Wanted: Leaders for a TB-Free United States

By Joseph Iser, MD, DrPH, MSc, Chief Health Officer, Southern Nevada Health District

This blog originally appeared in County Line Magazine

Every year on March 24 the health care community commemorates World TB Day to bring attention to a preventable disease that still impacts many people in the United States and around the world. This year’s theme is “Wanted: Leadersfor a TB-Free United States. We can make history. End TB.” It is a call for health care partners to work together on a local, national, and international scale to eliminate the disease.

Health care providers are instrumental in this process. For many patients, TB can present as a bad cold or respiratory infection that won’t go away. Physicians should always consider the possibility of TB when examining a patient with an ongoing respiratory infection, especially if it is accompanied by a persistent cough, night sweats, loss of appetite, and fatigue.

The risk of a missed diagnosis of TB disease can have widespread public health consequences. One case of active disease can result in a large-scale contact investigation that can sometimes impact hundreds of people in the community.

When initiating a contact investigation, the Southern Nevada Health District follows guidelines from the Centers for Disease Control and Prevention (CDC). Investigating potential contacts of active TB patients to identify and treat those identified with latent TB infection (LTBI) is a proven strategy for the control and elimination of TB.

As the leading provider of TB services in Southern Nevada, the Health District’s Tuberculosis Treatment and Control Clinic offers programs to ensure people with active TB disease are treated and that people who are exposed to TB are evaluated and treated, if appropriate, to prevent the further spread of the disease. In addition to testing and treatment, clinic staff members provide specialized case management services to assure that patients with active and suspect TB disease receive individualized patient care. Directly observed therapy (DOT) is a standard of care to promote adherence and completion of TB treatment, and it is offered to active and suspect TB patients.

The Health District’s TB Clinic staff also work with health care partners to provide information and education on detection, treatment, and prevention. Providing education to both clients and medical providers is a fundamental component of TB control and a continuing priority for the Health District.

The TB program is committed to quality improvement. To this end, the program conducts evaluations of its clinical activities to promote and improve the outcome of treating clients until cured. Staff conduct weekly case reviews using a multi-disciplinary team consisting of TB clinic nurses, TB nurse case managers, medical providers, and disease investigation and intervention specialists. Quarterly TB cohort reviews are conducted to evaluate the delivery of care to patients and improve patient outcomes. The cohort review process analyzes treatment outcomes of every TB case to assist with ongoing quality improvement efforts.

Nationwide, the CDC reports there were a total of 9,272 TB cases in 2016. This is a decrease from the number of cases reported in 2015 and the lowest case count on record in the United States. In Clark County, there were 62 cases in 2017, an increase from 46 cases in 2016.

World TB Day is an opportunity to shine a light on this critical issue for one day a year. As health care professionals, we have a responsibility to incorporate TB awareness and education into our practice every day. Working together we can end TB.

For more information about the Health District’s TB Treatment and Control Clinic go to our website at www.southernnevadahealthdistrict.org/tb/index.php. For additional information on World TB Day 2018 visit the CDC site at www.cdc.gov/tb/worldtbday/default.htm.