11 The cough heard ‘round the world: working with tuberculosis
11 The cough heard ‘round the world: working with tuberculosis
Sharon Connor, PharmD
Jennifer Lashinsky, PharmD, BCCCP
Stephanie Lukas, PharmD, MPH
Topic Area
Global health/Infectious disease
Learning Objectives
At the end of this case, students will be able to:
- Describe how the health of US populations is impacted by the health of populations around the world
- Understand the mechanism of and risk factors for tuberculosis (TB) transmission
- Explain proper TB prevention measures, including the use of personal protective equipment, as well as recommendations for TB screening
- Analyze the impact of multidrug-resistant tuberculosis (MDR-TB) on currently available treatment options, length of therapy, and elimination of TB worldwide
Introduction
Tuberculosis (TB) is the world’s leading killer amongst infectious diseases. In 2017, 1.6 million people died from TB, making it one of the top ten causes of mortality worldwide.1 TB is preventable and curable, but elimination remains a challenge. Worldwide, the regions with the highest number of cases of TB are Southeast Asia and Africa, accounting for approximately two-thirds of the reported cases.2 As such, the elimination of TB is a key priority of the WHO,3 included in the Sustainable Development Goals (SDGs) with a target to “end the epidemics of AIDS, TB, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases” by 2030.3
In the United States specifically, public health initiatives within health departments and TB control programs had a tremendous impact on the prevention and management of TB.5 Although it remains a concern, the rate of TB in the United States continues to drop slowly. A total of 9,105 TB cases (a rate of 2.8 cases per 100,000 persons) were reported in the US in 2017. This is a decrease from the number of cases reported in 2016 and the lowest case count on record.6 However, due to the ongoing public health implications of the disease, TB remains a focus area in the Healthy People agenda for the nation. Included in the specific topics and objectives are goals to reduce TB, increase the completion rate of all TB patients who are eligible to complete therapy, and to increase the percentage of contacts to sputum smear-positive TB cases who complete treatment after being diagnosed with latent TB infection (LTBI) and initiated treatment for LTBI.7
Elimination of TB will require a worldwide effort to decrease transmission for active cases, access to quick treatment, as well as strategies to screen for and manage latent TB infection. The USPSTF recommends screening for latent TB infections in populations at increased risk.8 Cases of active TB must be treated quickly, as the disease is contagious, with an estimated capacity of a single person with untreated and active disease to infect as many as 15 people within a year.1 Drug resistance is also a concern, with over half a million new cases of TB in 2017 demonstrating resistance to f