TUBERCULOSIS

By Elizabeth Peck, Zoe Ellis and Gareth McKnight

(Akst, 2019)
 INTRODUCTION
This presentation will discuss:
• What is Tuberculosis (TB)?.
• How it affects the patient.
• Public health concerns.
• National strategies to combat the spread of TB.
• Local strategies to combat the spread of TB in Ealing.
• The role of the community nurse.
• References.
 WHAT IS
TUBERCULOSIS (TB)?
• Air born bacterial infection caused by Mycobacterium tuberculosis
• Two types of TB:
Latent – patients who are infected but do not express
symptoms
Active – where the infection spreads and allows symptoms to
develop.
• Up to 10% of people who have latent TB will develop active TB.
(NHS, 2016)

(Optima, 2019)
 HOW IT AFFECTS THE
PATIENT
• Long treatment periods: Initial phase last 2 months and then the continuation
phase lasts 4 months.
• Numerous tablets, some very large and all have numerous side affects.
Some being very harsh on the individual taking them.
• Feeling of isolation from family and friends.
• General un-wellness as indicated by the previous slide and pain.
• Informing work and or educational areas of prolonged contact with an active
TB carrier who has been in close contact with other members of their team or in
the school.
• Time absent from work and or school, leading to financial worries. (Sampath, 2015)
(TB alert,2018)
 PUBLIC HEALTH CONCERNS
• WHO estimates 1.5 million deaths linked to TB globally in 2018.
• 484,000 cases of multi-drug resistant TB (MDR-TB)
(World Health Organisation, 2019)
• 4655 New cases in England in 2018.
• A decline of 8%, approximately 415 fewer cases from 2017.
• 2001-2014, between 387 and 518 TB deaths per year.
• 1.5% of TB cases in UK MDR-TB in 2015.
(Public Health England, 2019a)
• 1,919 TB cases in London in 2017, 12% reduction from 2016.
• TB rate in London (21.7 per 100,000) is over twice the rate of that for England (9.2 per 100,000)
(Public Health England, 2019)
 NATIONAL STRATEGIES TO COMBAT THE
SPREAD OF TB.
• Improving early diagnosis by making services more easily accessible.
• Ensuring universal access to high quality diagnostics for all service users.
• Enhancing treatment and care services.
• Ensure all service users maintain continuity of care and continued contact with service
providers.
• Improve BCG vaccination uptake where appropriate.
• Reduction of incidence of drug-resistant TB.
• Tackling TB in at risk communities.
• Methodically screening new entrants for latent TB.
• Enhance on going surveillance and monitoring of TB.
• Maintaining appropriate staffing to deliver effective TB control.

(Public Health England, 2015)

• England is now at an all time low of reported tb cases, since the Mid 80’s when records began.
Although, due to inequality the rate of TB is six times higher amongst the most deprived 10% of
the population.

• TB rates among people born inside the UK remain 14 times lower then those born outside the UK

• 13% of patients with TB will have at least one social risk factor for the illness i.e. a history of
substance misuse, homelessness, or time spent in prison.

• TB remains concentrated in major cities with London experiencing over 36% of cases.

• Almost 30% of people with pulmonary form of TB, the potentially infectious form of the disease,
experienced had a delay of four months or more between start of symptoms and the beginning of
treatment.

(Public Health England, 2019a)

 LOCAL STRATEGIES TO COMBAT THE
SPREAD OF TB IN EALING
• Increasing understanding and awareness of TB in the local community.
• Improving outreach work to better enable vulnerable groups and local communities to access
services.
• Screening new entrant members and new GP patients in groups of higher risk within two-five
years of entry into the UK for TB and/or latent TB.
• Supporting patients with a TB diagnosis to complete their course of treatment, focusing on
those receiving treatment in hospitals in other areas. Strengthening communication and
organisation of care between Ealing and the other TB services should be treated as a priority.

(Dr Wakhisi ,2014)

TB incidence in Ealing remains one of the highest in London and the North West
sector.

Table 1: Number/rate per 100,000 population of new TB notifications in North West sector residents by local authority and year of
notification – reported to the London TB register.

Local Authority of 2010 2011 2012 2013 Year Ending

residence 31/03/2014
No. Rate No. Rate No. Rate No. Rate No. Rate
Brent 297 97.4 313 100. 309 98.2 283 89.9 267 84.9
2
Ealing 210 62.9 247 72.8 247 77.5 214 62.8 207 60.8
Hammersmith & Fulham 54 29.9 68 37.3 46 25.6 48 26.7 48 26.7
Harrow 137 57.7 153 63.6 184 75.9 147 60.8 142 58.6
Hillingdon 126 46.8 132 47.9 140 49.7 101 35.8 110 39
Hounslow 192 77 185 72.6 197 74.1 165 63.7 153 59.1
Kesington & Chelsea 36 22.4 47 29.7 33 21.2 37 23.7 40 25.7
Westminster 63 29 68 31 54 24.1 61 27.2 61 27.2
North West 1115 57.1 1213 61.2 1205 60.3 1056 52.8 1028 51.4
London 3257 40.4 3519 42.9 3423 41.2 3017 36.3 2925 35.2

(Dr Wakhisi ,2014)

 ROLE OF THE COMMUNITY NURSE
Tuberculosis community nurses have many different roles to play when it comes to managing TB in
the local community including detection, treatment, side effects and symptom control as well as :
(NMC, 2018)

• Testing and Immunisations. (NMC, 2018)

• Epidemiology. (NMC, 2018a)
• Education. (NMC, 2018b)
• Communication and translation services. (NMC, 2018c)
• Access to specialised services such as immigration, counselling, housing services and
specialised fast track medical services. (NMC, 2018d)
• Giving emotional support to the infected individual as well as family members and friends, this
includes empathy, understanding, not isolating a patient mentally and maintaining their
confidence in the process. (NMC, 2018e)
•
REFERENCES
Akst. J (2019) First New Tuberculosis Drug Approved in 50 Years Available at: https://www.the-scientist.com/news-
opinion/first-new-tuberculosis-drug-approved-in-50-years-66278 (Accessed 05/11/19)
• Dr Wakhisi. A (2014) Tuberculosis, Chapter 7: Strengthen the Role & Impact of Ill Health Prevention, Page 2 Available at:
https://www.ealing.gov.uk/downloads/file/13892/tuberculosis_-_jsna_2014 (Accessed 05/11/19)
• Health committee (2015) Tackling TB in London’. Page 7 Available at:
https://www.london.gov.uk/sites/default/files/FINAL_TacklingTBinLondon.pdf (Accessed 05/11/19)
• TB Alert (2018) Side effects, Available at: https://www.tbalert.org/about-tb/global-tb-challenges/side-effects/ (Accessed
05/11/19)
• National Health Service (2016) Causes , tuberculosis TB Available at: https://www.nhs.uk/conditions/tuberculosis-
tb/causes/ (Accessed 05/11/19)
• Nursing and Midwifery Council (2018), The Code Page 9, Section 6 Available at:
https://www.nmc.org.uk/standards/code/ (Accessed on 5/11/19)
• Nursing and Midwifery Council (2018a), The Code Page 11, Section 10. Available at:
https://www.nmc.org.uk/standards/code/ (Accessed on 5/11/19)
• Nursing and Midwifery Council (2018b), The Code Page 10, Section 9. Available at:
https://www.nmc.org.uk/standards/code/ (Accessed on 5/11/19)
• Nursing and Midwifery Council (2018c), The Code Page 9, Section 7. Available at: https://www.nmc.org.uk/standards/code/
(Accessed on 5/11/19)
• Nursing and Midwifery Council (2018d), The Code Page 10, Section 8. Available at:
https://www.nmc.org.uk/standards/code/ (Accessed on 5/11/19)
• Nursing and Midwifery Council (2018e), The Code Page 7, Section 3. Available at: https://www.nmc.org.uk/standards/code/
(Accessed on 5/11/19)
• Public Health England, (2015) Collaborative tuberculosis strategy for England: 2015 to 2020. Available at:
https://www.gov.uk/government/publications/collaborative-tuberculosis-strategy-for-England (Accessed on 5/11/19)
• Public Health England, (2019) Tuberculosis in London Annual review (2018 data). Available at:
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/833288/TB_2018_L
ondon.pdf (Accessed on 05/11/19)
• Public Health England, (2019a) Tuberculosis in England 2019 report: executive summary, Available at:
https://www.gov.uk/government/publications/tuberculosis-in-england-annual-report (Accessed 05/11/19)
• World Health Organisation, 2019, Global Tuberculosis Report 2019. Available at: https://www.who.int/tb/global-report-
2019 (Accessed 05/11/19)

Pictures:
• Optima (2019) TB Signs and Symptoms. Available at: http://www.optimabloem.co.za/world-tuberculosis-day/tb-signs-and-
symptoms/ (Accessed 05/11/19)
• Sampath. P (2015) World Tuberculosis Day 2014: Revolutionary medicine — doctor treats MDR-TB patients with leprosy
drugs. Available at: https://www.thehealthsite.com/diseases-conditions/world-tuberculosis-day-2014-revolutionary-medicine-
doctor-treats-mdr-tb-patients-with-leprosy-drugs-137084/ (Accessed 05/11/19)