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slides21 - Person-to-person transmission N ov 2 9 , 2 0 0 6...

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Person-to-person transmission Nov 29, 2006 Ch. 26
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Tuberculosis (TB) • Someone in the world is newly infected with TB bacilli every second • Overall, one-third of the world's population is currently infected with the TB bacillus • 5-10% of people who are infected with TB bacilli (but who are not infected with HIV) become sick or infectious at some time during their life
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Areas of Concern TB cases continue to be reported in every state Drug-resistant cases reported in almost every state Estimated 10-15 million persons in U.S. infected with M. tuberculosis - Without intervention, about 10% will develop TB disease at some point in life
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Transmission of M. tuberculosis Spread by droplet nuclei Expelled when person with infectious TB coughs, sneezes, speaks, or sings Close contacts at highest risk of becoming infected Transmission occurs from person with infectious TB disease (not latent TB infection)
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Pathogenesis 10% of infected persons with normal immune systems develop TB at some point in life HIV strongest risk factor for development of TB if infected - Risk of developing TB disease 7% to 10% each year Certain medical conditions increase risk that TB infection will progress to TB disease
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Conditions That Increase the Risk of Progression to TB Disease • HIV infection • Substance abuse • Recent infection • Diabetes mellitus • Silicosis • Prolonged corticosteriod therapy • Other immunosuppressive therapy
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TB Morbidity Trends in the United States From 1953 to 1984, reported cases decreased by an average of 5.6% per year From 1985 to 1992, reported TB cases increased by 20% Since 1993, reported TB cases have been declining again 18,361 cases reported in 1998
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Factors Contributing to the Increase in TB Morbidity: 1985-1992 Deterioration of the TB public health infrastructure HIV/AIDS epidemic Immigration from countries where TB is common Transmission of TB in congregate settings
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Factors Contributing to the Decrease in TB Morbidity Since 1993 Increased efforts to strengthen TB control programs that Promptly identify persons with TB Initiate appropriate treatment Ensure completion of therapy
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Persons at Higher Risk for Exposure to or Infection with TB Close contacts of person known or suspected to have TB Foreign-born persons from areas where TB is common Residents and employees of high-risk congregate settings Health care workers (HCWs) who serve high risk clients
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Testing for TB Disease and Infection
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Purpose of Targeted Testing Find persons with LTBI who would benefit from treatment Find persons with TB disease who would benefit from treatment Groups that are not high risk for TB should not be tested routinely
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Groups That Should Be Tested for LTBI Persons at higher risk for exposure to or infection with TB Close contacts of a person known or suspected to have TB Foreign-born persons from areas where TB is common Residents and employees of high-risk congregate settings Health care workers (HCWs) who serve high risk clients
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slides21 - Person-to-person transmission N ov 2 9 , 2 0 0 6...

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