1. Tuberculosis for Addiction Counselors
Catherine Kroll, MPH, CPH

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

3. 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

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

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

6. 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

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

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

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

10. 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

11. 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

12. 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

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

14. What can I do?
Work within your program to refer symptomatic people for confidential testing
Get tested annually
WAC
Call Clark County Public Health TB Program with questions