MDR TB -- HEALTH CARE WORKERS IN RESOURCE LIMITED COUNTRY
Past and current outbreaks and epidemics of drug-susceptible, multidrug-resistant, and extensively drug-resistant TB have been fueled by HIV infection, with high rates of morbidity and mortality and linked to the absence or limited application of airborne infection-control strategies in both resource-rich and resource-limited settings.
MDR-TB has emerged and spread due to the inadequacy of treatment. Today, treatment for drug-resistant TB can take up to two years, and is so complex, expensive, and toxic that many patients are unable to access treatment. Of those who do, more than a third will die. Today, drug-resistant TB is also quite common in India and China — the two countries with the highest MDR-TB burdens.
Airborne infection-control strategies are available—grouped into administrative, environmental, and personal protection categories—and have been shown to be associated with decreases in nosocomial transmission of TB; their efficacy has not been fully demonstrated, and their implementation is extremely limited, particularly in resource-limited settings.
Individuals who spent time with someone known to have drug-resistant TB disease[1] are vulnerable to the Infection.
Individuals with MDR-TB who traveled on multiple transatlantic flights received extensive media coverage and raised awareness of drug-resistant TB in developed countries and the possibility of airborne transmission not only in health care facilities but also in a broader array of public settings. In addition to the fear of transmission of untreatable TB, this vividly revealed the longstanding collective neglect and deficiencies in TB prevention, including infection control, diagnosis, and treatment, and the great need for resources and renewal of global interest in TB control. HCWs are at particularly high risk of M. tuberculosis infection and TB disease. Nosocomial TB transmission to HCWs further deepens the already severe human resources crisis in global health and in HIV and TB services. In a review of M. tuberculosis infection and TB disease in HCWs, the median annual incidence of occupationally acquired TB was 5.8% (range, 0%–11%) and 1.1% (range, 0.2%–12%) in low- and high-income countries, respectively; was consistently higher than TB incidence in the general population; and was linked to degree of TB exposure and the presence or absence of airborne infection control[2,3].
Keeping these things in mind the Dots plus in India where the officers are in direct contact with the cases needs to take care and caution; they face challenges they in their job, most of them contractual employees. The brunt of disease they handle goes unnoticed except by the families of the patient, who give them due regard. Environment control with personal protective masks and due health care to health care workers need to be reinforced.
1. http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm.
2. Joshi R, et al. Tuberculosis among healthcare workers in low- and middle-income countries: a systematic review. PLoS Med 2006;3:e494.
3. Menzies D,. Risk of tuberculosis infection and disease associated with work in health care settings. Int J Tuberc Lung Dis 2007;11:593-605
Rapid Response:
Re: Managing drug resistant tuberculosis
MDR TB -- HEALTH CARE WORKERS IN RESOURCE LIMITED COUNTRY
Past and current outbreaks and epidemics of drug-susceptible, multidrug-resistant, and extensively drug-resistant TB have been fueled by HIV infection, with high rates of morbidity and mortality and linked to the absence or limited application of airborne infection-control strategies in both resource-rich and resource-limited settings.
MDR-TB has emerged and spread due to the inadequacy of treatment. Today, treatment for drug-resistant TB can take up to two years, and is so complex, expensive, and toxic that many patients are unable to access treatment. Of those who do, more than a third will die. Today, drug-resistant TB is also quite common in India and China — the two countries with the highest MDR-TB burdens.
Airborne infection-control strategies are available—grouped into administrative, environmental, and personal protection categories—and have been shown to be associated with decreases in nosocomial transmission of TB; their efficacy has not been fully demonstrated, and their implementation is extremely limited, particularly in resource-limited settings.
Individuals who spent time with someone known to have drug-resistant TB disease[1] are vulnerable to the Infection.
Individuals with MDR-TB who traveled on multiple transatlantic flights received extensive media coverage and raised awareness of drug-resistant TB in developed countries and the possibility of airborne transmission not only in health care facilities but also in a broader array of public settings. In addition to the fear of transmission of untreatable TB, this vividly revealed the longstanding collective neglect and deficiencies in TB prevention, including infection control, diagnosis, and treatment, and the great need for resources and renewal of global interest in TB control. HCWs are at particularly high risk of M. tuberculosis infection and TB disease. Nosocomial TB transmission to HCWs further deepens the already severe human resources crisis in global health and in HIV and TB services. In a review of M. tuberculosis infection and TB disease in HCWs, the median annual incidence of occupationally acquired TB was 5.8% (range, 0%–11%) and 1.1% (range, 0.2%–12%) in low- and high-income countries, respectively; was consistently higher than TB incidence in the general population; and was linked to degree of TB exposure and the presence or absence of airborne infection control[2,3].
Keeping these things in mind the Dots plus in India where the officers are in direct contact with the cases needs to take care and caution; they face challenges they in their job, most of them contractual employees. The brunt of disease they handle goes unnoticed except by the families of the patient, who give them due regard. Environment control with personal protective masks and due health care to health care workers need to be reinforced.
1. http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm.
2. Joshi R, et al. Tuberculosis among healthcare workers in low- and middle-income countries: a systematic review. PLoS Med 2006;3:e494.
3. Menzies D,. Risk of tuberculosis infection and disease associated with work in health care settings. Int J Tuberc Lung Dis 2007;11:593-605
Competing interests: No competing interests