Introduction
Tuberculosis (TB) is a disease caused by the Mycobacterium tuberculosis bacteria that predominantly affects the respiratory system, the lungs specifically. While TB is preventable is curable, its spreading occurs from one person to another through the air. When an individual with tuberculosis in their cough sneezes or spits, they propel the germs of the disease into the air, which may be inhaled by others who, in turn, get infected. Notably, individuals who get infected but do not get ill with tuberculosis cannot transmit it to others.
It is notable that TB predominantly influences adults in their most productive years, even though all age groups are at risk of developing it. WHO (2022) reports that individuals diagnosed with HIV are sixteen times more likely to develop active tuberculosis. Moreover, the risk of the active stage of the disease is also higher in people who suffer from immune system-impairing conditions, which can range from one person to another. In general, the impairment of well-being through accompanying factors, such as alcohol or tobacco use, undernutrition, and others. It should be noted that the incidence of TB reached its peak in 2003 and has been declining slowly since that time.
Factors Contributing to TB Resurgence
The resurgence of tuberculosis in recent decades has been attributed to globalization and the factors associated with the socioeconomic situation within a specific context. For instance, migration to such countries as the United States of individuals from developing regions may increase the risks of TB burden development (Menzies et al., 2018). Even though there were increasing efforts to strengthen services of TB prevention in high-risk countries, their success has been variable and could not guarantee decreased incidence of the disease (Menzies et al., 2018). Moreover, individuals from developing countries may have undiagnosed HIV, as well as disadvantaged persons, and the prison population. All of these population groups contribute to the higher risks of tuberculosis infection because their immunity status makes them more susceptible to Mycobacterium tuberculosis and its adverse impact on the lungs and body in general.
Comparison of Statistics: Worldwide, USA, South Carolina
Even though in the recent two decades, the incidence of TB across the world has been decreasing, comparing the statistics on the disease in different locations may speak volumes about the current situation. The World Health Organization (WHO, 2022) estimated that around a quarter of the global population has been infected with the bacteria TB, even though most of them would not develop the disease, and some will clear the infection. According to the WHO (2021) epidemiology report, more than 1.7 billion people are estimated to be infected with TB.
Among United States-born persons, cases per 100,000 population increased from 0.71 in 2020 to 0.79 in 2021, and among non-US-born persons, the incidence increased from 11.71 to 12.16 in the same years (Filardo et al., 2022). The significant difference between the two population groups is indicative of the trend that in countries that have a lower quality of healthcare, there are limitations in early diagnosis with symptoms onset, which results in ongoing underdiagnosis of the condition.
In South Carolina, the incidence rates of tuberculosis have been decreasing in the period between 2017 and 2021, according to the S.C. Department of Health and Environmental Control (DHEC, 2022) findings. Among all counties, the highest total of cases fell in the Lowcountry, with the 2021 number of cases totaling 32 (DHEC, 2022). The lowest total number of cases in 2021 occurred in Pee Dee country, with 13 cases in total (DHEC, 2022). When comparing the rates of disease over time, the state total decreased from 2.0 per 100,000 in 2017 to 1.7 per 100,000 in 2021 (DHEC, 2022). The national total for 2021 was 2.4 per 100.000 (DHEC, 2022), which shows that South Carolina has a lower rate of TB compared to the nationwide indicators.
Persisting Challenges to TB Control
The persisting challenges that prevent the control of TB both in the USA and globally cover several areas, which include limitations in diagnosis and treatment, the need for WHO Direct Observed Therapy (DOTS) expansion, HIV coinfection, and multidrug-resistant tuberculosis (MDRTB). For example, the tools used for TB diagnosis tend to be ineffective and outdated, while the majority of labs also lack the facilities for identifying MDRTB (Xi et al., 2022). Notably, MDRTB is a significant public health issue that represents an associated risk factor that is crucial for the development of effective strategies for TB control (Xi et al., 2022). Therefore, an improvement in the diagnostic methods is necessary for addressing challenges in the timely identification of the disease.
In terms of public health initiatives, the WHO DOTS program should be expanded to all countries worldwide and include not only individuals with positive smear tests but also lower-priority individuals with chronic TB or MDR-TB. Preventing MDRTB is possible through rapid case diagnosis, the following of suggested treatment guidelines, monitoring treatment responses, and ensuring that therapy is completed (Jang & Chung, 2020). The implementation of programs on a broader scale is necessary to maintain the relevance of TB in the global agenda, especially due to recent delays in diagnosis and treatment associated with the COVID-19 pandemic that was the focus.
HIV coinfection remains a significant challenge to the control of TB because it increases the risks of getting infected with the disease. Globally, tuberculosis is the leading cause of death among individuals diagnosed with the human immunodeficiency virus, which compromises the immune system of the affected person (HIV Info, 2021). Therefore, all people with HIV must undergo regular testing for TB infection for early diagnosis and treatment. It should be noted that the treatment can be complicated because of the comorbidities that HIV-infected individuals have, which is why it is recommended that such patients be carefully monitored. Considerations of drug-drug interactions are imperative to prevent any side effects and treatment limitations.
Conclusion
To conclude, tuberculosis is a global health challenge that remains to be addressed through a systematic approach to treatment and diagnosis. More attention must be given to issues of prevention, early diagnosis, and practical and complete treatment. The support of the advanced healthcare community should be given to countries where healthcare quality is at a lower level, which facilitates increased TB cases due to the limitations in diagnosis. For example, among US residents, non-US-born individuals have a significantly higher TB incidence compared to US-born persons. Persons with coinfections and conditions that compromise their immunity should be given special attention in TB prevention efforts. Overall, the assessment and reporting of the TB epidemic status and its development can facilitate responses at levels of healthcare.
References
DHEC. (2022). South Carolina tuberculosis incidence rates by county, 2017-2021. Web.
Filardo, T. D., Feng, P. J., Pratt, R. H., Price, S. F., & Self, J. L. (2022). Tuberculosis – United States, 2021. MMWR. Morbidity and mortality weekly report, 71(12), 441–446. Web.
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Jang, J. G., & Chung, J. H. (2020). Diagnosis and treatment of multidrug-resistant tuberculosis. Yeungnam University Journal of Medicine, 37(4), 277–285. Web.
Menzies, N. A., Hill, A. N., Cohen, T., & Salomon, J. A. (2018). The impact of migration on tuberculosis in the United States. The International Journal of Tuberculosis and Lung Disease: The Official Journal of the International Union against Tuberculosis and Lung Disease, 22(12), 1392–1403. Web.
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Xi. Y., Zhang, W., Qiao, R-J., & Tang, J. (2022). Risk factors for multidrug-resistant tuberculosis: A worldwide systematic review and meta-analysis. PLoS ONE, 17(6). Web.