NURS 217 Health Assessment: Non-endemic Communicable Diseases TB

In 2009-2010, the Centers for Disease Control and Prevention (CDC) confirmed diagnosis of locally acquired dengue infection among residents of Key West, Florida (CDC, 2010). The diagnosis of dengue was prompted when an indexcase in New York was suspected for dengue with a recent travel history to Key West. This incidence pressed increased vector control measurements including an intense door-to-door campaign to find and eliminate mosquito breeding sites (CDC, 2012). The emergence of dengue and other communicable diseases in non-endemic regions emphasizes the necessity for strong surveillance.

For this Discussion,  select a recent example of an outbreak of a non-endemic communicable disease. Consider the event, the problems that were found, and how surveillance was used to monitor the event. In addition, think about the prevention and control activities used and the strengths and limitations of the response.

A communicable disease is a disease that spread through various ways such as contact with body fluid or by the bite of insects even by inhaling airborne virus and from one person to another one (Communicable Disease – ACPHD, 2017). The non-endemic communicable disease is now a crucial issue for not only medical professionals but also for government globally. There are many non-endemic communicable diseases such as gonorrhoea, hepatitis A, tuberculosis, HIV, malaria, dengue and much more.

In this research, the non-endemic communicable disease Tuberculosis or TB has been chosen, and risk factors responsible for a breakout of TB, surveillance to prevent this disease and the ways that can be used to control have been discussed. As opined by Lawn et al., (2015), there are also many difficulties to monitor or prevent a non-endemic communicable disease, but in this essay one example has been discussed which shows the positive response regarding control this disease.

Risk factors associated with the outbreak of TB:

According to WHO, about 9 million people become infected with TB annually. Even already there are more than 2 billion people who are infected by tuberculosis bacteria. Mycobacterium tuberculosis bacterium which causes tuberculosis is one of the top three reasons of death for women of the age group of 15 to 44 (Tuberculosis (TB) – ACPHD, 2017). These bacteria at first infect the lung, and then other parts of the body get affected by TB bacteria.

There are several risk factors which are responsible for a breakout of this non-endemic communicable disease TB.

As TB bacteria are airborne pathogens, it can easily spread from person to person through the air. Even according to Zuñiga, Muñoz, Johnson & Garcia (2014), a TB patient can infect more or less 10 to 15 people within a year. Moreover, when a TB infected person sneezes or coughs, the bacteria get free in the air and then if a person who is in frequent and close contact with that patient breathe in those bacteria, that person become infected.

The symptoms of tuberculosis are not very prominent. The symptoms include fever, cough (sometimes with blood and mucus), night sweats, and loss of appetite, weight loss, fatigue and much more which are also found in many other minor diseases. Most of the time TB is detected in an advance stage where not only lungs but also kidney, brain, bones or spine become affected with the bacteria (Li et al., 2013). This can be dangerous and it is not very easy to cure at this stage.

Problems found by the surveillance:

The data of report of each new case of TB disease in the United States is collected by National TB Surveillance System. This surveillance is done by a coordinated effort of local and state health departments and CDC (The Centers for Disease Control and Prevention). TB surveillance is done by sharing the collected data, validation, dissemination and analysis of data (Marks, 2014).

Surveillance or screening of TB is done by several methods. In the words of Schepisi et al., (2014), the first stage of observation or screening may be done by a doctor by using a stethoscope to listen to the lungs and by checking if the lymph nodes are swelled or not. But one of the most frequent diagnostic tests for tuberculosis is the skin test where an extract of tuberculosis bacteria is injected in the forearm (inside portion). After three days if the injected site becomes hard and a reddish bump swells up, then it indicates that the person is TB infected. There are many other tests such as blood tests, sputum tests or chest x-rays to diagnose TB infection.

However, there are some obstacles to surveillance or screen TB properly. The skin test for detection of TB is not 100% faultless. It has been found in some cases that this test gives incorrect negative and positive results (Nasr et al., 2014). It is very problematic to diagnose TB in Children. Multidrug-resistant TB is also very tough to diagnose. Apart from this the latent TB does not have any symptoms but may become active anytime. According to Golub et al., (2015), recent surveillance studies also show that there is a close relation between HIV infection and TB disease. Active TB infection is very common among HIV patients and mortality rate due to tuberculosis is very high in those cases. It has also been reported that TB disease is more prone to smokers.

Prevention of TB disease:

• According to Marais, Schaaf & Menzies (2013), the Tb infected person need to avoid going to workplace or school or any public place. The people need to use a mask which will cover the mouth and live in an airy room. These general things will help to restrict the spread of TB pathogen to a non-infected person.
• The TB patient should complete his entire medicine course properly. On the contrary, there is a huge chance to be affected by multidrug-resistant TB, which is not curable by general TB treatment and also cause high mortality rate. The treatment of multidrug-resistant TB is very complicated one (Tessema et al., 2017). Though in some countries BCG injection is used as a vaccine to prevent TB disease in the United States this vaccine is not used generally as it is not useful for adults and also hampers the result of skin testing diagnosing system of TB.

Example to control the outbreak:

There is a lack of awareness about TB in many persons. For this, a door-to-door campaign is very helpful to aware people. Make them understand the importance of TB screening and proper medication, identification of symptoms and collect all the data and analyses it and give emphasis where required will be a steady step to prevent TB disease (Scott et al., 2014). If the symptoms of TB persist for more than two weeks in a person, the person needs to consist for the screening of tuberculosis. Only proper awareness of people can prevent multidrug-resistant TB disease which is a new threat globally.

Conclusion: 

As discussed above, it is clear that TB disease is now a severe threat to the world. The mortality rate due to this disease is also very high. Proper campaigning, screening, medication, treatment and also the awareness are the weapons to fight against tuberculosis. It can also be said that special emphasis should also be given to resisting multidrug-resistant TB. An example has also been discussed which will also be very helpful to prevent TB disease. Surveillance of TB should be continued not only in the United States but also in all over the world.

References

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Schepisi, M. S., Contini, S., Gualano, G., Bellucci, A., Gnolfo, F., Rocca, G., ... & Girardi, E. (2014). Tuberculosis active case finding based on symptom screening among irregular immigrants, refugees and asylum seekers in Rome and Milan, Italy. European Respiratory Journal, 44(Suppl 58), 1698.

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Zuñiga, J. A., Muñoz, S. E., Johnson, M. Z., & Garcia, A. (2014). Tuberculosis Treatment for Mexican Americans Living on the US–Mexico Border. Journal of Nursing Scholarship, 46(4), 253-262.