Public Health Problem Tuberculosis

Tuberculosis, or TB for short, is a disease that is easily transmittable from one individual to another [1]. It is a highly deadly disease which accounts for approximately ten million new individuals being infected each year, according to the World Health Organization (WHO) [1]. Tuberculosis is also the first global emergency, regarding health, that was declared by WHO [2].

Tuberculosis is caused by a pathogenic bacterium strain called Mycobacterium tuberculosis which possesses multiple methods of survival and infecting new hosts [1]. Mycobacterium tuberculosis travels through the air to find and infect its next new host [2]. The acquisition of Tuberculosis results in the multiple symptoms, including persistent coughing and weight loss [1]. The most common place for the pathogenic bacteria to colonize and reproduce is the lungs of an individual, but it is possible for it to infect other parts of the body as well [1]. However, even with the various symptoms that inform an individual that they have the pathogenic strain in their body, they may not be aware of their condition until sometime after the initial infection due to a latent period [1]. The presence of this latent period may help in explaining why Tuberculosis is a public health problem that still exists today in this society. Another factor that may help in contributing to TB remaining a public health problem today may be the emergence of antibiotic resistance strains, a condition in which drugs are not able to act on the bacterial strain and kill the infectious strains [3]. In addition; the restrictions that come with diagnosing, treating, and controlling TB all aide in TB maintaining its status as a current public health problem [4]

Unfortunately, there is no country that is free of tuberculosis because Tuberculosis remains to be a global health problem, with approximately 8.7 million new cases diagnosed in just 2011 alone, and approximately 1.4 million deaths just from Tuberculosis according to WHO [4]. However; even though it is considered a global health problem, there are locations where individuals are more prone to the bacterial disease. The disease is most common in underdeveloped countries [5]. There are also certain individuals who have a higher likelihood of getting infected by the bacteria. These individuals include but are not limited to; people who do not get enough nutrition in their diet, human immunodeficiency virus (HIV) patients, young children, and diabetic patients [5].

Individuals who suffer from malnutrition also have a weakened immune system, which makes them easier targets for the bacteria to attack and prosper because it is harder for his or her immune system to fight off the bacterial infection [5]. There was a study that was done on diabetic individuals. This study found that there are approximately 70% of these individuals live in the poorer community and that the numbers of the TB infections that were reported were increasing within this population [5]. This correlation can be due to the observation that individuals who are situated in the communities that are not as well off are more prone to obtaining Mycobacterium tuberculosis and acquiring this deadly disease because the socioeconomic status of an individual unfortunately does matter when it comes to who is at a higher risk of getting infected with this certain strain of the bacteria [5]. In addition to the study that was done on diabetic patients, there was also a study that was done on children. This study was done by exposing children to either a positive or a negative sputum smear. The study showed that at a young age, 60%-80% of the children that were exposed to the positive smear was got infected compared to only roughly 30%-40% of the young children getting infected when exposed to the negative case [5].

How to Solve the Problem

Due to the apparent dangers that tuberculosis brings to everyone globally, there have been several attempts at controlling the number of new patients, by potentially eliminating any new happenings of the disease. One of the many attempts to control and potentially solve the tuberculosis problem worldwide is known as DOTS [3]. It is a strategy that was developed by the World Health Organization and was initially launched back in 1994. However; due to its noticeable progress in decreasing the numbers of newly diagnosed tuberculosis patients, it is a strategy that is still widely used today in hopes of further decreasing the new occurrences of tuberculosis [3]. The strategy's name, DOTS, is an acronym for directly observed therapy, short-course [6]. Overall, the strategy is comprised of five different components that can help in both preventing more cases of the disease as well as treating the patients who have already come into contact with the disease causing bacterial strain [3]. One of the five components deal with the government's involvement and providing enough funding when it comes to research in the field of tuberculosis drugs or vaccinations [3]. Another one of the components is diagnosing individuals who display the symptoms and providing the individuals who are diagnosed with tuberculosis with a standardized treatment [3]. Finally, a separate system should be present regarding the management of the drugs along with a drug supply and patients who are receiving treatment should be monitored [3]. This approach that is aimed to solve the problem has been proven effective in decreasing the number of patients, with data showing that approximately 17 million patients were getting effective treatment for tuberculosis by the year 2003 [3].

Another strategy that has the same goals as the DOTS strategy is known as the End-TB strategy and this strategy is for the years following 2015 [7]. The End-TB strategy comprises of modifications from previous methods that were employed to fight tuberculosis and consists of modifications from previous strategies that came before it [7]. There is however several big changes that were made in the End-TB strategy that were not present in the previous methods that were used in hopes of eliminating tuberculosis [7]. For starters, it considers the socioeconomic situation of potential patients and politics that surround this issue, based off of the idea, that no one country can be tuberculosis free unless all countries come together to fix the problem [7]. Another difference that can be seen between the End-TB strategy with the previous ones is that now there is a greater emphasis on the importance of funding, regarding the research to be done when it comes to diagnosis and treatment options. This is because it was realized that in order for steps to be made in eliminating the occurrence of tuberculosis, new methods of diagnosis and treatment are needed [7]. However; possibly the biggest change that can be observed is that while the diagnosis and treatment options were the primary focus of previous control plans, the End-TB strategy also addresses the prevention measures that can be taken to decrease one's likelihood of obtaining this bacterial infection [7].

Different countries, such as China, have developed their own approaches in fighting tuberculosis disease and infection. China is a country with a high incidence (11%), with approximately one million new cases in just the year 2010 alone, and the second highest incidence rate globally, which can be possibly explained with the poor health system that is found in the country [8]. China as a nation began addressing the severity of the incidence of tuberculosis back in the 1990s and the approach that was adopted was based on the DOTS strategy [8]. China's new plan was put into place in 2001 and it was an expansion of the programs that were already in place through DOTS [8]. This new strategy involved the government providing a new treatment method, providing free treatment to patients, and shift the treatment facilities from the hospitals to public health centers [8]. Overall, the prevalence of TB deceased from 170 per 100,000 to 59 per 100,000 from the 1990s to 2000 [8]. To observe how effective the method was in a study was done comparing the number of new cases that were observed in areas that implemented the plans to the areas that did not implement it and found that implementing the plan helped in reducing the numbers of new cases [8].

In addition to the current efforts in place, there have been instances in history where people tried to fight against TB and one of these instances was the development of the first immunization against TB [1]. It was first developed in 1906 by Albert Calmette and Camille Guerin. Even though the vaccine was used since 1921, the use of the vaccine was not globally accepted until after World War I [1].

Public Health in the Future

Even with all the efforts in place in hopes of eliminating TB, there is still so much that can be done in the future. For example, new vaccines can be created and aide in the prevention of the disease [9]. There was hope back in 2015 when a new vaccine, MVA85A, was developed, but it failed, in terms of being better than the current vaccine [9]. For this to be successful, more funding needs to be provided because groups that provide the funding have become reluctant after the disappointing results of MVA85A [9]. The future vaccine to be developed will help in preventing the progression of the disease of individuals in all age groups [9].

Besides developing a new vaccine, another step that can be taken to help fight against tuberculosis is creating new drugs [9]. This new approach can prove to be helpful and effective in treating the strains of the disease causing bacterial strains that have become resistant to the current drugs that are being used to treat tuberculosis [9]. There have been new drugs that have been created, but these drugs are not yet able to be used on people because the new drugs must still go through clinical trials before they can be prescribed to fight tuberculosis [9]. A few examples of the drugs that are in the process of going through the clinical trials to become drugs that can be prescribed include bedaquiline, delamanid, pretomanid, sutezolid, and SQ109 [9].

In my opinion, education is the biggest thing that can help in the prevention of the tuberculosis. In a study that was done, less than half of the people that were asked basic knowledge about TB were unable to give the correct answer, such as how it is transmitted [10]. Everyone should be educated, regardless of whether they are situated in a prone community or not because regardless of where people may live, there is always a possibility that people can get infected. Another prevention measure that can be taken is to not look at coughing so lightly, especially if in a high-risk community.

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