Tuberculosis for Addiction Counselors Catherine Kroll, MPH, CPH

Basics Agent: Bacteria Spread: Respiratory Droplets Symptoms: Prolonged cough-sometimes with blood! Fever/Night sweats Weight Loss

Infection vs. Active Disease Infection: Bacteria sleep in your body without causing illness 10% of infected progress to active disease Active disease: “event” occurs that wake up the bacteria and they reproduce leading to illness Contagious if pulmonary Can be in any body site

History Hippocrates 1600s U.S. Sanitariums Community Treatment 460 BC Primary cause of death in Europe U.S. Sanitariums Community Treatment

Testing Infection Contagious Disease Skin Test Blood Test X-ray Bacterial culture

Treatment Active Disease Latent Disease 4 months to 2 years to treat Standard Treatment 4 drugs for 2 months then 2 drugs for remainder Latent Disease 9 months with INH 4 months with Rifampin 12 weeks with New DOT regime

Drug Resistance Evolution Miss use of antibiotics Selective Pressure Miss use of antibiotics Not DOT Lack of new medications

Cost of Drug Resistance Depends on what medications person is resistant to Recent AZ case $250,000

Role of Public Health Department Ensure Treatment of Active Case Directly Observed Therapy Investigate Contacts Identify Screen Evaluate/test Treat

Is it really a problem? ~1/3 of the world’s population is infected ~5% of the US population infected 22 cases of active TB in Clark County in 2010

What does it have to do with me? Risk to become infected Injection Drug Users Homeless Congregate Living Settings Risk of moving from infection to contagious disease Substance Abuse Weak immune systems

Link to Substance Abuse Hotboxing Smoking in an enclosed place so that smoke is repeatedly inhaled Sharing bongs Shot Gunning Inhaling smoke directly into face of another person

What happens if I get exposed? Risk Assessment Skin Testing or Blood Testing Treatment

What can I do? Work within your program to refer symptomatic people for confidential testing Get tested annually WAC 388-805 Call Clark County Public Health TB Program with questions 360-397-8182