Communicable Diseases: Tuberculosis

Running head: COMMUNICABLE DISEASES: TUBERCULOSIS

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Communicable Diseases: Tuberculosis Introduction Communicable diseases refer to infectious diseases that can be easily transmitted from one person to another. The causative agents are often bacteria, viruses, parasites and fungus that infect body tissues resulting in an infection. These pathogens can either be transmitted directly through body contact or indirectly through disease vectors. These infections create a public health concern due to their transmissible nature; hence, the need to study their distribution, incidence and patterns of transmission. Through this, effective prevention and control measures will be achieved. In this paper, the concepts of epidemiology and nursing research will be applied to tuberculosis as a common communicable infection.

Description of the Disease Tuberculosis (TB) is a communicable infection that mainly affects the respiratory system.

However, in advanced cases, it can affect other body organs including the brain and spine. A bacteria known as Mycobacterium tuberculosis causes it. The bacteria are easily spread from one person to another through the air. An infected individual releases air droplets containing the bacteria that can be inhaled and infect a healthy individual (Chaisson & Bishai, 2017).

The bacteria infects the lungs of a person causing respiratory symptoms such as coughing, sneezing and chest pains. There are two kinds of TB infections, latent TB and active TB. In Latent TB, the bacteria remain inactive in the body and does not cause any symptoms or cause transmission. Active TB causes symptoms and is transmissible (Chaisson & Bishai, 2017).

It is mainly characterized by persistent productive coughs that last for several weeks, which is often accompanied by blood and sputum. Other symptoms include body weakness, fatigue, loss of appetite, fever, weight loss and night sweats.

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Tuberculosis is one of the top ten causes of death in the world. According to the World Health Organization (2018) fact sheet, over 10.4 million people were infected with TB in 2016 of which 1.7 million died of the illness. Tuberculosis is common in developing countries and among the low and middle-income individuals. It is also the major cause of death among HIV infected individuals and those with compromised immune systems. With early diagnosis and treatment, TB is curable. The antimicrobial agent is used over a period of 6-9 months. However, drug resistance is one of the major drawbacks in treatment. Drug adherence is also an issue owing to the period of treatment (Raviglione & Sulis, 2016).

Since TB is highly communicable and fatal, new cases need to be reported to public health officials. Reporting is often done for individuals diagnosed with active TB infections, latent TB and those suspected to be infected. Through this, public health measures to prevent the spread of the disease can be put in place. Also, reporting aids in disease surveillance and epidemiologic studies (Abubakar, Rangaka, & Lipman, 2016).

Determinants of Health Determinants of health refer to the factors that influence the health status of an individual. These factors can be categorized into biological, socioeconomic, behavioral, health services and environmental. They mainly contribute to the spread of communicable diseases as well as their mortality and morbidity rates. Each of these factors plays a role in the transmission and treatment of TB. Biological factors include sex, age and genetics. Tuberculosis affects all individuals irrespective of their sex. It commonly affects young children and older adults causing active TB infections, leading to high mortality rates in the age groups. Tuberculosis infections are however not influenced by an individual’s genetics. Therefore cannot be inherited. However, the health

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status of a person can determine their risk. Individuals with a compromised immune system such as HIV positive persons are at an increased risk (Huddart, Nafade, & Pai, 2018). In addition, individuals with conditions that weaken the immunity such as diabetes and cancer can easily be infected.

Socioeconomic factors influence both the transmission and treatment of the condition.

Populations in low and middle-income areas are more prone to TB infections. This is largely attributed to their living conditions, which is characterized by dense populations in the poorly ventilated housing (Raviglione & Sulis, 2016). Such populations are more likely to be undernourished, thereby increasing the risk of infection and its progression to active TB. Also, poor socioeconomic conditions influence the behavior of an individual by increasing habits such as smoking, alcohol use, and drug abuse, which increases their risk of exposure. Lastly, the poor economic background is associated with poorly managed chronic conditions, poor lifestyles and HIV infections, which increases an individual’s risk.

The availability of health services also determines the health of a population. Areas with good access to care have less and more controlled infections. Lack of access to health services leads to late diagnosis and treatment that lengthens exposure time in TB. Also, preventive measures and public education is compromised, thereby increasing the risk of infections. The health-seeking behaviors of the population are also affected increasing cases whereby individuals seek treatment only when their health status worsens (Huddart et al., 2018). This affects the response to treatment, increases mortality and increases the risk of transmission to healthy individuals.

The Epidemiologic Triangle as it Relates to TB

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The epidemiological triangle is a model used in infectious diseases to determine their causative agents and how they are spread (Abubakar, Rangaka & Lipman, 2016). The model is in the form of a triangle with the three vertices representing three factors related to the transmission of infectious agents. These factors include agent, host and the environment, placed on the respective vertices of the triangle forming a triad. Through the interrelation of these factors, the epidemiology of infectious diseases can be studied and understood.

The agent represents the pathogen responsible for the infection. This can either be a virus, bacteria, fungus or a parasite. In TB infections, the causative agent is a bacterium. The agent denotes what causes the infection. Identifying the agent in epidemiological studies helps in coming up with measures to eliminate it. It also makes it easier to understand the disease and its transmission.

The host refers to the individual or a person harboring the causative agent and is being affected by the pathogen. Hence, the individual has to be susceptible to the pathogen. In this case, the host is a human being or a person that is infected with the Mycobacterium tuberculosis.

Since the condition affects the host, the presenting signs and symptoms can be used in identifying and diagnosing the causative agent. In the same way, treatment and management of the condition is influenced by host factors.

The last of the vertices represents the environment. This refers to the external factors that cause or promotes the spread or transmission of the disease. These factors can be further classified as physical, biological or socioeconomic. They all-important role in the transmission of Mycobacterium tuberculosis. Particularly, they facilitate the exposure to the pathogen, the risk of contracting the pathogen as well as the progression of the infection.

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In summary, the epidemiological triangle represents the cause, facilitator and effect of an infectious disease. By studying the triad, a better understanding of the causative organism and its transmission is achieved. The information obtained is useful in coming up with interventions or measures to control and even eliminate infectious diseases in a population. Each of the triad factors plays a role in control and elimination. For example, the causative agent is eradicated, host infections are reduced and prevented, and the environmental factors that promote the interaction of the host and the agent are reduced (Abubakar et al., 2016).

In TB infections, the bacteria is eliminated through treatment with antibiotics. Treatment also eradicates the bacteria since it does not survive outside the body of a host. This measure also reduces new infections and promotes recovery. Also, measures to minimize new host infections by controlling the environmental factors is achieved through measures such as public education, proper ventilation, improving the socio-economic condition of populations and improving healthcare delivery among others.

The Roles of a Community Health Nurse Community health nurses play an important role in the recognition, reporting, management and control of infectious diseases. Since they work in the community, they recognize symptoms that are similar among patients and identify their causes or link them to certain conditions. Through this, they are in a position to confirm the presence of an infectious disease in a population. They must report new cases of infections to the relevant public health bodies. In addition, they take part in placing and effecting preventive and control measures in the community (Edmonson et al., 2017) Community health nurses are in a position to recognize and establish the presence of a communicable infection. They achieve this through collecting data regarding diagnosis and

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identifying patterns of common symptoms. They also record and monitor the numbers of new infections and inform other healthcare providers of the infection. Furthermore, they aid in epidemiological studies to ascertain the causative agents and take part in eradicating it.

Regarding control and eradication, nurses are the major effectors as they carry out public education as well as monitor trends through follow up. They set up and implement both short term and long-term interventions. In long-term strategies, nurses help in creating lasting strategies to control infections and reduce new infections (Edmonson et al., 2017).

National Agency or Organization National agencies and organizations are formed to address issues related to infectious diseases. These organizations or agencies have varied objectives depending on their specific goals and visions. They are also formed for specific types of infection. One of such agencies is the National Tuberculosis Controllers Association. Formed in 1995, the association has a vision of achieving a world free of tuberculosis.

The mission of the organization is to eliminate tuberculosis in the United States thereby protecting the public’s health. The association is working towards achieving its goals through rigorous and collaborative action with the state, local and territorial programs. It voices for TB controllers to advance TB elimination activities in the US. Alongside working with other organization and agencies, the association also advocates for positions, laws, policies and means to advance the elimination and control of TB. Global Implication of the Disease Tuberculosis has a worldwide distribution. However, as mention earlier, it is more common in developing countries. According to World Health Organization (2018), high burden countries include India, Indonesia, China, Philippines, Pakistan, Nigeria and South Africa. Each

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country addresses its health issues in different ways. However, the global impact of the infection is dependent on the advances of preventive measures, diagnosis and treatment in high endemic areas (Raviglione & Sulis, 2016).

Measures employed to curb infections are relatively similar in most countries. These include placing environmental measures to prevent transmission, putting in place air-borne measures, public education, early diagnosis and treatment and isolation of infected individuals (Huddart et al., 2018). In some countries, vaccines are being used to prevent TB. Conclusion Tuberculosis is a communicable infection caused by Mycobacterium tuberculosis. Just like other infectious illnesses, it is of public health concern as it can be easily transmitted from one person to another. TB is particularly transmitted directly through inhaling infected air droplets. It affects the upper respiratory tract in active infections. Tuberculosis is common in developing countries due to their socioeconomic status. Apart from the socioeconomic factor, other determinants of health related to TB include biological, behavioral, health services and related environmental factors.

The epidemiological triangle, consisting of the agent, host and environmental factors is used in studying the cause and transmission of infectious agents. Its concept is also applicable to tuberculosis that can be utilized in coming up with preventive measures. Community health nurses also contribute a lot in infectious diseases. They recognize the presence of an infection in a population, report it, places measures to curb it and carry out follow up procedures. Agencies and organizations also take part in disease control and eradication.

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References Abubakar, I., Rangaka, M. X., & Lipman, M. (2016). Investigating emerging infectious diseases. In Infectious Disease Epidemiology, pp. (87). Oxford: Oxford University Press.

Chaisson, R. E., & Bishai, W. R. (Eds.) (2017). Handbook of tuberculosis. Cham (ZG) Switzerland: ADIS Edmonson, C., McCarthy, C., Trent-Adams, S., McCain, C., & Marshall, J. (2017). Emerging global health issues: A nurse's role. Online Journal of Issues in Nursing, 22(1). doi: 10.3912/OJIN.Vol22No01Man02 Huddart, S., Nafade, V., & Pai, M. (2018). Tuberculosis: a Persistent health challenge for India. Current Epidemiology Reports, 1-6. doi. https://doi.org/10.1007/s40471-018-01343 Raviglione, M., & Sulis, G. (2016). Tuberculosis 2015: Burden, challenges and strategy for control and elimination. Infectious disease reports, 8(2), 6570. doi: 10.4081/idr.2016.6570 World Health Organization. (2018). Tuberculosis (TB). Retrieved from http://www.who.int/mediacentre/factsheets/fs104/en/