12/12/06 — Tuberculosis is a concern for health officials

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Tuberculosis is a concern for health officials

By Andrew Bell
Published in News on December 12, 2006 1:45 PM

The number of cases of tuberculosis treated by the Wayne County Health Department more than doubled last year and Director Jim Roosen said that although reported cases have decreased in recent months, he is still concerned about the potential for the disease to spread.

The department treated 18 cases of tuberculosis from July 1, 2005, through June 30 of this year.

The bacteria that carries the disease can be transferred between people who are in close proximity, Roosen said.

"Eighteen cases may not seem like a lot when we have more than 100,000 people here, but those 18 people came into contact with hundreds of people," he said.

Last year's statistics show that the health department saw 4,415 patients who had been exposed to tuberculosis.

"That's a lot of work and a hell of a lot of cases to investigate," Roosen said.

People affected by tuberculosis have a slow-growing bacteria in their bodies that usually resides in the lungs. It is transmitted from one person to another by coughing, talking or sneezing. The airborne particles transmitted by someone with the tubercular bacteria in his or her lungs after coughing can be inhaled by another person, said Josa Vaughn, the health department's communicable disease manager.

But tuberculosis can only be spread by someone who has the disease. That person, in turn, could spread a tuberculosis infection to another, Mrs. Vaughn added.

The difference between the infection and disease is that a person with the tuberculosis infection has the tubercular bacteria in the body, but it is dormant and cannot be passed on to another person during that stage, Mrs. Vaughn said.

But if the infection goes untreated, the infection could "wake up" and that person could develop the tuberculosis disease, Mrs. Vaughn said. The disease manifests usually in the lungs and begins to affect its host soon thereafter.

The disease bacteria begins by taking over the active lung tissue, which causes the person's immune system to break down and can eventually cause death. Tuberculosis symptoms include a persistent cough for more than three weeks, chest pain, chills, fever, loss of appetite, unexplained weight loss, feeling weak or tired, coughing up blood or excessive phlegm and night sweats.

When someone is diagnosed with tuberculosis, health officials immediately try to determine who they have been in close contact with. Those people are then given a skin test to determine if they have the bacteria. If the test is positive, the person is then given a chest X-ray and a sputum culture is taken.

A sputum culture requires the person to spit into a container, which is then taken to the state laboratory in Raleigh. The bacteria that grows from that saliva is tested for the tuberculosis disease. If that test proves positive, then treatment begins, Mrs. Vaughn said.

When a person contracts the infection, he or she receives the drug isoniazid daily for nine months. The treatment is voluntary, but it is offered to anyone who has a positive skin test but a negative chest X-ray. That person will always test positive during the skin test for the tuberculosis bacteria, but Mrs. Vaughn said the drug builds a wall around the germ to prevent it from spreading to other parts of the body.

If someone contracts the disease, treatment is more specialized. Those who contract the disease undergo a four-drug treatment for six months. They are required to take their medication daily for the first 14 days and twice a week until the regimen is completed.

During the two weeks, patients are not allowed to interact with the public. If they do, they must wear a mask that covers the nose and mouth -- even around family and friends within their own home until those people have been tested, Mrs. Vaughn said. And they must take their medicine, she emphasized.

"In North Carolina, we don't have sanitariums anymore, so (tuberculosis) control is done through the local health offices and is mandated by state law," Mrs. Vaughn said. "If a person with the tuberculosis disease becomes non-compliant, we can issue an isolation order. That says that the person must take their medicine. If they don't, they can be prosecuted. We have done that before and a person can get up to two years in prison if they're found guilty."

To ensure that the law is followed, a public health nurse visits a tuberculosis disease patient every day to give them their medications. Even after the treatment is complete, symptoms can re-emerge. But it only happens in rare cases, Mrs. Vaughn said.

"We want people to know that it can be prevented, it can be treated and it can be cured," she said.

Reported tuberculosis cases have slowed down since July, Roosen said. Two people have contracted the disease and another 34 began therapy for tuberculosis infection.