What is TB?
Anyone can get TB. However, most of us in developed countries, such as the UK, are healthy and have a strong immune system which stops the disease developing. TB is an opportunistic disease which preys on those who have weaker immune systems.
It is an infection caused by bacteria (Mycobacterium Tuberculosis), which mainly affects the lungs, but can affect other parts of the body such as the spine or brain. Only TB carried in the lungs is infectious.
If not treated properly, TB can be fatal. An individual might be infected with TB for years (latent disease) but have no symptoms as the body is able to control the disease. However, if the immune system becomes less effective, the disease can become active.
In a person with active disease, the bacteria grow and begin to destroy tissue, such as the lungs, and the TB becomes infectious. If a person with active TB coughs or sneezes, they may pass the disease to others, particularly those they are in close contact with.
The BCG vaccine has helped to protect against TB for many years but it does not prevent it in all cases.
Whilst no longer routinely given in the UK, it is still recommended for those who are at high risk of catching tuberculosis.
In many developing countries, where the chance of being infected in the early years is high and may lead to devastating widespread disease, the BCG vaccine is given at birth. However, it is not effective in preventing TB in the long-term.
Diagnosis & Treatment
Active TB may start with a persistent, dry cough which worsens over weeks or months, and the individual may cough up phlegm or even blood. Weight loss, night sweats, fatigue and fever are also common.
Tuberculosis is usually diagnosed by analysing sputum samples under a microscope, and a chest x-ray may also be necessary.
Treatment is relatively cheap, and involves three or four different kinds of antibiotics, in combination, over a period of 6 to 9 months. Most countries now offer TB treatment free of charge.
The DOTS (Direct Observed Therapy Short course) programme, developed by the World Health Organisation, is the global standard for TB control.
A key feature of DOTS is treatment supervision, either at home or in hospital with trained nurses or community workers. This support has proved to be very successful but there is a need to expand the programme, and increase the speed of expansion worldwide.
What is DOTS
It has five crucial elements to make it effective:
1. Sustained commitment from the government
2. Access to quality-assured TB sputum microscopy to check for the presence of bacteria
3. Standardised short-course chemotherapy using a range of antibiotics for all cases of TB under proper case-management conditions
4. Uninterrupted supply of quality-assured drugs
5. Recording and reporting system enabling outcome assessment