Tuberculosis

Watching tuberculosis (TB) ravish populations in 2007 is like watching history repeat itself. A hundred years ago, TB was the most dreadful disease of its day, with no vaccine, cure or effective treatment. Patients were sent to sanatoriums not just to rest and get the fresh air that was thought to help fight TB, but also to take them out of circulation, preventing the disease’s spread to family members. Then in the 1940s came the wonder drugs—antibiotics—one of which proved immediately effective at killing TB bacteria. Suddenly TB became not only manageable, but curable, and by the 1970s was on its way to becoming an endangered disease.

Well, it’s back, now reeking havoc in the developing world largely because of HIV—a virus that attacks the immune system and makes anyone with it more likely to become sick with tuberculosis. As HIV has skyrocketed around the world so has TB. In 1993, the World Health Organization (WHO) declared it a global emergency and last year helped launch the “Global Plan to Stop TB” —a mission that, the WHO hopes, will cut rates dramatically over the next decade. Although it hardly seems possible, the WHO estimates that up to one-third of the world’s population—over two billion people—is now infected with TB bacilli.

In fact, it is entirely too possible to rack up such shocking statistics, mostly because of the technical way TB bacteria operate. The one-third estimate includes all people who are thought to have been infected with the bacteria but are not actually sick with TB disease. Most people who get infected won’t even know it, because when TB bacteria are inhaled from an openly sick person, the microbes can lie dormant in the lungs for years, sometimes a lifetime. Only five to 10 percent of non-HIV infected people will become ill with TB. While there are other forms of TB (it can grow in organs and tissue), only pulmonary TB, or TB of the lung, is really contagious. It’s also the most prevalent form worldwide.

Luckily for travellers, although TB is endemic in many countries and transmitted person-to-person, it’s harder to catch than most infectious diseases. You can’t get TB through toilet seats or handshakes, or by sharing glasses, dishes, towels or clothes. Only someone with active TB—who is exhibiting symptoms—is contagious to other people, when the bacteria are present in sputum and spit and get passed by coughing, sneezing, shouting or laughing.

The bad news is that people travelling to regions where TB is widespread are identified as a high risk group (though paradoxically, TB is considered low risk to travellers). This can be of concern for two reasons. If you have unknowingly inhaled TB bacteria on your round-the-world dream trip, there’s a chance you’ll become sick during your lifetime, if for some reason your immune system is weakened. Age can do this, so can alcohol or drug abuse, and chronic conditions like diabetes and cancer. Suddenly that little cluster of bacteria walled off in your lungs when you were 25 and backpacking through south-east Asia starts to grow. Secondly, while certain antibiotics are used to treat TB, they’re becoming less effective each passing year. Drug-resistant TB is a major obstacle in the fight against the disease, in some places compromising chances for survival. Perhaps the best reason to avoid getting infected is that by the time you may need treatment, a cure may no longer be so firmly guaranteed.

Symptoms of Active Pulmonary Tuberculosis

• Persistent cough that lasts three or more weeks, chest pain when you cough, fever, night sweats, chills, weight loss, loss of appetite, fatigue; in extreme cases, coughing up blood. See doctor immediately if you have these symptoms, even if travelling.

TB Treatment

• For latent TB infection (have bacteria but are not sick): mono-drug regime of one antibiotic for up to nine months.
• For Active TB: multi-drug, multi-antibiotic regime, for at least six months or longer.

TB & Air Travel

• Risk is present, but minimal. Centers for Disease Control and Prevention say that there are few documented cases of airline passengers contracting TB after long flights, and only when seated near someone with active TB. You can’t get it through the ventilation system, as most modern planes have air filters that capture microbes, and air itself circulates in sections.

High TB Regions By Percent of Total Global TB Cases

• South-East Asia (33%), Africa (29%, but with sub-Saharan Africa having the highest per capita rate in the world), Western Pacific (22%).

High TB Burden Countries (not including Africa)

• Afghanistan, Cambodia, India, China, Bangladesh, Vietnam, Indonesia, Pakistan, Philippines

Check out our Q&A with Dr. Elizabeth Rea on Page 2…