The Deadliest Infectious Disease
The fight against tuberculosis (TB) continues
Today, the news headlines will be filled with the Coronavirus pandemic — appropriately so. In the two weeks since the World Health Organization (WHO) declared the outbreak a pandemic the number of cases has almost quadrupled globally, to over 400,000 confirmed cases.
Today is also World Tuberculosis Day. Tuberculosis, or TB as it is often abbreviated, is one of the world’s oldest known diseases. It causes progressive damage to the lungs, and can also affect other parts of the body, such as the brain, kidneys, or spine. Before the Spanish Flu in the 20th century, pandemic TB ravaged the world, killing about a quarter of Europe’s adult population in the 19th century.
On this day in 1882, Dr. Robert Koch — a Nobel Prize-winning German physician — discovered the bacteria that causes tuberculosis. Prior to Dr. Koch’s discovery, many believed that TB was an inherited, rather than infectious, disease. Antibiotics to treat TB would not be discovered until the 1950s, but Dr. Koch’s discovery was nonetheless vital to opening a path for the diagnosis and treatment protocols we have today.
Today, with access to the right medical support and antibiotics, most cases of both latent and active tuberculosis can be treated and cured. Latent TB occurs when a person is infected with TB, but does not show signs of the active disease. Without the appropriate treatment, latent TB can progress to active TB, which can be fatal.
Treatment for TB requires taking multiple drugs for a duration of 6–9 months, continuing even after initial symptoms have improved. When this treatment is interrupted — which may happen if the treatment is too costly or hard to access — then the bacteria can become resistant to the treatment drugs. Multidrug-resistant tuberculosis (MDR-TB) is a form of the disease resistant to at least the two most potent anti-TB drugs: isoniazid and rifampin. Extensively drug-resistant tuberculosis (XDR-TB) is resistant to at least four of the core anti-TB drugs. MDR-TB and XDR-TB are significantly harder to treat than drug-responsive tuberculosis.
Today, TB is the world’s single most deadly infectious disease, leading to over 4000 deaths per day (1.5 million annually). TB occurs in every country in the world, but the vast majority of cases and deaths are in developing countries. It is an opportunistic disease, occurring more often and more severely in people with weakened immune systems. As a result, HIV and TB co-infection is a major concern, with TB being the major cause of death for HIV-infected people across the world.
Here are two of the initiatives BHI is supporting in the global fight against TB:
Fighting Hospital-Acquired Infections
While hospitals are expected and intended to be places of care and healing, they can also be unintended reservoirs for tuberculosis and other diseases. Globally, healthcare workers are between 2.4 and 3.7 times more likely to contract tuberculosis than the public. A study of physicians working in Peruvian hospitals found that the incidence of TB among healthcare workers was 10–12 times higher than that of the public.
Reducing the risk of nosocomial infections is a key consideration whenever BHI designs healthcare facilities. One of the ways BHI reduces this risk through our designs is with the use of upper-room ultraviolet germicidal irradiation (UVGI) fixtures. UVGI fixtures are ceiling- or wall-mounted units that, when installed and maintained properly, emit UV-C radiation and act as a passive means of sterilizing pathogens from the air. In BHI’s designs, UVGI fixtures are combined with other elements — such as passive or active ventilation, and temperature and humidity controls — to maximize airflow and disinfection.
New Research & Treatment Infrastructure
Infrastructure’s important role is often understated in the fight against global disease. For Peru, the Center for Global Health — a project of Socios En Salud (Partners In Health) — will mark a turning point in the management and the treatment of tuberculosis and other infectious diseases. Designed by BHI, the three-story diagnostic and treatment complex will provide both outpatient and inpatient services for patients fighting tuberculosis. It will also include a research center and BSL-3 laboratory to allow for the diagnosis of other infectious diseases, including HIV, hepatitis, meningitis, cholera, Zika, and chikungunya.
In Peru, there are over 30,000 new cases of tuberculosis annually, including 4,700 cases in children. Socios En Salud grew out of a fight against TB in the slums of Carabayllo, north of Lima, in 1996. Today, Socios En Salud provides treatment for patients with extensively drug-resistant TB (XDR-TB) from across the country, as well as providing TB care in more than 20 hospitals, 300 health centers, and 16 prisons. “The idea is to make this a great complex where we can provide the best standard of care using all of our combined experience,” says Dr. Leonid Lecca, a renowned tuberculosis expert and Executive Director of Socios En Salud. “We can then say to the world, ‘Here, all TB patients are cured. Here no patient abandons treatment.’”
Ela Hefler is Build Health International’s Development & Communications Specialist. She writes about the intersections of health and infrastructure, with a focus on the impact of BHI’s work on fragile health systems.
