What is tuberculosis?
TB is an airborne disease caused by a bacterial infection. The most common form of TB is pulmonary TB (or lung TB). TB can also spread from the lungs to other parts of the body, and this is called disseminated TB. TB can be successfully treated if a patient gets medical treatment early and completes the course of medication.
However, there are new strains of TB which have become resistant to the standard TB drugs, and which require stronger medication over a longer period. These are referred to as multi-drug-resistant TB (MDR) and extremely drug-resistant (XDR) TB, and are difficult to treat. If TB is not treated, you can die.
TB spreads and travels through the air in droplets. If an infected person coughs, spits or sneezes, airborne germs (called bacilli or bacteria) can be breathed in by you. It is more likely to spread where there is no ventilation, as the TB germ can stay alive and air-born for up to 8 hours. The spread of TB happens mostly in communities where there are poor and cramped living conditions, poverty and high unemployment. This is usually the case in developing countries (South Africa included), where there is what we call a ‘high burden’ or ‘high exposure’ of TB.
No. When you breathe in the germ and it enters your system, it is said that you become infected with the TB germ. This does not mean you are ill with TB, because the germ is not active. TB bacteria can exist in your system for many years without being active. This is called latent TB. The World Health Organisation estimates that one third of the world’s population has latent TB. It is possible to determine whether you are infected by doing a test for TBcalled a Tuberculin (TST) skin test. People infected with TB stand a 10% chance of the TB bacteria becoming active. When the TB bacteria become active, they attack the body. This is when you are said to have TB disease.
The TB germ can become active when someone’s immune system is weakened (‘compromised’), through poor nutrition, stress and ill health. The germs will start attacking the body, and then TB disease sets in. This is mostly noticeable through the signs and symptoms experienced when becoming ill with TB. TB is also common amongst those who have HIV, a disease that attacks the immune system.
Common signs and symptoms of TB include: coughing for two weeks or more, blood in sputum (which is the phlegm you cough up from your lungs), unexplained night sweats for two weeks or more, unexplained weight loss, unexplained fever for more than two weeks; unexplained loss of appetite and unexplained shortness of breath. If you suffer from any or all of these symptoms, you have to consult a doctor immediately. If left untreated, depending on the severity of the disease, you could die. People with untreated TB are infectious and can infect between 10 to 15 people per year.
In South Africa, and many other countries, TB treatment is available free of charge through local clinics and hospitals.
If you get diagnosed with lung TB, you will be put on ‘aggressive treatment’ for a period of about two months. You should respond to intensive treatment after two months, after which you are no longer ‘infectious’. However, you would generally need to complete an additional four months of treatment to be cured of TB. Most importantly, if you do undergo the treatment, always make sure you finish the course! However, if the course of treatment is completed and you fail to respond, it means that your strain of TB could be resistant. This means that you have to carry on with additional intensive treatment for longer, sometimes for up to a year or two.
If you live with someone who has been diagnosed with TB, equip yourself with information about TB and the treatment. Know the symptoms of TB. Make sure the person completes the treatment. Provide much-needed encouragement and support to the patient, as often there are side-effects to the medication, and they will need to be motivated to take their medication and complete their treatment. Other measures that will help TB from being spread in the home include:
always have the windows open, allowing fresh air to circulate.
Be sure to practise what we call ‘cough etiquette’ - when you cough, cover your mouth and make sure that you cough either into your hand, sleeve, or a tissue. Cough etiquette should be practiced whether you have TB or not to prevent the spread of airborne infections.
Infectious TB patients are encouraged to wear a mask, but this is often difficult for them to do because of the negative stigma associated with having TB.
Make sure you have yourself checked out for TB as well!
The best way to do this is to live a healthy lifestyle and keep your immune system strong by eating healthily, exercising, and reducing your stress. Practise cough etiquette, as well as washing your hands before eating. If you’re in a room, open the windows to ensure adequate ventilation. Likewise, if you use public transport such as taxis, busses and trains, open a window to let fresh air in, where possible.
The difference between a vaccine and TB treatment is that a vaccine will prevent you from getting TB, while TB drugs are used to treat those who already have TB, a process which is costly to governments. It is cheaper and more effective to give people a vaccine to prevent TB in the first place.
A vaccine can protect you from getting disease in the first place. It helps the body to develop its own protection against disease when it becomes infected with the germ. A vaccine is a more permanent way of protecting yourself from disease. The current TB vaccine, BCG, is given to babies soon after birth to protect them from serious TB. However, the BCG vaccine, which has been around since 1921, does not prevent lung TB, the most common form of TB. SATVI is working with international partners worldwide to find a new TB vaccine which will be effective and safe for all forms of TB, for all ages, and for those living with HIV. At the moment 12 new TB vaccines are being tested worldwide, of which SATVI is testing 4 at its research site in the Boland. SATVI is one of many TB vaccine trial sites in the world, some of which are in Mozambique, Uganda, Kenya, Cambodia and India, all countries with a high burden of TB.
The Boland, an hour’s drive from Cape Town, has one of the highest levels of TB disease in the world. Because of the high numbers of people who have TB there, we will be able to determine more effectively in this community if a new vaccine works to prevent TB.