Essay Sample on Disease Epidemiology

Introduction

For long time tuberculosis remained to be a disease of public health significance as evidenced by increased incidence and prevalence of the disease, increased risks of morbidity and mortality. Over the years, implementation of various public health strategies has remained vital in the now low incidence of the disease both in the United States and in different parts of the world. Foreign-born persons in the United States have the highest incidence of TB infection standing at 15.1 cases per 100,000 as compared to 1.2 cases per 100,000 for IS-born individuals (Salinas, 2016).

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In the year 2015, the Asians had the highest count of TB infections in the class of foreign-born individuals. The rate of infection of tuberculosis has however decreased by more than 67.6% as from the year 2000 showing good progress toward eradication of the disease (Scott et al., 2015). However, in terms of the incident rate of the infection, most countries that seem to have made significant improvements are the high-income countries while most African countries still have a very massive burden of the disease (Glaziou et al., 2015). According to the global report for Tuberculosis infection worldwide by the World Health Organization, South-East Asia and Africa regions account for up to 71.8% cases of tuberculosis infections.

In areas where the rate of disease infection is still high, there is a significant burden posed by the disease on the community. The condition continues to be the top cause of morbidity and mortality worldwide with about 9.6 and 1.5 million new cases and deaths every year respectively (Raviglione & Sulis, 2016). Countries also have to bear a high cost in buying drugs for management of the infection and recent development of the Multidrug-resistant TB (MDR) has not made conditions any better. HIV/AIDS which up to now still has no cure also remains one of the highest risk factor for the infection of tuberculosis, hence a massive burden on the affected regions.

Public Health Plans in Controlling the Disease

Mycobacterium tuberculosis is an obligate aerobe organism that survives intracellularly. It is a non-motile organism with a protective cell wall against lysosomal attacks consisting of mycolic acids, long chain glycolipids, and phospholipoglycans. There is the use of the term acid-fast organism in its description because it retains the fuchsin dye after rinsing with acid, remaining bright red after staining and one cannot use a gram stain on it. Antimicrobial agents used in the management of the disease as a public health plan include rifampicin, isoniazid, ethambutol, pyrazinamide, and streptomycin (Horsburgh, Barry & Lange, 2015). They each have different mechanisms all aimed at the elimination of the mycobacteria.

Isoniazid is bactericidal inhibiting cell wall and DNA synthesis. One has to give it concurrently with pyridoxine to minimize the side effects of causing peripheral neuropathy. Rifampicin works by inhibiting the DNA-dependent RNA polymerase thus bactericidal to the mycobacterium. The drug is a cytochrome enzyme inducer and may, therefore, increase metabolism of some drugs such as oral contraceptive pills thus reducing their effectiveness and hence caution in terms of dosage modifications necessary. One of its significant side effects to look out for in patients is the emergence of Stevens-Johnson syndrome. The drug pyrazinamide is bacteriostatic inhibiting mycobacterial cell wall synthesis and should not be for patients with gout and those with liver disease. Other drugs such as ethambutol interfere with the production of essential metabolites in the bacteria with a severe side effect of ocular toxicity, and finally, streptomycin is an aminoglycoside that works by inhibiting mycobacterial protein synthesis.

High Risk Groups

High-risk groups of individuals likely to get infected with TB include patients with HIV/AIDS due to an already suppresses immune status and therefore easy for the mycobacteria to replicate and cause disease manifestation (Glaziou et al., 2015). Health workers dealing with TB patients are also at an increased risk due to close contact with the patients and the fact that the mode of transmission of the disease is aerosol by inhaling the mycobacteria. Infants and under-five children are also at an increased group because of their immune system which has not developed fully. Finally, close contacts of individuals with TB also have an increased risk.

Various actions can be put in place to minimize infection of the disease in high-risk individuals. For HIV positive patients, it is necessary that health practitioners screen for TB and manage it early before the administration of antiretroviral therapy to minimize the development of the disease. For health-care practitioners, use of protective gears including facial masks is vital when dealing with TB positive patients. It is also critical that there is the isolation of TB positive patients to minimize spread to other patients. Finally, contact tracing for all individuals diagnosed with TB will help in the early identification of individuals at risk of the disease and appropriate management initiated.

Protection of Adults and Children

Among children, isolation from people with TB including family members is critical to reducing the spread of the infection. The administration of the BCG vaccine for all children immediately after birth remains to be one of the significant public health methods for prevention of TB infection among infants. Chemoprophylaxis with isoniazid is also a protective measure for protecting both adults and children from TB infections. There is no significant difference in the methods of protecting adults and children from TB infections as the mode of transmission is the same for them, yet it is the main stage targeted in preventive measures.

Most adults lie in the high-risk groups discussed in the high risks section, and therefore the prevention strategies will be the same. For instance, there is a necessity to screen all adults diagnosed with HIV for TB and manage them accordingly before the institution of ART. For adults working as health practitioners, use of protective gears including facial masks is vital when dealing with TB positive patients. Finally, health education through health promotion events on TB is significant in reducing the risks of TB infection.

Challenges in Implementing Public Health Plans against TB Infections

One major challenge in the implementation of public health plans described in the paragraph above is the lack of finance to support the implementation. Especially in third world countries, the lack of enough funds remains a crucial problem in the implementation of various public health plans. For instance, if focusing on isoniazid chemoprophylaxis, it will be hard for any country to spend money treating individuals who don't even have symptoms of TB at the expense of other more severe conditions such as malaria in the tropical countries.

Health policies are essential in promoting health (Glaziou et al., 2015), and in a country where there are no supportive health policies, it is difficult to implement different public health plans. For instance, a standard procedure for all patients diagnosed with HIV/AIDS according to the public health plan in context is to have them undergo screening to rule out TB first. For as long as there is no health policy supporting this act, very few health practitioners will commit to going out of their ways and screen HIV patients for TB before starting them on ART thus posing as a challenge in the public health plan implementation.Other obstacles would include lack of commitment by health-care practitioners and high levels of illiteracy, especially in third world countries.

What I Would Have Changed

If I was in position, one thing I would ensure is the involvement of different health-care providers including the public, private and voluntary providers in the promotion of the International Standards for Tuberculosis Care (ISTC). ISTC will be vital in reducing the risks of developing Tuberculosis infections. Another critical activity I would engage in is Health Promotion on TB. The target population will include patients in hospitals, students in learning institutions and use of community health workers more so in the rural areas. Through health promotion, it will be essential to inform individuals of the common symptoms of TB including productive cough and night sweats and mode of transmission of the disease. It is also necessary to educate people on the primary preventive measures such as creating a barrier with a handkerchief on the mouth while coughing to reduce the risk of transmission. In doing the stated things, I will be in a better position to control the disease.

References

Glaziou, P., Sismanidis, C., Floyd, K., & Raviglione, M. (2015). Global epidemiology of tuberculosis. Cold Spring Harbor perspectives in medicine, 5(2), a017798.

Horsburgh Jr, C. R., Barry III, C. E., & Lange, C. (2015). Treatment of tuberculosis. New England Journal of Medicine, 373(22), 2149-2160.

Raviglione, M., & Sulis, G. (2016). Tuberculosis 2015: burden, challenges and strategy for control and elimination. Infectious disease reports, 8(2).

Salinas, J. L. (2016). Leveling of tuberculosis incidence-United States, 2013-2015. MMWR. Morbidity and mortality weekly report, 65.

Scott, C., Kirking, H. L., Jeffries, C., Price, S. F., & Pratt, R. (2015). Tuberculosis trends-United States, 2014. MMWR. Morbidity and mortality weekly report, 64(10), 265.