NRS 425 Benchmark – Epidemiology Paper

Sample Answer

Tuberculosis (TB) is a respiratory tract infection caused by Mycobacterium tuberculosis. The infection is a health concern due to the chronicity of the illness and the post-infection complications resulting from extra-pulmonary disease.

The purpose of this paper is to describe the disease, epidemiological factors, prevention, and reporting criteria. The paper will also describe an organization that addresses TB as an infectious disease and the global impact of TB.

Overview of TB

Tuberculosis results from an infection caused by Mycobacterium tuberculosis, an atypical bacterium. The infection spreads from person to person through aerosol inhalation of expelled bacteria from an infected person when they cough, sneeze, or talk.

Upon reaching the lungs, the macrophages internalize the bacteria as part of an immune response to the infection (Alsayed et al., 2023). Additionally, more cells are recruited, and a granuloma is formed, which may lyse and cavitate. Cavitation leads to bacterial reactivation, development of active TB, and ease of spread of the infection to another new host when the infected individual coughs, speaks, or talks.

The primary infection affects the lungs and is referred to as pulmonary tuberculosis. The bacteria tend to have a high predilection to the lymph nodes, facilitating its spread to other organs such as the pleura, meninges, peritoneum, joints, and bones. The complications include pleural effusion, TB meningitis, intestinal obstruction, Potts disease, and osteoarthritis.
The persons at risk include immunocompromised, including HIV-infected persons. In

HIV/TB co-infected persons, both pathogens deteriorate the immune system, accelerating the decline of immunological functions (Diriba et al., 2022). Other persons that are at higher risk of infection due to impaired immune status include persons with malnutrition, immune suppressive medications such as corticosteroids, chemotherapy, uncontrolled diabetes mellitus, sepsis, drug or alcohol addiction, chronic renal failure, smoking, and malignancy.

Another group that is at high risk due to chronic and recurrent exposure includes those living in poorly ventilated areas such as prisons and concentration camps, homeless persons, and healthcare workers.
TB is a communicable disease that requires healthcare providers to report in case of a new infection.

The Centre for Disease Control and Prevention (CDC) guidelines require every healthcare provider to report the disease as it can have the potential to cause significant epidemics resulting from its high transmission rates. The data collected is used to identify TB outbreaks, track best practices in treating TB, monitor disease outcomes, inform TB prevention and intervention guidance and policy, and monitor progress toward TB elimination in the United States (CDC, 2024).

Furthermore, reporting aims to identify and prevent the rise of Multiple-drug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB) by ensuring infected persons adhere to their medications and are quarantined (Cole et al., 2020). When a TB diagnosis is established, the hospital, healthcare provider, or laboratory sends information about this case to the public health department.

The public health department receives and uses disease data to identify and control disease outbreaks, ensure every patient gets treatment, and provide testing and preventive care to those exposed.

TB Epidemiologic Triangle

The epidemiological triangle of TB includes Mycobacterium tuberculosis, which is the infectious agent, humans as the hosts, and environmental factors that enhance the spread of the disease. Mycobacterium tuberculosis infects exposed humans and causes the disease either as pulmonary or extra-pulmonary TB (John et al., 2023).

Host factors that increase TB susceptibility include close contact with a person having TB disease, poor nutritional status, preexisting co-morbidities such as HIV infection, and immunosuppression in conditions such as leukemia.

Host susceptibilities may vary depending on the age and genetic composition, where children and the elderly are more susceptible to the infection. On the other hand, environmental factors such as crowding, poor ventilation, inadequate sanitation, and indoor air pollution also facilitate the transmission of TB.

The Role of the Community Health Nurse in TB Prevention

A community health nurse (CHN) can actively engage in primary prevention by promoting measures that prevent the establishment of TB. The measures include advocating for infant and young child BCG immunization, using TB preventative therapy for immunocompromised and exposed persons, and continuous public education on preventing the disease through measures such as good ventilation (Cole et al., 2020).

The nurse can also facilitate contact tracing to identify and link any exposed person to care. Additionally, the CHN can institute secondary preventive measures to ensure early diagnosis of TB. The measures include early detection and treatment of persons with latent TB and regular screening for persons at high risk, such as healthcare providers.

A CHN can also provide tertiary prevention of TB through strategies such as appropriate TB drugs for those already diagnosed with TB, rehabilitation for the critically ill and referring patients for imaging services to exclude the risk of Potts disease and TB meningitis (Caruso et al., 2023).

The nurse should also provide regular follow-ups to patients undergoing chemotherapy with TB drugs to monitor drug response, tolerance, and compliance and look out for TB complications.

A National Agency That Addresses TB

The CDC has been actively developing worldwide guidelines for the prevention and treatment of TB. It provides guidelines dictating disease control at national, regional, healthcare facilities, and community levels (Caruso et al., 2023).

Furthermore, the organization stipulates how the disease is diagnosed using microscopy and Gene-Expert in samples such as sputum and cerebrospinal fluid. Additionally, it has provided treatment guidelines for TB, including how to manage latent and MDR-TB. As a result, all these measures contribute to reducing the prevalence and incidence of the disease globally.

Global Implications of the Disease
According to the World Health Association (WHO), 1.3 million people died from TB in 2021. As a result, TB became the 13th leading cause of death and the second leading infectious killer after COVID-19 (WHO, 2022). Additionally, in 2021, around 10.6 million people in all countries and age groups were diagnosed with TB.

However, MDR-TB remains a public health crisis due to challenges in the treatment and prevention of infection in undiagnosed persons. In addition, only about two in five people with drug-resistant TB access appropriate treatment that can help clear the infection.

TB also has a high financial burden as around 13 billion US dollars is needed annually for TB prevention, diagnosis, treatment, and care to achieve the global eradication of the disease. In 2022, the WHO found that TB was endemic in three world regions. They included South-East Asian, African, and Western Pacific regions where regions were associated with high mortality and morbidity rates.

WHO also noted that countries such as Australia, New Zealand, the Republic of Korea, Canada, Singapore, China, the United Kingdom, Kiribati, and Vanuatu have legislation for reporting TB to control the spread of the disease. Lastly, most countries have initiated TB preventative and intensive treatment therapy to reduce the number of infected cases with additional isolation of MDR-TB.

Conclusion

TB is a common respiratory tract infection with secondary manifestations in other sites, such as the peritoneum, bone, and pleura. The infection is a notifiable disease due to its impact on persons exposed to it and those at high risk of infection, such as immunocompromised and immunosuppressed persons. Proper diagnosis and management of the disease are needed to reducethe morbidity and mortality rates and global burden.

References

• Alsayed, S. S. R., & Gunosewoyo, H. (2023). Tuberculosis Pathogenesis, Current Treatment Regimens and New Drug Targets. International Journal of Molecular Sciences, 24(6), 5202. https //doi.org/10.3390/ijms24065202
  
• Caruso, E., Mangan, J. M., Maiuri, A., Bouwkamp, B., & DeLuca, N. (2023). Tuberculosis testing and latent tuberculosis infection treatment practices among health care providers — United States, 2020–2022. Morbidity and Mortality Weekly Report, 72(44), 1183-1189. https //doi.org/10.15585/mmwr.mm7244a2
  
• Cole, B., Nilsen, D. M., Will, L., Etkind, S. C., Burgos, M., & Chorba, T. (2020). Essential components of a public health tuberculosis prevention, control, and elimination program Recommendations of the Advisory Council for the Elimination of Tuberculosis and the National Tuberculosis Controllers Association. MMWR Recommendations and Reports, 69(7), 1-27. https //doi.org/10.15585/mmwr.rr6907a1
  CDC. (2024). Tuberculosis Case Reporting. Tuberculosis (TB). https //www.cdc.gov/tb/php/case-reporting/index.html
  Diriba, K., & Awulachew, E. (2022). Associated risk factor of tuberculosis infection among adult patients in Gedeo Zone, Southern Ethiopia. SAGE Open Medicine, 10. https //doi.org/10.1177/20503121221086725
  
• John, T. J., & Kompithra, R. Z. (2023). Eco-epidemiology triad to explain infectious diseases. The Indian Journal of Medical Research, 158(2), 107-112. https //doi.org/10.4103/ijmr.ijmr_3031_21
  WHO. (2022). https //www.cdc.gov/globalhealth/newsroom/topics/tb/index.html