Tuberculosis - Old Disease - New Queensland Web Site !

 Whilst we work in the Health Care Industry, there is the potential for complacency when it comes to communicable diseases  that many of us  don't see or treat regularly.When we  consider Tuberculosis (TB) Australia has one of the lowest rates of TB in the world, due to strict controls for the diagnosis and treatment of TB  within our country. Over the last 10 years there has been between 5 - 6 cases of TB per 100,000 people. In QLD the risk to the general public is very low with only 3 cases diagnosed per 100,000 people each year. To assist in ensuring ongoing containment and appropriate management Queensland  Health has a specific Queensland Tuberculosis Control Program. Check the  new web site out - it has great resources  and easy to understand information for consumers and health care workers!

                  Mycobacterium tuberculosis bacteria using acid-fast Ziehl-Neelsen stain ( CDC Public Health Library)

Reminders:

Tuberculosis (TB) is a bacterial infection that can affect almost any part of the body but most commonly affects the lungs. TB found in the lungs is called pulmonary tuberculosis. TB found in other parts of the body is called extrapulmonary tuberculosis. Examples of extrapulmonary TB are lymph node TB, abdominal TB, tuberculous meningitis, TB of bones and joints and genitourinary TB. These forms of tuberculosis can cause many different symptoms and mimic various other diseases.

Symptoms:Tuberculosis seldom begins with striking signs or symptoms, and may progress for weeks or even months before suspicion is aroused.

Symptoms can include:

       a persistent cough that lasts for more than two to three weeks

       an irritating hoarseness in the throat

       coughing up blood from the lungs

       persistent or recurring chest pains

       fevers

       night sweats

       a steady loss of weight

       poor appetite

       indigestion

       fatigue

Transmission:Pulmonary TB is transmitted from person to person via droplets from the throat and lungs of an infected person. An infected person expels droplets of moisture containing TB germs from their lungs when they cough, sneeze, laugh or speak. You can become exposed to TB by inhaling these droplets. Occasionally, cattle can transmit TB to humans through the milk of infected animals however this is extremely rare due to milk pasteurisation and extensive testing for bovine TB in cattle. Extrapulmonary TB results from dissemination of TB  from the lungs through the blood stream or via lymphatic channels.

X-ray of a patient diagnosed with advanced bilateral pulmonary tuberculosis.( CDC Public Health Library )

Treatment:In many cases, TB can be treated with a six-month course of anti-tuberculosis medications including Isoniazid (INAH), Rifampicin, Ethambutol and Pyrazinamide. Uncomplicated tuberculosis responds readily to treatment in the early stages, but response may be slower if the disease is advanced.  Treatment is longer and more complicated if there is drug resistance or reactions to the major drugs.  Alternative treatment with second-line drugs requires a longer course of treatment (which can be up to two years or more in complicated drug-resistant cases).

If left undiagnosed and untreated, TB can be a very serious disease. However, provided anti- tuberculosis medications are taken exactly as prescribed, patients with active TB disease can be cured. Once treatment is completed, it is unusual for the disease to reactivate with most patients remaining free of TB disease for the rest of their life.
The majority of the population who are infected by inhaling the TB germ (around 80 to 90%) are able to fight the TB infection through their immune system and do not become sick with the disease. Instead, the TB bacteria lays dormant within their body for years, and their body develops immunity to fight off further infection. However, if an infected person’s immune system is weakened (such as during a HIV infection), the chances of becoming sick with TB disease are greater. Only five to ten per cent of people who are infected with TB bacteria become sick with active TB disease with potential for infectiousness to others at some time during their life. Therefore, only a small percentage of the population infected with the TB germ (less than 20%) goes on to develop active TB disease. Left untreated, each person with active infectious TB disease will infect between 10 and 15 people every year (on average).  This is why early diagnosis and effective treatment of TB remain the best preventive measures for controlling TB.

Reference: Queensland Health Web Site

Measles: Reliance on Herd Immunity is not Enough!

In Australia  and generally within our health care system  there is a sense of confidence   that all is under control  in  regard to  most communicable diseases as there is  reliance on Herd immunity. Herd immunity (or community immunity) is  a type of immunity that occurs when the vaccination of a portion of the population (or herd) provides protection to unprotected individuals. Herd immunity theory proposes that, in diseases passed from individual to individual, it is more difficult to maintain a chain of infection when large numbers of a population are immune. The higher the proportion of individuals who are immune, the lower the likelihood that a susceptible person will come into contact with an infectious individual.

On 25 August 2010  Queensland Health put out a media release titled Have you been vaccinated for measles?
The media release and related advice re confirms that we must remain vigilant in our infection control practices and the commitment to eradicating communicable diseases.

Queensland Health is urging all Queensland residents to ensure they have been vaccinated for measles, after cases were confirmed in Tweed Heads, Gympie and Moranbah. The current cases  were identified as  all being highly infectious while out and about in various communities.

Measles is one of the most infectious of all communicable diseases, and can be acquired in public places such as shopping centres or on public transport if infectious people are present.
 Queensland Health Communicable Diseases Branch Senior Director Dr Christine  Selvey recommends anyone born during or since 1966, who has not had two documented doses of Measles, Mumps, Rubella (MMR) vaccine or had proven measles, to visit their local GP for a free extra vaccination.

 Dr Selvey has identified  that  all Queenslanders  should  check if they need to be vaccinated against measles.

 

Basic Facts re  Measles ( Rubeola )

• Measles is extremely infectious and is spread by tiny droplets through coughing and sneezing or through direct contact with secretions from the nose or mouth.. The virus can last for several hours in the environment.
•  Measles can cause serious complications such as pneumonia (lung infection), encephalitis (inflammation of the brain) or otitis media (middle ear infection). Complications are more common and more severe in people with a chronic illness and very young children. Deaths occur mainly in children under five years of age, primarily from pneumonia, and occasionally from encephalitis. Measles should not be regarded as a simple childhood disease.

Symptoms:

 Measles begins with symptoms such as fever, tiredness, cough, runny nose and/or red inflamed eyes. These symptoms usually become more severe over three days. The cough is often worse at night and the affected person may wish to avoid light because of sore eyes. At this stage there may be small white spots on a red base in the mouth on the inside of the cheek (Koplik’s spots).

This is then followed by a blotchy, dark red rash usually beginning at the hairline. Over the next 24 to 48 hours the rash spreads over the entire body, during which time the person generally feels very unwell. Typically with measles, the fever is present and the person feels most unwell during the first couple of days after the rash appears. The rash usually disappears after six days.

 The time from contact with the virus until onset of symptoms is about 10 days but may be from 7 to 18 days.

 A person may be infectious from about five days before the onset of the rash until about four days after the rash appears.

Treatment
There is no specific treatment for measles. The symptoms of measles are usually treated with rest, plenty of fluids, and paracetamol to lessen pain or fever. Do not use aspirin for treating fever in children.
Control
People with measles should be excluded from work, school or childcare centres for at least four days after the appearance of the rash.
People who have not been vaccinated against measles and those who have any condition that compromises their immune system and have been in contact with a person with measles, should be excluded from school and childcare for 14 days from the day the rash appeared in the person diagnosed with measles.

 If unvaccinated contacts are vaccinated with the measles mumps rubella (MMR) vaccine within 72 hours of their first contact with the original person with measles, they may return to childcare, school or work.

Prevention

Vaccination with the MMR vaccine is the most effective way to prevent measles. Two doses are necessary to provide high levels of protection.
The MMR vaccine is recommended for:

•  all children at 12 months of age; and at 4 years of age.
• Vaccination is also recommended for:all children who have not previously received MMR vaccine
• children over 4 years of age who have only received one dose of MMR vaccine
• adults born during or since 1966 who have not received 2 doses of MMR vaccine
• susceptible women should be identified during antenatal counselling and vaccinated with MMR vaccine at least 28 days before pregnancy or immediately after delivery.

For further information contact your local doctor, community health centre, nearest population health unit or the13HEALTH information line (13 432584). Check out Queensland Health  and Government Immunise Australia

 References

  Heymann, D., ed. 2004. Control of Communicable Diseases Manual, 18th edition. Washington, DC: American Public Health Association.

 National Health and Medical Research Council, 2003. The Australian Immunisation Handbook (9th Ed.) Canberra: National Capital Printing.