By Lt. j.g. Richelle Magalhaes, U.S. Naval Hospital Guam, Preventive Medicine Dept.
March 24th is World TB (tuberculosis) Day.
TB is a bacterial infection that can spread through the lymph nodes and bloodstream to any organ in your body. It is most often found in the lungs, according to WebMD. It is spread through the air when someone with an active case aerosolizes the bacteria through actions such as: coughing, sneezing, speaking, and even singing.
TB is a major cause of illness and death worldwide, especially in Africa and Asia. In 2012, an estimated 8.6 million people developed TB and 1.3 million died from the disease. The number of TB deaths is unacceptably large given that most are preventable. According to the World Health Organization (WHO), TB is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent.
Guam has high rates of TB per Guam Department of Public Health Services (DPHSS), roughly 15 times more than that of the United States and six times more than that of Hawaii. The WHO estimates that out of 100,000 people in the U.S., three will have an active case of TB per year, as opposed to Guam which will have 42 cases (2012, DPHSS Guam). In the Federated States of Micronesia, our close neighbors, there will be 212 cases of TB per 100,000 people per year.
TB is generally classified as being either latent or active. Latent TB is when the bacteria are inactive but present in the body. The patient has no symptoms and is not contagious. Active TB is when the bacteria are active and make the patient ill. Active TB is contagious. Most active cases come from nearby islands and countries that do not have the access to medical care that more developed countries do. Unfortunately, there is no vaccine for TB, but eating a healthful diet that boosts the immune system, having regular TB tests if you work or live in a high risk environment, and completing a TB medication regimen are good methods to help prevent contracting it or prevent relapses for those who have had it before. Additionally, to prevent transmitting the disease to others: stay home, cover your mouth, and ensure proper ventilation.
The Guam DPHSS has robust programs in place to try to combat the high TB rates on the island. One of their approaches is to educate the community so that they can spot cases and try to prevent the spread from person to person. Additionally, there are Guam Public Laws (GPL) focused on case investigations, isolation, quarantine and testing. GPL 22-130 requires all students attending public/private schools, college and university on Guam provide a report of TB skin test or screening. Students who are entering from the U.S. or states or its territories are required to show proof of TB screening conducted 6 months prior to enrollment. If a student is found to have a positive PPD skin test, a certificate of TB evaluation is required. Contact Guam DPHSS for additional information.
Annual TB tests are required for students and adults that require a health certificate to work on and off base. Active duty personnel stationed on Guam must also have an annual Mantoux test. This a simple skin test in which a small amount of purified protein derivative (PPD) tuberculin is injected into the forearm. After 48 to 72 hours, a doctor or nurse looks for a reaction at the injection site. For those people who have a reaction to the PPD, they will undergo a series of tests, and maybe even chest x-rays, to decipher if they have an active or latent case of TB. The Immunizations Department at USNH can administer the PPD tests and the Preventive Medicine Department can read these tests for all who need them.
What does TB have to do with Preventive Medicine? The Preventive Medicine Department at Naval Hospital Guam conducts disease investigations for any illness seen at the hospital that is infectious or highly contagious. TB qualifies as an infectious disease. Once it is determined that a patient has active TB, we conduct an investigation to determine where they may have contracted it and to whom they may have given it. We also assist the providers in administering TB medications and assuring that the patients adhere to the treatment program.
Many exceptional situations can arise when people travel all over the world. Diseases that are somewhat rare in some parts of the planet are still rampant in other parts. TB is not something that is emphasized in U.S. education due to the scarce occurrence and unlikelihood that it would be seen in the States; however, it is very real here in the Pacific. Normally, March 24th would go by unnoticed, but since we live in a part of the world where TB is still a disease threat, World TB Day is a day to understand what unique diseases are still plaguing humanity right in our backyard.