There are many more infectious diseases on our planet that humanity is struggling with, but cannot yet completely defeat. The most formidable of them, annually killing 1.5 million human lives, is tuberculosis. The situation is complicated by the fact that HIV-infected people who have also become ill with this disease have difficulty recovering and spread tuberculosis.
Causative agent of infection
Tuberculosis is an infectious disease, its causative agent is the bacterium Micobacterium tuberculosis, formerly called Koch's bacillus. Now this term is almost never used, because due to mutations a lot of Koch sticks appeared with each of the features available.
Tuberculosis bacteria may exist for some time outside the human body. For example, on the sidewalk they do not die within 10 days, and in water - 5 months. In the dried state, they remain viable for a year and a half, and in the frozen state - 30 years! For them, a temperature of 80 degrees is not terrible, they can withstand it for 5 minutes. But dampness, darkness and the temperature of the human body are best suited for these bacteria, here they can already multiply.
Most often, the bronchopulmonary system of a person is affected by tuberculosis, but there is tuberculosis of the skin, bones, nervous system and even the whole body. In the place of the body of the sick person where mycobacteria settled, foci of inflammation are formed, which are small tubercles. In Latin, the word "tubercle" sounds like tuberculum, and the name of this disease came from it.
Tuberculosis infection routes
In order to understand the methods of prevention of this serious disease, it is necessary to consider all the possibilities of infection. There are several ways to get infected:
- Infection by airborne droplets from a patient with an active form of tuberculosis during coughing, laughing, sneezing. This is the most possible way of infection from all existing.
- Infection through all kinds of contacts with the patient’s things or with himself (kisses and sexual contacts). The possibility of obtaining a virus from an animal cannot be ruled out.
- Infection through food is possible if tuberculosis prevention measures are not followed. This can happen when buying products that have not passed sanitary control in the market.
- Perhaps intrauterine infection of the fetus in case of illness of a pregnant woman, especially with a combination of tuberculosis and HIV infection.
Signs of the disease
At the beginning, the disease is similar to an acute respiratory infection: the patient feels fatigue, weakness, general malaise, the temperature in this case is usually low-grade (37.1 - 38 degrees). These signs are joined by a cough if there is a pulmonary form of tuberculosis, or other numerous signs with extrapulmonary form.
In the future, others are added to these signs: a person is losing weight and constantly sweating, his face is sharpened, and an unhealthy glow appears on his cheeks. A dangerous symptom of the disease is hemoptysis.
What is the likelihood of contracting tuberculosis?
This probability is very high. According to available statistics, one tuberculosis patient infects about 15 people during the year.
According to WHO, 2.5 billion people on the planet are infected with tuberculosis, but not every one of them is sick. Human immunity is a barrier that can prevent the development of the disease. Therefore, it is very important to prevent this barrier from weakening and to observe tuberculosis prevention measures. Immune weakening factors: malnutrition, vitamin deficiency and stress.
The importance of prevention
In 2017, the World Health Organization presented a report with plans for its activities to combat tuberculosis for the period from 2016 to 2035. This report outlines health goals that include a 90% reduction in mortality from this disease by 2030 and an 80% reduction in incidence compared to 2015 levels. To achieve these goals, it is necessary to strengthen tuberculosis prevention, which includes the following measures:
- Prevention of the disease by social methods.
- Prevention of the disease by sanitary methods.
- Prevention of the disease by specific methods.
- Chemoprophylaxis.
Social methods of prevention
Prevention of the disease by social methods includes a set of measures provided by the state that contribute to improving people's lives. These measures should contribute to improving the living standards of the population and the eradication of diseases of society. All these goals should be included in the economic development plan of the state. These goals include the following activities:
- A patient with an open form of this disease needs to have isolated housing, as his family’s health is at risk. For families with children living in dormitories, in order to prevent tuberculosis in children, the legislation provides for the provision of a separate residential building.
- Improving working conditions, as well as reducing working hours and limiting working hours for minors.
- Improving the living conditions of the population, which includes water supply for dwellings, supply of sewage and their gasification.
- Improving the environmental situation in the state: landscaping of settlements, combating environmental pollution.
Sanitary Prevention Methods
Prevention of the disease with sanitary methods is a whole range of measures that can protect healthy people from patients and prevent the possibility of infection. A potential danger is the focus of tuberculosis. All foci are divided into 3 groups. There are rules that must be followed by representatives of medical institutions in relation to the source of infection, as well as sanitary rules of conduct for patients with tuberculosis and their families.
Group 1 has the highest degree of danger and includes the following situations:
- The patient’s place of residence is a dormitory, and the patient himself releases a large number of mycobacteria.
- There are children or pregnant women in the patient's family.
- The family does not comply with the sanitary rules for the prevention of tuberculosis.
Group 2 has a lesser degree of danger than the first, and includes such situations:
- The number of mycobacteria allocated to the patient is insignificant, and he has no children.
- The patient does not secrete mycobacteria, but he has children.
Group 3 has an even lower degree of danger and includes such situations:
- The patient does not secrete mycobacteria, he has no children, and he and his entourage observe all hygiene rules.
The work of medical personnel in the focus of infection
Prevention of tuberculosis in adults includes the following actions. After the diagnosis of the disease is established, the focus of infection is visited by a TB doctor, an epidemiologist and a nurse, after which they draw up a sanitary work plan for the rehabilitation of this facility.
The plan includes the following sections:
- Prescribing medications to a patient.
- Disinfection of the room.
- The patient is protected from the rest of the family.
- Training the patient and his surroundings with all the rules of conduct.
Rules of conduct for the patient and his environment
Here are some guidelines to follow:
- The patient should be provided with separate dishes, a towel and soap and a soap dish, and all his belongings should lie separately from the rest of the belongings of the family members.
- The patient’s dishes should be boiled for 20 minutes.
- The patient's underwear also requires a 20-minute boil.
- A necessary condition for the care of the patient's room is daily cleaning with the use of disinfectants.
- The recommendation for the prevention of tuberculosis contains a clause on the need for patients to use spittoon in the amount of two pieces. When using one of them, the second patient at this time should be disinfected with a 5% solution of chloramine. Then the spittoon needs to be rinsed with water.
Specific tuberculosis prevention
This is the use of vaccines for the population. The vaccine against tuberculosis infection was first applied in 1921 by French scientists Calmette and Guerin. In the Latin spelling of the bacillus Calmette-Guerin it is written like this: bacillus Calmette-Guerin (BCG), and in Russian letters BCG.
Now in the Russian Federation this specific tuberculosis prophylaxis is given to all children on their 3-7th birthday. BCG protects a small person from tuberculous meningitis and miliary tuberculosis, which, if they become ill without vaccination, can lead to death. The vaccination lasts 15-20 years. BCG does not reduce the spread of tuberculosis among the population, but protects children from the occurrence of severe forms of the disease in them.
This vaccine is well tolerated by newborns, in addition, for weakened children, there is a BCG vaccine, including 50% of the mycobacteria contained in the main BCG vaccine. Therefore, young parents should not risk the life of the child and avoid this type of tuberculosis prevention.
Methods for identifying tuberculosis patients
There are the following methods for timely detection of cases of this disease in the population:
- Mantoux test.
- Chest x-ray.
If necessary, other studies are added to these analyzes: enzyme immunoassay and bacteriological.
Mantoux test
This is a special test that allows you to determine the status of the subject in relation to the mycobacterium tuberculosis. This test is done to all children every year to prevent tuberculosis in children.
For this, 0.1 ml of a test solution consisting of tuberculin is injected subcutaneously into the child's hand. By the appearance of a skin reaction at this place, one can judge the body's ability to cope with the infection.
Sample results and what they mean:
- 5-15 mm is a normal reaction, which means that the child has immunity to this disease, which he acquired after vaccination, or was infected with tuberculosis and defeated the infection.
- 16 mm or more is an abnormal reaction that indicates a reduced immunity of the child. Perhaps the infection occurred recently, so the body has not yet managed to defeat the infection, but another thing is also possible - the disease is in the phase of transition to the acute form. Such a child needs a TB consultation.
- 0-2 mm - no response. This means that the effect of the vaccine has already died out. Such children need revaccination.
Booster vaccination
Tuberculosis prevention at school is a mandatory Mantoux test and subsequent revaccination, which is carried out for all 6-7-year-old children who have no response to the Mantoux test, which means the termination of the previous vaccination. All of the following revaccinations are carried out every 7 years until a person reaches the age of 30.
New rules SanPiN "Prevention of tuberculosis"
Sanitary Rules and Norms (SanPiN) is a resolution of the Chief State Sanitary Doctor of the Russian Federation No. 60 dated October 22, 2013, which entered into force on July 2, 2014.
These rules supersede existing ones. A new paragraph appeared in them, which makes it possible to identify regions requiring increased attention, and which determines the frequency of fluorographic examinations in them. If in a certain region of the Russian Federation the incidence of tuberculosis is 60 people or more for every 100 thousand of the population, then the population of this region aged 15 years and older is subject to an annual examination, including fluorography.
The new rules of SanPiN "Prevention of tuberculosis" (paragraphs 5.2 and 5.3) have introduced some legal confusion. According to these rules, children vaccinated against tuberculosis are admitted to children's and school institutions. If the child is not vaccinated, then he must have a certificate from the TB doctor that he is healthy. And this is true, since it involves the prevention of tuberculosis. BCG vaccine and Mantoux reaction are considered unnecessary by some parents, and they do not vaccinate their children, but at the same time do not want to bring a document from a TB specialist. This conflict is often resolved in court, which obliges parents to bring the necessary information.
Chemoprophylaxis
There are groups of people with a high degree of possibility of contracting tuberculosis. To prevent morbidity, they are prescribed anti-TB drugs. This is called chemoprophylaxis. It is carried out to the following persons:
- People who are in direct contact with a patient with tuberculosis and who have a negative Mantoux test (0-2 mm).
- People with a positive Mantoux test and not having any manifestations of tuberculosis, as evidenced by X-ray examination, but in contact with a patient with tuberculosis.
Tuberculosis is a formidable disease. According to the World Health Organization, it claims 1.5 million human lives on our planet annually. The fight against this disease is conducted by all countries at the state level, but each person can also independently take part in it. To do this, it is enough to study the instruction leaflet on tuberculosis prevention and carry it out. The main provisions of this memo are set forth in this article.