Tuberculosis and Immunization and the Role of Community in Treatment

Immunization not only safeguards a person, but also safeguards those in the general public by expanding the general proportion of protection in the community and therefore reducing the expansion of infection (Ministry of Health, 2015). For this reason, Fiji introduced the Expanded Program on Immunization, 2013 - 2016 (EPI), which targets the twelve main infectious diseases in Fiji. This written assignment will only be focusing on one of these diseases, which is Tuberculosis.

Tuberculosis is caused by the bacteria known as Mycobacterium Tuberculosis which prevailed 15,000 to 20,000 years ago and was discovered in remains from age-old Egypt, India and China (Mandal, 2017). Tuberculosis commonly causes disease in the lungs, but also can affect any other part of the body.

This disease often involves reproductive age group at intervals of 15 to 55 years of age who expose themselves to numerous communal and coincidental determinants (Ministry of Health and Medical Services, 2016). According to an article from the Fiji Journal of Public Health, Fiji had an occurrence rate of 27/100,000 and an incidence rate 40/100,000 population. In the year 2010, there were about 191 active tuberculosis reported cases and 213 cases in 2013 which was documented by the national program. From these 213 cases, 42% were from the Central/Eastern division, 41% from the Western Division and 17% from the northern division. An approximated 7 to 11% of the accumulated tuberculosis cases were characterized over children below the age of 15 years of age. Tuberculosis is an air-borne disease, which passes from one person to another through direct contact, either through singing, coughing or speaking, so, individuals close to an infected person may inhale these organisms and develop this disease (How TB Spreads, 2016). Some of the common risk factors associated with tuberculosis are presented in the table below.

Risk Factors and Rationale

People who are diagnosed with HIV

Individuals that live with HIV are 16-27 times more likely to be infected with TB then those who are not (TB and HIV, 2012). These group of people, as HIV progresses, this results in the decrease of the immune system. So they are susceptible to getting infected with the Mycobacterium Tuberculosis.

Diabetes

Diabetes triplicates the risk of TB, because diabetes also causes the weakening of the immune system Therefore, the percentage of TB are greater in those with diabetes than the rest of the population. Diabetes causes defective glucose resistance which is a danger for developing diabetes. If a person already has diabetes, the recurrence is incomparably great and the likelihood of death is inevitable.

Malnutrition

Malnourishment increases the risk of TB and TB can lead to malnourishment. Malnutrition can result in secondary immunodeficiency that will increase the host's susceptibility to infection (Gupta, Gupta, Atreja & Vishvkarma, 2009). Once a person who is malnourished becomes infected with TB, the individuals condition which is malnutrition will worsen leading to fatal death.

Tobacco Smoking

Tobacco smoking escalates the risk of TB 2-3 times and is correlated with low TB treatment results. Chemicals present in the cigarette causes the lungs to degenerate and the ability for the lungs to efficiently exchange gases decreases. Also, smoking decreases immune response for the body. So, if the lung is infected and the immune system is weak, there is no doubt, that TB can enter the body without any resistance to fight against it, and the lung will not be able to filter the bacteria out of the body, allowing it to circulate and affect the rest of the body.

Harmful use of alcohol

Unending overwhelming liquor utilization can cause anomalies in the blood, prompting iron deficiency (low hemoglobin, the segment of blood that bears oxygen to the body) and low platelets (help counteract bleeding). Chronic substantial liquor utilization likewise smothers the immune framework (for e.g. negatively influencing the white platelets that battle diseases), making it more troublesome for the body to ward off both viral and bacterial diseases. Individuals who drink intensely are more likely to experience or be exposed to illnesses such as hepatitis C infection and most deadly of all, tuberculosis.

Immigration

Individuals who have moved from places that has had high rates of TB, may bring with them the bacteria, and it spreads to those that will be living with them in their new home.

Health workers

Those who have a job or dwell in facilities or institutions that are home to people who are at great risk for TB such as hospitals, homeless shelters, correctional facilities, nursing homes, and residential homes for those with HIV.

Immature Immune system

This is referring to infants or newborns. At infancy, the immune level is still low because the development of the immune system is still incomplete. Thus, babies are prone to infection.

Tuberculosis have multiple signs and symptoms that may indicate that a person may have been infected or has developed the disease because of exposure to the bacteria when associating with an infected person. Some individuals that are infected with tuberculosis do not present any signs or symptoms (asymptomatic), but a small-scale ratio evolve clinical illness, sometimes many years after the initial epidemic. The most common signs and symptoms of these disease are indicated in the table below:

1. Coughing that finishes three or more weeks.
2. Coughing with blood.
3. Chest pain or feeling of pain when breathing or coughing.
4. Unintended loss of weight.
5. Feeling lethargic.
6. Experiencing night perspiration.
7. Chilliness.

Tuberculosis also affects more parts of the body. This includes the spine, the kidneys and most devastatingly, the brain. Once TB arises out of the lungs, sign and symptoms differ given the organs that are involved. For instance, tuberculosis that occur in the spine may cause back ache, and tuberculosis that occur in the kidneys results in bloody urine.

Tuberculosis is a disease that can be managed using drug therapy to suppress the bacteria from multiplying and spread to other parts of the body, destructively. According to the Expanded Program of Immunization, tuberculosis vaccine known as BCG (bacilli Calmette-Guerine) vaccine, is given to babies less than twelve months old. This vaccine was introduced to Fiji in the early 1960’s. Commonly, it is given to the child immediately after birth in the labor room. This vaccine is given only once in an individuals’ lifetime. This vaccine is given intradermal, at an accurate dose of 0.05 ml. The site of the BCG vaccine given is at the mid upper left arm of the child.

For children who have developed TB, they must be put on the balance and weighed monthly throughout the treatment and the dosage must be suited accordingly. The procedure with ethambutol, an antibiotic drug that inhibits the growth of bacteria in the body, must be restrained from youngsters with tuberculosis meningitis, osteo-articular tuberculosis or with TB-HIV co-infection because the drug will not counteract the growth of the disease since it has spread to the vital parts of the body already. The usual dose of ethambutol is 20mg/kg. Included with this drug are other drugs that are given to children. They are isoniazid (10mg/kg), pyrazinamide (35mg/kg) and rifampicin (20mg/kg). All these drugs are administered orally.

In addition, other management of tuberculosis would be to emphasize on maintaining respiratory remoteness or isolation to avoid airborne transmitting from one person to another. As nurses, it is our responsibility to teach these TB patients about proper hand hygiene after handling sputum, because running water removes microbes from the hands. Must maintain oxygen saturation to 90% or greater because lower than that can cause tissue hypoxia, acidosis, dysrhythmias and change in level of consciousness. Tuberculosis can be prevented. This can be achieved when a person does not stay for long period of time in an unventilated, enclosed environment with an individual who has active tuberculosis until that person has been treated for at least 2 weeks. The use of preventative measures such the use of face mask which is important especially while working in a facility that takes care of people who have untreated TB. The most important preventative measure is, when you are aware of someone that has TB, it is advisable to help and encourage that individual to follow treatment instructions and the sanitary practices in order to avoid the spread of disease to another part of the body and also avoid the transmission of the bacteria from one person to another. Individuals who are not affected must take extra precautions such as barrier precautions in order to safeguard themselves from the infectious disease (Perry & Potter, 2014).

The rise in tuberculosis cases in our country calls for more awareness, and it is our responsibility to conduct client counseling, health education and health promotion programs to the local communities so they are aware of this deadly infectious disease. These health education and health promotion program can target the nutrition, dietary habits and life style to prevent tuberculosis. Nurses must have educational objectives, formulate activities that will allow the nurse to address these objectives. The nurse must have a detail plan of action before she is able to conduct these health promotions. Some activities can be discussions on balanced diet and dietary habits in mothers group with the help of the community health volunteer.

The contents would be dietary habits, backyard gardening, healthy cooking habits and the importance of a balanced diet. The target group for these topics is the mothers group, because they are in control of the family’s daily meal and once they are educated, they are able to make changes in the way they prepare food for their individual families. The most effective method and medium of discussion is simply group discussion and the use of flipcharts and diagrams. These topics avoid malnutrition or obesity, because as discussed in the risk factors, these two conditions are contributing to the vulnerability of the individual acquiring tuberculosis.

In the community, there will be individuals who are having or are presenting with the various signs and symptoms that must be addressed immediately. Most of these signs and symptoms are mistaken for other diseases. So, it is important for nurses to go into communities, with the help of charts, diagrams and informative techniques. In addition, to make sure that after the discussion, they return demonstrate all that was being presented. This is to confirm that they have understood, and took into consideration whatever that have been discussed and presented.

The role of the community health nurse in the prevention of tuberculosis is important because in this way, the members of the public are able to take ownership of their health and safeguard themselves from getting exposed to this deadly disease. The prevention message that needs to be put across is to teach the members of the community about the cough etiquette, which is to cover the mouth and the nose while coughing or sneezing and to avoid spitting carelessly which is also a very unhygienic practice. In addition, the community must ensure that their individual homes must be well-ventilated and the beddings are regularly sun out. In a home, they must avoid overcrowding and advise them to seek medical advice or TB screening when experiencing onset signs and symptoms and nurses must advocate for the BCG vaccination for pregnant mothers.