TB CONTROL PROGRAMME KZN - WTBD Media Session What is TB
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TB CONTROL PROGRAMME
KZN
WTBD Media Session
What is TB
22nd March 2011
WHAT IS TB • Tuberculosis or TB is a curable, infectious disease caused by a germ called Mycobacterium tuberculosis, that attacks any part of the body, but mostly the lungs • TB of the lungs is called Pulmonary TB (PTB) • TB outside the lungs is called Extra Pulmonary TB (EPTB) and can be in the skin, bones, lymph nodes, stomach etc.
HOW IS TB SPREAD • The TB germs are spread into the air when a person who has TB coughs, sneezes or spits • The germs float in the air, and can be breathed in by people who come into contact with the infected air • The TB germs now infect the lungs (PTB ) • The TB germs can also spread to other parts of the body ( EPTB ) • TB germs are so small they can only be seen under a microscope
Number and Size of Organisms
Liberated
Number of Organisms Liberated:
Talking 0 – 200
Coughing 0 – 3 500
Sneezing 4500 – 1 000 000 Jennison [1942]
WHO Definition of exposure:
Contact between persons in sufficient proximity to carry on a
conversation OR within confined spaces where ventilation is
poorSIGNS & SYMPTOMS OF TB • A persistent cough that lasts for 2 weeks or longer • Shortness of breath, and chest pain • Coughing up blood • Loss of appetite, and loss of weight • A general feeling of illness • Tiredness and weakness of the body, and loss of motivation • Night sweats and fever, even when it is cold
HOW IS TB DIAGNOSED • Firstly, TB is suspected by observing the clinical signs and symptoms • Secondly, by obtaining 2 sputum specimens from the patient which are tested in the laboratory under a microscope to identify the TB bacillus ( Smear Positive Case ) • Thirdly, if the patient does not prove positive on sputum examination, x-rays and cultures can be done to confirm diagnosis
PATIENT CATEGORIES • New patient – a patient who has not had TB or been treated before • Re-treatment patient – a patient who has been treated for TB before (5yrs) however, now a move to 2yrs • MDR TB patient – a patient who does not respond to the normal TB drugs
TB Drugs
First Line
• R – rifampicin - tablet
• H – isoniazid - tablet
• Z – pyrazinamade - tablet
• E – ethambutol - tablet
• S – streptomycin – injectionFirst Line Drugs Blue in use
Rifampicin New Patient
Isoniazid New Patient
Pyrazinamide New Patient
Ethambutol New Patient
Streptomycin Added to above for Re-
Treatment PatientsTB Treatment cont. • Fixed Dose Combinations – makes it easier for the patient to take the tablet • 4 in 1 = all 4 intensive phase drugs in 1 tablet • 2 in 1 = all 2 continuation phase drugs in 1 tablet
TB REGIMENS • New patient – 6 months treatment – 2 months intensive phase with 4 drugs ( RHZE ), followed by 4 months continuation phase with 2 drugs ( RH ) • Re-treatment patient – 8 months treatment – 3 months intensive phase with 5 drugs ( RHZES ) for first 2 months and 4 drugs ( RHZE ) for third month, followed by 5 months continuation phase with 3 drugs ( RHE ) • TB treatment is taken 7 days a week
MDR/XDR TB Case Definition • MDR TB is defined as TB that is resistant to both the 2 main first line drugs Rifampicin and Isoniazid (INH) with or without resistance to other drugs • XDR-TB is defined as resistance to at least rifampicin and isoniazid, (MDR-TB), in addition to any fluoroquinolone, and at least one of the three following injectable drugs capreomycin, kanamycin, and amikacin (WHO)
MDR / XDR TB Drugs Second Line Drugs
Blue in use for MDR TB / Green are new drugs for XDR TB
Category Drug(s)
Aminoglycosides Kanamycin
Amikacin
Thioamides Ethionamide
Prothionamide
Polypeptides Capreomycin
Fluoroquinolones Ofloxacin
Ciprofloxacin
Cycloserine / Terizidone Cycloserine / Terizidone
PAS PASMDR Treatment
• Intensive phase – Minimum 6 months
– 5 drugs – at least 6 x per week
• Aminoglycoside ( 5 x weekly) (Kanamycin/Amikacin)
• PZA
• Ofloxacin
• Ethionamide
• Terizidone/Cycloserine
• Ethambutol
• Pyridoxine (B6) - 150mg daily with
Terizidone/Cycloserine
• Continuation Phase – Minimum 18 months
– Drugs at least 6 x per week
• Ethionamide
• Ofloxacin
• Terizidone/Cycloserine
• Continue PZADOTS
• DOTS = Directly Observed Treatment Short Course Strategy
(6mths)
– Political Commitment / sustained TB programme activities
– Sputum smear microscopy for diagnosis of infectious cases
– Standardised short course anti-TB treatment with directly observed
treatment
– Uninterupted supply of TB drugs
– Standardised reporting and recording system that allows assessment of
treatment outcomes
• DOT = Directly Observed Treatment
• In other words all TB patients should have a treatment
supporter to help them to complete their full 6 months of
treatment, as remembering to take your treatment every day
for 6 months is not easy
• however
• Move towards focus on patient educationTB Indicators
• Bacterial coverage = % of PTB patients diagnosed by sputum –
target 90%
• Smear conversion rate = % of smear + patients converted to
negative at end of intensive phase treatment – target 85%
• Cure rate - % of patients smear negative at end of treatment,
and also on at least one other occasion during treatment –
target 85%
• Default / Interruption rate = % of patients stopped taking
treatment for longer than 4 weeks – targetTB Infection Control Remember • Number of Organisms Liberated: • Talking 0 – 200 • Coughing 0 – 3 500 • Sneezing 4500 – 1 000 000
TB Infection Control Simply put • Cough Hygiene • Open Window policy = good ventilation At facility • Both of the above • Staff baselines • N95 Respirators • Triaging of patients • Mechanical ventilation / UV lights
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