Tuberculosis: epidemiology, transmission, and treatment

Scope and Depth of the Problem
One of the top ten causes of death worldwide, tuberculosis kills almost two million people per year (World Health Organization, 2018). Viewed another way, the Centers for Disease Control and Prevention (CDC, 2018) claims that one quarter of the world’s population is currently infected with tuberculosis. The number of cases in the United States has declined slowly, and is currently less than 10,000 (CDC, 2017a). All fifty states reported at least one case of tuberculosis in 2016 (CDC, 2017b). Worldwide, though, there are about 10 million new cases each year as of 2016, the majority of which occur in just seven countries: India, Indonesia, China, Philippines, Pakistan, Nigeria, and South Africa. Tuberculosis is preventable when diagnostic and treatment interventions are available. The infection can also remain latent and non-contagious. However, there are some tuberculosis strains that have been becoming drug-resistant, impeding the effort to eliminate the disease (CDC, 2017b). Moreover, the latent form of the disease can develop into an active, and contagious, infection (“Tuberculosis (TB) Fast Facts,” 2018). Although tuberculosis infection rates have been falling, they are falling relatively slowly, revealing both the scope and depth of the problem.
International and National Impact 
Progress in meeting the goal of eliminating tuberculosis has been sluggish, both in the United States and worldwide. In the United States, the rates of new infection and also rates of death from tuberculosis have declined but slowly. Foreign born persons in the United States are at a higher risk for tuberculosis infection with top five countries of origin being Mexico, the Philippines, India, Vietnam and China (TB Statistics United States, n.d.). The international impact of tuberculosis is much more serious than the national impact, although much care and attention should be placed on reducing infection and death rates domestically. Although the United States is considered a “low burden” country in terms of lowest rates of new infections as well as lowest mortality rates, the stagnant numbers do represent a persistent issue that needs to be addressed in public health reform (“TB Statistics United States – National, drug resistance & state,” (n.d.).
The largest number of new tuberculosis cases occurs in Asia (45% of new cases), with Africa second at 25% of new cases (World Health Organization, 2018). High burden tuberculosis countries in addition to the top three of India, China, and Indonesia include Nigeria, Pakistan, South Africa, Bangladesh, Philippines, DR Congo, Ethiopia, Myanmar, UR Tanzania, Mozambique, Viet Nam, Russian Federation, Thailand, Kenya, Brazil, Uganda, Afghanistan, Cambodia & Zimbabwe (“TB Statistics United States – National, drug resistance & state,” n.d.). Therefore, the international impact of tuberculosis disproportionately affects developing nations, but the disease can easily spread to low burden countries like the United States via migration and travel.
Past and Present Efforts of Agencies
Formerly known as consumption, tuberculosis has been a known issue addressed by public health agencies for centuries. The World Health Organization made the first concerted efforts to eradicate the disease using the tools of public health administration and epidemiology (“Tuberculosis (TB) Fast Facts,” 2018). Declared a “global emergency” in 1993, tuberculosis cases did drop due to the World Health Organization’s robust efforts at distributing medications and staffing healthcare institutions with personnel capable of making accurate diagnoses as well as raising awareness about the disease and how to prevent it. By the year 2000, the World Health Organization could attribute the reduced rates of infection in Africa to its efforts (“Tuberculosis (TB) Fast Facts,” 2018). However, tuberculosis remains a problem worldwide and especially in Asia.
Current efforts of agencies still include the World Health Organization at the helm, leading the world in infectious disease prevention and amelioration programs. Unfortunately, the proliferation of drug-resistant tuberculosis stymies best efforts. Until the development of new pharmaceutical interventions become available for treating active tuberculosis, the disease may remain prevalent at its current stages. The World Health Organization does boast the current use of new faster diagnostic procedures that may help reduce the numbers of infections and reduce mortality rates worldwide (“Tuberculosis (TB) Fast Facts,” 2018). In the United States, current public health efforts are spearheaded by the Centers for Disease Control and Prevention (CDC). The biggest CDC setback occurred in 2011, when hundreds of patients and staff members were exposed to the disease (“Tuberculosis (TB) Fast Facts,” 2018).
Existing Disparities
Tuberculosis is an example of social disparities in health and healthcare, revealing the social determinants of health. Almost all (95%) of tuberculosis deaths occur in low or middle-income countries (World Health Organization, 2018). Tuberculosis disproportionately kills persons with HIV, with 40% of all HIV deaths being attributable to tuberculosis (World Health Organization, 2018). Disparities in disease prevalence are evident within the United States, too. Tuberculosis disproportionately infects and kills non-white minorities, with Asians bearing the brunt of tuberculosis cases, followed by Native Hawaiians and other Pacific Islanders (CDC, 2017b). Whites have the lowest rates of infection in the United States. Contributing factors may be related to access to effective diagnostic procedures, as well as to treatment options both for the latent and manifest forms of the disease. Offering additional screening for the foreign born and persons with HIV infections may also help reduce infection and mortality rates domestically and internationally to reduce overall disparities.






References

CDC (2018). Data and statistics. https://www.cdc.gov/tb/statistics/default.htm
CDC (2017a). TB Incidence in the United States, 1953-2016. https://www.cdc.gov/tb/statistics/tbcases.htm
CDC (2017b). Trends in tuberculosis. https://www.cdc.gov/tb/publications/factsheets/statistics/tbtrends.htm
“TB Statistics United States – National, drug resistance & state,” (n.d.). TB Facts. https://www.tbfacts.org/tb-statistics-united-states/
“Tuberculosis (TB) Fast Facts,” (2018). CNN. https://www.cnn.com/2013/07/02/health/tuberculosis-tb-fast-facts/index.html
World Health Organization (2018). Tuberculosis: key facts. http://www.who.int/news-room/fact-sheets/detail/tuberculosis