as TB is opportunistic of a compromised immune system and HIV attacks the immune system. HIV medication often reacts negatively with TB medication, which complicates matters. South Africa has the most cases of HIV and TB coinfections in the world.
I think this is because everyone seems to believe it is an illness that only affects the poor, but this is not the case (although they do suffer the most for various reasons). Yes, it is easier for pulmonary TB (TB of the lungs) to be spread in poorer more densely populated communities, but anyone could be potentially at risk of infection if exposed to someone who is infected and is coughing infectious droplets into the air. More than a third of people worldwide are exposed to at least one type of primary TB infection at some point in their lives, but a healthy immune system will in most instances prevent the bacteria from developing a full infectious disease.
It is possible to get TB of the skin, spine, intestines, lymph nodes and TB meningitis, but we are most aware of pulmonary TB and how it is spread.
It’s not easy to get TB if you have a strong immune system, but many things can compromise an immune system and make you vulnerable to infections. Stress, depression, bad diet, being a smoker, substance abuse, being HIV-positive or suffering from another disease or illness that compromises the immune system, can put you at risk if you are exposed to someone who has pulmonary TB who is infectious and not yet receiving treatment.
What’s even more concerning is the fact that there are increasingly more multiple-drug resistant and extensive drug-resistant strains of the virus being diagnosed around the country. These forms of TB don’t respond to 1st-line medications and so much stronger 2nd-line medications must be used, which often have terrible side-effects that can cause hearing loss, kidney failure and liver damage. Fewer than half of all people diagnosed with multiple drug-resistant strains of TB are ever cured.
Treatment for multiple drug-resistant strains of TB can take anything from six months to more than two years, and involve more than 14 pills and a few injections required per day. Failing to adhere strictly to this treatment regime increases the risk of extensively drug-resistant strains developing, which is even more difficult, expensive and time-consuming to treat.
According to a Fact Sheet circulated by the KZN Department of Health: “Only people who are sick with TB in their lungs are infectious. When infectious people cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A person needs only to inhale a small number of these to be infected.
Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year. But people infected with TB bacilli will not necessarily become sick with the disease.”
How to prevent the spread of TB:
- Keep your immune system active, lead a healthy lifestyle, eat well and get enough rest, and if you do start to develop symptoms that include chest pain, fever and coughing blood, do not take antibiotics (unless specifically prescribed to do so by your doctor) as this can result in the development of multiple drug-resistant strains of TB. Be sure to tell your doctor if you feel that you have been exposed to anyone who may have TB.
- TB does not like well-aired and sunny environments, so make sure that public spaces are well ventilated and get plenty of sunlight. If someone in the workplace develops a persistent cough ensure that this individual knows to cover their mouth with their elbow when they cough (this will also minimise the spread of colds and flu). The sooner someone with TB begins to receive treatment the sooner they will cease to be infectious.
- Avoid adding to the stigma and ignorance around TB whenever you can. Stigma is what prevents people from seeking treatment and becoming healthy. People with TB need support and compassion, and this will minimise the spread of TB dramatically, as treatment is often arduous and challenging for people with TB.
KZN Dept. of Health TB Fact Sheet
South Africa’s battle against tuberculosis
Fighting drug-resistant Tuberculosis in South Africa
Fighting TB – South Africa’s ‘insidious epidemic’
Dr. Stacey Rizza describes the risk factors for tuberculosis
What is TB? | Infectious diseases | NCLEX-RN | Khan Academy
Bruce J. Little is a contributing writer for Anova Health Institute. These are his views, which may or may not reflect those of Anova and its affiliates.