THE COMMUNITY

Csilla Orban Bonacci

Tuberculosis is a terrible disease.  It is mostly found in Eastern Europe, Latino countries, Russia, Asians, and non-US-born immigrants.  It manifests with cachexia, night sweats, cough that lasts longer than 3 weeks, and in the end stages blood in the sputum. The person becomes weak and unable to function as it does affect the whole body. 

I live in Florida and based on the CDC Wonder cases of tuberculosis (TB) in Florida vary from year to year. I was surprised to see though that 500 cases of TB were identified in Florida in 2021. Lake County where I live seems to have had less than 0.5%, but Miami leads in those cases. In Miami, in 2021 they had 103 cases and Lake County had 4 cases only. Hillsborough, Duval, Broward, Palm Beach, and Orange County are the next cities and counties that have high incidents of TB in Florida (CDC Wonder, 2020)

    According to the data more Hispanics, Asians, Pacific Islanders, and other non-US-born patients are likely to be found with TB. However, efforts to reduce the number of incidents are common (Filardo et. al. 2022).

     To manage the high incidence of TB cases I believe in our case Debbie could apply some measures such as primary, secondary, and tertiary interventions.

Primary interventions would be focused on prevention such as the administration of vaccines such as BCG which is given in other countries to babies. Also, advise travelers to not stay in close and long contact with others in crowded spaces. Healthcare personnel needs to wear N95 masks when working with a potentially infected population. Keep sick people behind closed doors to avoid infecting healthy ones. Educating the public about the symptoms of illness and encouraging them to seek help right away is important. Often people will write off a cough as a cold, but it might be TB (Harries et.al, 2020). The nurse here has a very important role when it comes to educating the public on the signs and symptoms of tuberculosis.

 

     Secondary prevention would be testing and screening of the suspected infected population. Encouraging people to not be afraid of a stigma or put off being checked out while understanding the gravity of this illness is something she could add to her plan. Also, explaining that not seeking help when they think they might have been exposed is putting them and their family at risk.

 

Tertiary intervention would be appropriate for those who have a positive result. Treatment with antibiotics long term is the treatment for tuberculosis. Pills are taken in front of the healthcare worker to ensure compliance. And again, the nurse needs to educate the patient that it is imperative he/she finishes the treatment even if it is long or the illness can progress and even cause death. One of the things that patients worry about as immigrants is the lack of insurance. They worry about paying for these pills. Nurses should inform them that this is free. Tuberculosis treatment is free at the health department. During this phase, Debbie should gauge the understanding of the patient of what the treatment entails such as commitment, testing, and follow-ups. 

    Since in my community, the prevalence of these incidents is low I believe primary, secondary, and tertiary interventions is are suitable. We should not let our guards down especially considering the high influx of immigrants in the state of Florida. Florida is very crowded and has many vacationers and as crowds grow so does the risk of contracting TB. Even though only 13 cases of TB were found in total in Lake County in the past 5 years, the health department is on the watch. People are mobile. They move from one area to another and all it takes is just one infected person to move from one area to another and bring the infection with them to a healthy area. Collaboration with surrounding areas is crucial in stopping the spread of an outbreak.

I believe that the interventions here in Lake County are like what Debbie should apply. We do have a large population of immigrants here and unfortunately coming from a low socio-economic status many have not been to a doctor in a while. I believe what we should also encourage that is different here is well-being checkups. We should not wait until TB surfaces but encourage everyone to go to their yearly check-ups. A provider can help identify something someone might have brushed off as “no big deal”. Setting them up with a social worker to help them apply for insurance, a discount, or charity to be able to see a provider, as well as directing them to clinics that accept non-citizens should be something that is implemented in the clinics. 

 

 

 

References

CDC.Wonder.2020.  http://wonder.cdc.gov/Links to an external site.

Filardo TD, Feng PJ, Pratt RH, Price SF, Self JL. Tuberculosis - United States, 2021. MMWR Morb Mortal Wkly Rep. 2022 Mar 25;71(12):441-446. doi: 10.15585/mmwr.mm7112a1. PMID: 35324877; PMCID: PMC8956339.

Harries AD, Kumar AMV, Satyanarayana S, Thekkur P, Lin Y, Dlodlo RA, Khogali M, Zachariah R. The Growing Importance of Tuberculosis Preventive Therapy and How Research and Innovation Can Enhance Its Implementation on the Ground. Trop Med Infect Dis. 2020 Apr 16;5(2):61. doi: 10.3390/tropicalmed5020061. PMID: 32316300; PMCID: PMC7345898.