GGRB28 Lecture 8: Geographies of TB- Nov 8, 2012
Sample Test Question:
1. Explain the difference b/w MDR and XDR Tuberculosis
- Air borne illness
o Transmitted through air droplets
- latent infections (90%) and active disease (10%)
o latent means the infections are asleep; you have them but not active in the body you cannot catch TB from
they are not infectious!
Not affecting them in any way
Unless you took a test, you would never know that you had TB diagnosis!
o Active disease = infectious
You are being affected by the disease
o latent infection can turn into the active disease when immune system is compromised or weakened!!!!
- Symptoms: cough, fever, chills, weight loss
- Also known as “consumption” or the “white plague”
o Consumption = b/c you waste away, you become a skeleton (something was consuming your body!)
- Creation of sanatoriums
o Huge rates of TB in Canada and US up until the 1950s
o As a result, sanatoriums created – send people there when 1) sick, for rest and treatment and 2) they didn’t infect
any one else
o These people had active TB
o Send of their relatives to these sanatoriums
o Spa-like places, clean air
o Also be seeking treatment there; some treatments were barbaric (cutting some of ribs, trying to get rid of the
o Very rarely survived when you went into sanatoriums!
o Pic – waverly hill sanatorium in Kentucky; all patients lying in bed overlooking meadow as getting TB treatments
o 100s of people dying a day; had a shute to dispose bodies!
o Very much a plague during this period of western history
- discovery of streptomycin in 1940s
o really changed effects of TB
o effective drug treatments; decrease TB infections in western world!
- improvement in social conditions
o understandings of hygiene and sanitation were coming about
o social developments were cleaner
o were understanding water sanitation, cleaner houses etc.
o animals no longer living in areas near people
o waste management!
- BCG vaccine – given to children (immunity only 10 years)
o No vaccine for TB
o Often times not given to adults, only given to children in childhood so they don’t have damage to body as they are
o BCG doesn’t work on adults; and if administered to adults may give a false positive
o We just treat it when it shows itself
TB – A social Disease
- TB is contracted through airbone drops
o Someone has to have active form and cough in your face to transmit TB
- Not particularly infectious, requires long and frequent exposure
o In close proximity for extended period of time, if you are healthy
- TB can progress quickly with lower resistance
o Length of time it takes you from having actual disease and dying will be shorter b/c body in unable to fight
disease! (immune system is already compromised/weakened)
- Associated with poverty
1 o People living in slum-like conditions
o Continued to have effect in third world now
o Allow for weakened immune conditions – therefore more susceptible!
o Highest rate in highest poverty-striken areas
o i.e. southern Africa! (also have high HIV rate here) – overlap b/w the two!
TB & DOTS
- “Directly Observed Therapy, Short – course”
- DOTS involved greater observation (i.e. people watching patients swallowing their pills)
o watch people take pills, and individually going door to door to take medication to the patient!
o Health is reduced in 3 world countries DUE TO ACCESS! Access issues prevent people from seeking treatment.
o Ensures completion of 6- 8 month treatment plan
- DOTS is 95% effective, cheap, 6-8 months
o TB treatment you need antibiotics for 6-8 months
o If your clinic is very far, and you barely work (don’t have enough $), you wont have the time to take
o TB continues to spread due to poor compliance – not taking medication properly! (blaming the victims…)
o This doesn’t take into account for people not being able to afford to buy medicine or be able to take off work;
infrastructure – (bridge washes out during stor,)
o May have will to do it.. but not the means!
o Generic products so its very cheap
o It doesn’t take a lot of time b/c you train community members to do it! Get a little bit of money
o DOTs is breaking down all those barriers
MDR & XDR TB
- MDR (Multi-Drug Resistance) – Resistant to 2 or more “1 line’ drugs
o 1 line drugs = first drugs created to treat TB (basic antibiotics)
- XDR (Extreme-Drug Resistance) – Resistant to 3 or more 2 ndline drugs
o Over the years we have created stronger antibiotics = line drugs
o There’s only 6 of them; you are reducing your chances of finding something that will actually help you!
o So there’s three types of strains – normal TB, then MDR, then XDR
- Improper use of medications
o New protocol for docs to reduce amount of antibiotics
o They are taking antibiotics for things that you don’t really need ant