On our planet, there are still many infectious diseases that humanity is fighting, but so far cannot completely win. The most formidable of them, claiming 1.5 million human lives annually, is tuberculosis. The situation is complicated by the fact that HIV-infected people who have also become ill with this disease experience difficulties in recovering and spreading tuberculosis.
Infectious agent
Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis, formerly called Koch's bacillus. Now this term is almost never used, because due to mutations, a lot of Koch sticks have appeared with the features that each of them has.
Tuberculosis bacteria can exist for some time outside the human body. For example, on the sidewalk they do not die within 10 days, and in the water - 5 months. In the dried state, they remain viable for a year and a half, and in the frozen state - 30 years! They are not afraid of a temperature of 80 degrees, they can withstand it for 5 minutes. But best suited for these bacteriadampness, darkness and temperature of the human body, here they can already multiply.
Most often, tuberculosis affects the bronchopulmonary system of a person, but there is tuberculosis of the skin, bones, nervous system, and even the whole organism. In the place of the body of a sick person where the mycobacterium has settled, foci of inflammation are formed, which are small tubercles. In Latin, the word "tubercle" sounds like tuberculum, and the name of this disease came from it.
Routes of contracting tuberculosis
In order to understand the methods of preventing this serious disease, it is necessary to consider all the possibilities of infection. There are several ways to get infected:
- Infection by airborne droplets from a patient with active tuberculosis during his coughing, laughing, sneezing. This is the most possible way of infection from all existing.
- Infection through all kinds of contact with the things of the patient or with him (kissing and sexual contact). The possibility of getting the virus from an animal cannot be ruled out.
- Infection through food is possible if tuberculosis prevention measures are not followed. This can happen when buying products that have not passed sanitary control in the market.
- Intrauterine infection of the fetus is possible in case of illness of a pregnant woman, especially with a combination of tuberculosis and HIV infection.
Signs of disease
At the beginning, the disease is similar to acute respiratoryinfection: the sick person feels fatigue, weakness, general malaise, the temperature in this case is usually subfebrile (37, 1 - 38 degrees). These signs are accompanied by a cough if there is a pulmonary form of tuberculosis, or other numerous signs in its extrapulmonary form.
In the future, others are added to these signs: a person loses weight and constantly sweats, his face sharpens, and an unhe althy blush appears on his cheeks. Hemoptysis is considered a dangerous symptom of the disease.
What is the probability of contracting tuberculosis
This probability is very high. According to available statistics, one tuberculosis patient infects about 15 people during the year.
According to WHO, 2.5 billion people on the planet are infected with tuberculosis, but not all of them are sick. Human immunity is a barrier that can prevent the development of the disease. Therefore, it is very important to prevent the weakening of this barrier and to comply with tuberculosis prevention measures. Factors that weaken the immune system: malnutrition, beriberi and stress.
The importance of prevention
The World He alth Organization in 2017 presented a report with plans for its activities to combat tuberculosis for the period from 2016 to 2035. This report outlines public he alth goals for a 90% reduction in deaths from this disease by 2030 and an 80% reduction in incidence compared to 2015 levels. In order to achieve the set goals, it is necessary to strengthen TB prevention activities, which include the following measures:
- Preventiondisease by social methods.
- Prevention of disease by sanitary methods.
- Prevention of the disease by specific methods.
- Chemoprophylaxis.
Social prevention methods
Prevention of the disease by social methods includes a set of measures provided by the state that help improve people's lives. These measures should contribute to raising the living standards of the population and eradicating the diseases of society. All these goals should be included in the economic development plan of the state. These goals include the following activities:
- A patient with an open form of this disease needs to have isolated housing, as the he alth of his family is in danger. For families with children living in dormitories, in order to prevent tuberculosis in children, the legislation provides for the provision of a separate living space.
- Improve working conditions, as well as shortening and limiting working hours for minors.
- Improvement of living conditions of the population, which includes water supply of dwellings, sewerage supply and their gasification.
- Improving the ecological situation in the state: planting greenery in settlements, combating environmental pollution.
Sanitary prevention methods
Disease prevention by sanitary methods is a whole range of measures to protect he althy people from sick people and prevent the possibility of their infection. The focus of tuberculosis is a potential danger. All foci are divided into 3 groups. There are rules that must be followed by representatives of medical institutions in relation to the focus of infection, as well as sanitary rules of conduct for TB patients and their families.
1 group has the highest degree of danger and includes the following situations:
- The place of residence of the patient is a hostel, and the patient himself excretes a large number of mycobacteria.
- There are children or pregnant women in the patient's family.
- The family does not comply with the sanitary rules for the prevention of tuberculosis.
2 group has a lower degree of danger than the first, and includes the following situations:
- The amount of mycobacteria excreted by the patient is negligible, and he has no children.
- The patient does not excrete mycobacteria, but he has children.
3 group has an even lower degree of danger and includes the following situations:
The patient does not excrete mycobacteria, he has no children, and he and his entourage follow all hygiene rules
The work of medical personnel in the focus of infection
Prevention of tuberculosis in adults includes the following actions. After the diagnosis of the disease is established, the phthisiatrician, epidemiologist and nurse visit the source of infection, after which they draw up a plan for sanitary work to improve the facility.
The plan includes the following sections:
- Prescribing medicines to a patient.
- Disinfectionpremises.
- Protecting the patient from the rest of the family.
- Teaching the patient and his environment all the rules of behavior.
Rules of behavior for the patient and his environment
Here are the guidelines to follow:
- The patient should be provided with separate dishes, a towel and soap with a soap dish, and all his things should lie separately from other things of family members.
- The patient's dishes should be boiled for 20 minutes.
- The patient's underwear also requires a 20-minute boil.
- A necessary condition for caring for the patient's room is daily cleaning with disinfectants.
- In the recommendations for the prevention of tuberculosis there is a clause about the need for patients to use spittoons in the amount of two pieces. When using one of them, the second patient at this time must be disinfected with a 5% solution of chloramine. Then the spittoon should be rinsed with water.
Specific TB prevention
This is the use of vaccinations for the public. For the first time, a vaccine against tuberculosis infection was used in 1921 by the French scientists Calmette and Guerin. In Latin spelling, Bacillus Calmette-Guerin is written like this: bacillus Calmette-Guerin (BCG), and in Russian letters BCG.
Now in the Russian Federation this specific prophylaxis of tuberculosis is given to all children on their 3rd-7th birthday. BCG protects a small person from tuberculous meningitis and miliary tuberculosis, which, if they become ill without vaccination,lead to death. The effect of vaccination lasts 15-20 years. BCG does not reduce the spread of tuberculosis among the population, but it protects children from developing severe forms of this disease.
This vaccine is well tolerated by newborns, in addition, for weakened children there is a BCG-m vaccination, which includes 50% of the mycobacteria contained in the main BCG vaccination. Therefore, young parents should not risk their child's life and avoid this type of TB prevention.
Methods for identifying TB patients
There are the following ways to timely identify people with this disease among the population:
- Mantoux test.
- Chest x-ray.
If necessary, other studies are added to these analyzes: enzyme immunoassay and bacteriological.
Mantoux test
This is a special test that allows you to determine the status of the subject in relation to Mycobacterium tuberculosis. This test is given to all children every year to prevent tuberculosis in children.
To do this, 0.1 ml of a test solution consisting of tuberculin is injected subcutaneously into the child's arm. According to the skin reaction that appeared at this place, one can judge the body's ability to cope with the infection.
Test results and what they mean:
- 5-15 mm is a normal reaction, meaning that the child has immunity to this disease, which he acquired after vaccination, or was infected with tuberculosis and defeated the infection.
- 16mm andmore - an abnormal reaction that indicates a reduced immunity of the child. Perhaps the infection has occurred recently, so the body has not yet managed to defeat the infection, but something else is also possible - the disease is in the phase of transition to an acute form. Such a child needs a consultation with a TB specialist.
- 0-2 mm - no response. This means that the effect of the vaccine has already faded. These children need a second vaccination.
Revaccination
Tuberculosis prevention at school is a compulsory Mantoux test and subsequent revaccination, which is carried out for all 6-7-year-old children who do not respond to the Mantoux test, which means that the previous vaccination is no longer valid. All following revaccinations are carried out every 7 years until the person reaches the age of 30.
New rules of SanPiN "Prevention of tuberculosis"
Sanitary Rules and Norms (SanPiN) is a resolution of the Chief State Sanitary Doctor of the Russian Federation dated October 22, 2013 No. 60, which entered into force on July 2, 2014.
These rules have replaced the previous ones. They have a new item that allows you to identify regions that require increased attention, and determines the frequency of fluorographic examinations in them. If in a certain region of the Russian Federation the incidence of tuberculosis is 60 people or more for every 100 thousand of the population, then the population of this region aged 15 years and older is subject to an annual examination, inincluding fluorographic.
New rules of SanPiN "Prevention of tuberculosis" (clauses 5.2 and 5.3) have introduced some legal confusion. According to these rules, children vaccinated against tuberculosis are admitted to children's and school institutions. If the child is not vaccinated, then he must have a certificate from a TB doctor that he is he althy. And this is true, as it involves the prevention of tuberculosis. The BCG vaccine and the Mantoux reaction are considered unnecessary by some parents, and they do not vaccinate their children, but at the same time do not want to bring a document from a TB doctor. This conflict is often resolved in court, which obliges parents to bring the necessary certificate.
Chemoprophylaxis
There are groups of people with a high risk of getting TB. To prevent morbidity, they are prescribed anti-tuberculosis drugs. This is called chemoprophylaxis. It is held by the following persons:
- People who are in direct contact with a TB patient and have a negative Mantoux test (0-2 mm).
- People who have a positive Mantoux test and who do not have any manifestations of tuberculosis, which is also confirmed by x-ray, but who are in contact with a patient with tuberculosis.
Tuberculosis is a formidable disease. According to the World He alth Organization, it claims 1.5 million human lives on our planet every year. The fight against this disease is carried out by all countries at the state level, but each person can also independently take part in it. To do this, it is enough to studytuberculosis prevention leaflet and follow it. The main provisions of this memo are set out in this article.
