What is tuberculosis?
Tuberculosis is an infectious disease caused by mycobacterium tuberculosis (bacteria of the Mycobacterium tuberculosis complex).
Tuberculosis of the lungs is the most common, but the disease can also affect other organs and body systems (such as the kidneys, spine, or brain) in addition to the hair and nails.
How can you get infected?
Tuberculosis (TB) is transmitted from a person who has an open form of TB (with active bacteremia) to another person by airborne droplets, that is, with drops of saliva or mucus during coughing, talking, and sneezing. The risk of infection depends on the duration and intensity of contact and the amount of bacteria inhaled by a healthy person. The probability of developing the disease after contact with bacteria depends on the state of the immune system. If it is not able to contain the infection, tuberculosis develops.
Latent tube infection and tuberculosis
The TB bacterium can "live" in the body without causing the development of the disease. This is called latent tubinfection (LTBI).
Persons with LTBI:
TB disease
The tuberculosis bacterium becomes active if the immune system cannot stop its spread. When the TB bacterium is active (that is, multiplying in the body), it is called TB disease. In this case, symptoms develop, and the patient can infect others until he receives adequate therapy.
Many people with LTBI will never develop the disease. In some patients, the disease develops quickly: within a few weeks after infection - before the immune system begins to fight the bacteria. Others may become ill years later when the immune system weakens for other reasons.
For people with a weakened immune system, especially for those infected with HIV, the risk of developing TB disease is much higher than for people with a normally functioning immune system.
What are the symptoms of the disease?
Symptoms depend on which organ or system is affected. Most often, tuberculosis bacteria infect the lungs. In this case, the following symptoms may be observed:
– cough lasting 3 weeks or more
– chest pain
– coughing up blood
Other possible symptoms of tuberculosis:
– weakness or fatigue
– weight loss
– lack of appetite
– chills
– fever
– profuse sweating at night
There may also be symptoms from other affected organs and systems: for example, back pain in the case of TB of the spine or blood in the urine in the case of TB of the kidneys.
Individuals with latent tubinfection have no symptoms and cannot infect others.
Most people with LTBI will never develop their own TB disease. However, the chances are high for certain groups, namely:
- HIV-infected;
– babies and small children;
- persons with diseases that weaken the immune system;
– patients with diabetes and chronic kidney diseases;
- elderly people;
- persons who did not receive adequate TB therapy in the past.
If the patient is at risk of developing an active form of the disease, the doctor prescribes chemoprophylaxis.
How to diagnose latent tubal infection (LTBI)?
LTBI in Ukraine is diagnosed using the Mantoux test. (At the patient's request, instead of the Mantoux test, he can conduct a quantiferon test at his own expense). Most often, LTBI is recorded in children. It is important to take into account that the Mantoux test is not routinely performed on all children. A pediatrician or family doctor uses a screening questionnaire to determine the need and conduct a Mantoux test, which can be found in the appendices to the order of the Ministry of Health No. 102. In the presence of risk factors, the child is referred for a Mantoux test. In the case of a positive test result, the child should undergo a phthisiatrician's consultation and, if necessary, receive prophylactic treatment so that LTBI does not turn into an active form of the disease. X-ray examination is not indicative for the diagnosis of LTBI and cannot replace the Mantoux test or the quantiferon test.
How serious is the disease? What complications are possible?
Tuberculosis is a curable disease, the success of the treatment depends on the timely initiation of effective medication and the patient's discipline in following all the doctor's recommendations and taking medication regularly. However, if not treated, tuberculosis can lead to serious consequences, including death. For example, the chances of such a development of events are high in the event that a child in the first year of life falls ill with tuberculous meningitis or miliary tuberculosis.
The following complications of TB are possible:
- back pain;
– joint damage (tuberculous arthritis);
– inflammation of the meninges (tuberculous meningitis);
- malfunction of the liver and kidneys;
- heart failure.
Tuberculosis develops in approximately 10% of people infected with tuberculosis bacteria. People with weakened immune systems (due to chronic diseases or taking certain medications) and young children are especially susceptible to tuberculosis, as their immune systems are not yet formed. BCG vaccine is used to protect the child from severe forms of tuberculosis.
How can you protect yourself from tuberculosis?
Unfortunately, there is no universal vaccine that would prevent all forms of tuberculosis. Although scientific developments in this direction are being conducted.
Today, in the arsenal of medicine there is a BCG vaccine against severe, generalized forms of tuberculosis, such as tuberculous meningitis and miliary tuberculosis. They are especially dangerous for children of the first year of life.
Without vaccination with the BCG vaccine, the risk of a fatal case in a child who contracts this type of tuberculosis reaches 92%. That is why this vaccine is administered so early — on the 3-5th day of a baby's life. This is the recommended age for vaccination, but children older than 5 days can and should also be vaccinated. If vaccination was not carried out before 2 months of life, the Mantoux test is used to assess the need for vaccination: BCG vaccination is carried out only if the test result is negative. Revaccination with the BCG vaccine is currently not recommended because its effectiveness has not been proven, so this vaccination is given once in a lifetime. During life, a person vaccinated with BCG may get tuberculosis, but will not have a generalized form of TB with multiple lesions of several organs. It is important to note that the BCG vaccine has no age restrictions: in case of a negative result of the Mantoux test in Ukraine, it is recommended to vaccinate children of any age with BCG. What's more: the Ministry of Health recommends that medical workers actively insist on BCG vaccination of children under 5 years of age during each of their visits to a medical facility. In some cases, BCG vaccination may also be indicated for adults: for example, for entry into a country that requires this vaccination; medical workers; persons living in a cell with patients with TB with extended drug resistance, who, due to the peculiarities of the course of TB disease in them, can constantly secrete TB mycobacterium in sputum.
BCG does not guarantee that the child will not get tuberculosis, but it provides full protection against the deadly generalized forms of tuberculosis - tuberculous meningitis and miliary tuberculosis.
Oksana Moloda, phthisiopulmonologist of the highest category, expert of the National Immunization Portal.
BCG is a live vaccine, but the mycobacteria in its composition are so weakened that they are unable to cause disease. BCG is used in many countries with a high prevalence of TB to protect children. Unfortunately, Ukraine is still on this list. For comparison, the TB incidence rate in Ukraine is 48 per 100,000 population, and in the EU countries it is from 0.1 to 1.2 per 100,000 population. That is why it is so important to adhere to the National Calendar of preventive vaccinations and protect your children from threats in time.
Scientific studies have shown that children who were not vaccinated get tuberculosis 15 times more often than those who received vaccinations on time. According to the data of the World Health Organization (WHO), within 4 years after the introduction of the BCG vaccine, the probability of tuberculosis infection in children decreases by 70%.
What reactions to BCG vaccine administration are possible?
A peculiarity of the BCG vaccine is that most of the vaccinated have a local reaction at the injection site. After 1-6 months, a red papule (spot protruding above the surface of the skin) forms at the injection site, which heals after a few weeks. After 6-12 weeks, a small oozing ulcer may form at the site of the papule: in this case, apply a dry bandage and do not use a patch. The ulcer healing process can take about three months, after which a small scar ("scar") will form. This process is normal and expected (although the absence of a "scar" is also a variant of the norm) and does not require treatment.
General reactions (such as fever and general malaise) to the administration of the BCG vaccine usually do not occur.
What are the statistics on the incidence of tuberculosis in Ukraine?
According to the data of the Public Health Center of Ukraine, in Ukraine in 2022, the number of newly registered TB diseases, including its recurrences, was 18,510, or 45.1 per 100,000 population, which is 2.5% more than in 2021 (18,241, or 44.0 per 100,000 population).
The incidence of TB among children under the age of 14 remained at the level of 2021 — 7.4 per 100,000 child population (450 cases).
The TB incidence rate among adolescents decreased by 17.6% — from 12.5 to 10.3 per 100,000 people aged 15–17 years inclusive (127 cases).
The incidence of active tuberculosis combined with human immunodeficiency virus disease decreased from 6.5 to 6.1 per 100,000 population in 2021 (2,490 cases).
In 2022, the incidence of tuberculosis among employees of health care institutions of Ukraine decreased to 148 people (2021: 152).