To Mark World TB Day 2021, Irish Thoracic Society Calls for
the Future-proofing of Healthcare Services in the Battle Against Infectious Diseases
To mark World TB Day 2021, Wednesday March 24, the Irish Thoracic Society (ITS) is calling on the government to take decisive action to combat the hidden but very real and devastating health, social and economic impact of tuberculosis (TB) and to bring Ireland in line with our European neighbours in the fight against this preventable disease. The call comes as the ITS joins a global call for accelerated efforts to end TB by 2030 and to mitigate the toll that COVID-19 is taking on TB services worldwide.
The ITS has outlined five key actions that Government needs to take including the appointment of a national TB controller, a national TB screening programme for high-risk groups, investment in contact tracing and surveillance activities, and an education and awareness programme for healthcare professionals and the public (more details below).
Ninth Leading Cause of Death
As the world continues its battle against another infectious disease, COVID-19, TB remains one of the world’s deadliest infectious killers and is the ninth leading cause of death worldwide. Each day nearly 4,000 people lose their lives to TB – approximately 1.5 million annually – and close to 28,000 people fall ill with this preventable and curable disease. Global efforts to combat TB have saved an estimated 63 million lives since 2000. In Ireland, 267 cases of TB were notified to the Health Protection Surveillance Centre in 2019.
COVID-19, now in its second year, is continuing to divert essential medical resources and attention away from providing life-saving diagnosis, medicine and care to people suffering from TB worldwide. In addition, drug-resistant and multi-drug resistant TB pose a significant threat to gains made, making the fight against TB ever more complex and challenging.
Likelihood of Rising TB Cases
According to Dr Marcus Butler, Consultant Respiratory Physician and Vice-President of the Irish Thoracic Society, Ireland’s highly dedicated but inadequately resourced TB service is struggling to protect the health of the population. This is particularly so for its most vulnerable and socially marginalised communities who are most susceptible to TB – those in the homeless and prison populations, as well as many in our migrant communities:
“Sub-standard and overcrowded living conditions, poor nutrition, drug and alcohol misuse, as well as a weakened immune system due to other illnesses are all factors associated with increased risk of acquiring TB. COVID-19 has worsened these conditions for many, while bringing many more below the poverty line for the first time.
“The likelihood of rising TB cases as a result of the pandemic comes against the backdrop of increased pressure on health services, re-allocation of staffing resources and reduced numbers of people presenting with their symptoms due to COVID-19 restrictions. All of these factors are storing up an unprecedented TB crisis for a resource-starved service on top of an already complex and demanding, albeit largely hidden, public health threat.
“The fragility of Ireland’s health infrastructure has been highlighted by the strain our healthcare service was placed under by the surges in COVID-19 cases over the last 12 months. This is partly due to chronic under-investment in appropriate infrastructure to care for patients with infectious diseases such as TB and COVID-19. Urgent action is needed to future-proof our healthcare settings and services in the battle against infectious diseases.”
To mark World TB Day 2021, countries are being urged to implement the priority recommendations outlined in the 2020 progress report on TB issued by the United Nations Secretary-General António Guterres and the World Health Organisation. At national level, these echo the central recommendations in the National Guidelines for the Prevention and Control of TB in Ireland launched in 2010 and reiterated in three subsequent reports.
| FIVE ACTIONS TO COMBAT TB IN IRELAND
For Ireland’s TB problem the ‘clock has been ticking’ for over a decade. The Irish Thoracic Society is now calling for urgent action as recommended by national and international experts in the following vital areas: 1. Leadership Call to action for Ireland: Appoint a national TB Controller to lead the development and integration of a national TB service. 2. Prevention Call to action for Ireland: Establish a national programme to screen for and treat latent TB in high-risk groups to reduce the incidence of the disease in Ireland. Such groups include people who are homeless, the prison population and new entrants to Ireland from countries with a high incidence of TB. If the disease is treated in its latent form – where infection exists but is not contagious and there are no symptoms of illness – it will prevent the development of an active, contagious form of the disease. 3. Diagnosis and Treatment Call to action for Ireland: Establish a co-ordinated and resourced national clinical programme encompassing hospital-based clinics, appropriate inpatient facilities, public health and laboratory services. Invest in public health resourcing of contact-tracing, case-management and surveillance activities. Develop the Irish Mycobacteria Reference Laboratory (IMRL) and the National Clinical TB Centre on the St. James’s Hospital site without further delay. 4. Drug Resistant TB Crisis Call to action for Ireland: Provide universal availability of expert TB care and ready access to well-supported hospital beds for multi-drug-resistant (MDR) TB cases, extensively drug-resistant (XDR) TB cases and complex TB cases in people who are socially marginalised. 5. Education and Awareness Call to action for Ireland: Promote education and awareness in relation to TB among healthcare professionals and members of the public. Raise awareness of the symptoms of TB which include persistent cough and phlegm or weight loss and night sweats. People experiencing these symptoms are encouraged to see a health care professional to get diagnosed and treated as soon as possible, to minimise the chance of long-term ill health and onward transmission. Ensure that under-served populations are aware of symptoms and can access treatment. As a society, tackle the health inequalities, social marginalisation and deprivation that put people at increased risk of TB. |
ENDS
Issued on behalf of the Irish Thoracic Society by: Don Delaney, tel. 01 910 8987 / 087 793 3249 or email don@d2communications.ie
Notes to Editors
TB prevalence
In 2019, 267 cases of TB were notified to the Health Protection Surveillance Centre. Resistance was reported in 27 cases or 10 per cent of total cases reported. In 2019, 40 per cent of all TB cases notified were in Irish-born people (107 cases). Foreign-born cases accounted for 44 per cent of all cases notified (118 cases). Country of birth was unknown for 16 per cent of cases. More information on TB in Ireland is available at www.hpsc.ie
What is TB?
Tuberculosis (TB) is a disease caused by germs that are spread from person to person through the air. TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. A person with TB can die if they do not get treatment.
What are the symptoms of TB?
The general symptoms of TB disease include feelings of sickness or weakness, weight loss, fever, and night sweats. The symptoms of TB disease of the lungs also include coughing, chest pain, and the coughing up of blood. Symptoms of TB disease in other parts of the body depend on the area affected.
How is TB spread?
TB germs are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. These germs can stay in the air for several hours, depending on the environment. People who breathe in the air containing these TB germs can become infected; this is called latent TB infection.
What is the difference between latent TB infection and TB disease?
People with latent TB infection have TB germs in their bodies, but they are not sick because the germs are not active. These people do not have symptoms of TB disease, and they cannot spread the germs to others. However, they may develop TB disease in the future. They are often prescribed treatment to prevent them from developing TB disease.
People with TB disease are sick from TB germs that are active, meaning that they are multiplying and destroying tissue in their body. They usually have symptoms of TB disease. People with TB disease of the lungs or throat are capable of spreading germs to others. They are prescribed drugs that can treat TB disease.
How do you get tested for TB?
There are two tests that can be used to help detect TB infection: a skin test or TB blood test. The Mantoux tuberculin skin test is performed by injecting a small amount of fluid (called tuberculin) into the skin in the lower part of the arm. A person given the tuberculin skin test must return within 48 to 72 hours to have a trained health care worker look for a reaction on the arm. The TB blood tests measure how the patient’s immune system reacts to the germs that cause TB.
What is Bacille Calmette–Guèrin (BCG)?
BCG is a vaccine for TB disease used in many countries worldwide, including Ireland up until 2015. BCG vaccination does not completely prevent people from getting TB. It may also cause a false positive tuberculin skin test. However, persons who have been vaccinated with BCG can be given a tuberculin skin test or TB blood test.
How is TB treated?
TB disease can be treated by taking several drugs for six to 12 months. It is very important that people who have TB disease finish the medicine, and take the drugs exactly as prescribed. If they stop taking the drugs too soon, they can become sick again; if they do not take the drugs correctly, the germs that are still alive may become resistant to those drugs. TB that is resistant to drugs is harder and more expensive to treat. In some situations, staff of the local health department meet regularly with patients who have TB to watch them take their medications. This is called directly observed therapy (DOT). DOT helps the patient complete treatment in the least amount of time.
References:
- Health Protection Surveillance Centre
- United Nations Global TB Report https://apps.who.int/iris/bitstream/handle/10665/336069/9789240013131-eng.pdf
- World Health Organisation – World TB Day 2021 Campaign
https://www.who.int/campaigns/world-tb-day/world-tb-day-2021
- Guidance on the Prevention and Control of TB in Ireland 2010
https://www.hpsc.ie/a-z/vaccinepreventable/tuberculosistb/guidance/tbguidelines2010amended2014/
- Centre for Disease Control
https://www.cdc.gov/tb/publications/factsheets/general/tb.htm