The mission of the Communicable Disease Prevention Branch is to assist the Fulton County Department of Health and Wellness in promoting, protecting and assuring the health of people in Fulton County by reducing and eliminating communicable diseases. The federal and state guidelines that govern the health department’s actions with regard to Tuberculosis are based on the Rules of the Georgia Department of Human Resources Public Health Chapter 290-5-16.
Tuberculosis (TB) is an infectious air-borne disease caused primarily by rod-shaped bacteria called Mycobacterium tuberculosis. Additionally, there are four very closely related mycobacterial species (M. bovis, M. africanum, M. microti, and M. canetti) that together they comprise what is known as the M. tuberculosis complex---this can also cause tuberculosis disease. The bacteria can attack any part of your body, including the kidneys, spine, or even the brain, but they usually attack the lungs. If not treated properly, TB disease can be fatal.
Tuberculosis has two general states: latent TB infection and active TB disease. Only those who develop active TB can transmit the disease.
If a person is diagnosed with latent TB infection it means that the person has inhaled TB bacteria and become infected with TB, but only has dormant (sleeping) TB bacteria in their body. However, not everyone who is exposed to the bacteria develops latent TB infection. In general, close contacts or persons with prolonged, frequent, or intense contact are at highest risk of becoming infected.
The dormant TB bacteria in the body are kept under control by the body’s immune system. The immune system does this by producing special immune cells that surround the TB bacteria. The cells form a hard shell that keeps the bacteria contained and under control. These dormant bacteria are not making them sick, and they cannot pass these bacteria to anyone else. A person with LTBI only, is not regarded as a case of TB. Many who have LTBI only--- never develop tuberculosis disease. In these people, the TB bacteria can remain inactive for a lifetime without causing disease.
|
People with Latent TB Infection (LTBI)
- Have no symptoms
- Don't feel sick
- Can't spread TB to others
- Usually have a positive skin test reaction or QuantiFERON-TB Gold test (QFT-G)
- May develop active TB disease if they do not receive treatment for latent TB infection
|
WHAT IS TB DISEASE?
Some people diagnosed with latent TB infection will develop TB disease. TB disease develops when the immune system cannot keep the dormant bacteria under control and the bacteria begin to rapidly multiply and destroy tissue in their body; the bacteria can actually create a hole in the lung. People with TB disease are sick and usually have symptoms of TB disease.
TB disease can develop very soon after infection or many years after infection. In the United States, older people, persons with issues of substance abuse, HIV infection, or cancer are more likely to progress from latent TB infection to active TB disease. People with a history of TB exposure have about a 10% risk, over their lifetime, of developing active TB disease. People with HIV and a history of TB exposure have about a 10% risk each year of life of developing active TB disease.
|
People with TB Disease
- Usually have signs and symptoms
- Usually feel sick
- May spread TB bacteria to others
- Usually have a positive skin test reaction or QuantiFERON-TB Gold test (QFT-G)
- May have an abnormal chest x-ray, or positive sputum smear or culture
- Need treatment to treat active TB disease
|
TB disease normally affects the lung and is called pulmonary TB. When TB occurs outside the lung it is referred to as extra pulmonary TB. TB in the lungs or throat can be infectious; meaning that the bacteria can be spread to other people. People with TB disease are most likely to spread it to people they spend time with every day, including family members, friends, and coworkers. TB disease in other parts of the body, such as the kidney or spine, is usually not infectious. TB is a serious illness; it is important to identify people who have active TB disease so they can be treated, preventing further spread of the bacteria and future cases of TB.
TB is contagious, but not as contagious as other diseases such as the flu or chickenpox. To get infected, a person usually has to spend many hours over an extended period of time with the person who has infectious TB disease. You must inhale the infectious droplet to become infected. People who live in overcrowded housing with poor air circulation may be more at risk of getting TB infection. The probability that TB will be transmitted heavily depends on these other factors:
- Infectiousness of the person with TB disease
- Environment in which exposure occurred
- Duration of exposure
- Virulence of the organism
What are the symptoms of TB?
General symptoms of TB disease may include feeling weak or sick, unexplained weight loss, or night sweats. More specific symptoms of pulmonary TB may include a bad cough that lasts 3 weeks or longer, chest pain, coughing up blood, fever and chills, and night sweats. Symptoms of extrapulmonary TB depend on the particular part of the body that is affected.
How can I tell if I have TB?
Your health care provider can do one of two different tests to find out whether you have TB infection in your body. First, the tuberculosis skin test (also known as the Mantoux skin test, tuberculin, or PPD test), is a test used to determine if someone has TB infection. The health care provider will inject a small amount of testing fluid (called tuberculin) just under the skin on the lower part of your arm. If a person is infected with TB, a hard swelling (induration) will develop at the site of the injection in 48 to 72 hours. A health care professional must measure the size of the reaction and tell you if the test is positive.
The QuantiFERON®-TB Gold test (QFT-G) is a whole-blood test that can also be used to aid the diagnosing of latent TB infection and TB disease. Blood must be taken using the special QFT-G vacuum tubes. QFT-G specifically detects responses to two proteins produced by Mycobacterium tuberculosis. Results can be available within 24 hours.
If either test is positive, the health care provider will perform more clinical evaluations and additional tests (such as a chest x-ray, sputum smear, and culture) will be ordered to confirm the diagnosis of LTBI or TB disease.
If I Have LTBI, How Can I Keep from Developing TB Disease?
Many people who have Latent TB Infection (LTBI) never develop TB disease. But some people who have LTBI are more likely to develop TB disease than others because they are at a higher risk for TB disease. They include:
- People with HIV infection
- People in close contact with a person who has infectious TB
- People who became infected with TB bacteria in the last 2 years
- People with weakened immune systems
- Elderly people
- Babies and young children
- People who inject drugs
If you have LTBI (a positive skin test reaction or positive reaction to QuantiFeron Gold) and you are in one of these high-risk groups, you need to take medicine to treat your LTBI and keep from developing TB disease. People who have LTBI, but do not get the treatment need to recognize the symptoms of TB disease. If they develop symptoms of TB disease later on, they should see a doctor right away.
The medicine usually used for treating LTBI is a drug called Isoniazid or INH. INH kills the TB bacteria that are inactive in the body. If you take your medicine as prescribed, LTBI treatment will keep you from ever developing TB disease. Standard INH treatment lasts for 9 months.
Sometimes people are given LTBI treatment even if their TB test reaction is not positive. This is often done with infants, children, and HIV-infected people who have recently spent time with someone with infectious TB disease. This is because they are at very high risk of developing serious TB disease soon after they become infected with TB bacteria. If you are prescribed to take treatment for LTBI, it is important that you take all the pills prescribed for you so that your LTBI treatment is effective. If you start taking INH, you will need to see your doctor or nurse on a regular schedule. He or she will check on how you are doing. Very few people have serious side effects to INH. However, if you have any of the following side effects stop taking INH and call your health care provider right away:
|
* No appetite
|
* Fever for more 3 days
|
|
* Nausea
|
* Abdominal pain
|
|
* Vomiting
|
* Tingling in the fingers and toes
|
|
* Yellowish skin or eyes
|
|
Warning: Drinking alcoholic beverages (wine, beer, and liquor) while taking INH can be dangerous. Check with your health care provider for more information.
What If I Have TB Disease?
If you're diagnosed with active TB, you're likely to begin taking four medications — isoniazid, rifampin, ethambutol, and pyrazinamide. TB disease can almost always be cured with medicine. But the medicine must be taken as the doctor or nurse tells you. The beginning phase of treatment is crucial for preventing the emergence of drug resistance and ensuring a good outcome. If you don’t take the pills the correct way it can be harder or not possible to cure your TB, you can stay sick for a longer time, the medicines can stop working, and you may have to take different medicines that have more side effects. Six months is the minimum acceptable duration of treatment for all adults and children with culture-positive TB.
What If I Also Have HIV Infection?
A person can have Latent TB Infection (LTBI) for years without any signs of disease. But if that person's immune system gets weak, the LTBI can quickly turn into TB disease. Also, if a person who has a weak immune system spends time with someone with active TB disease, he or she may become infected with TB bacteria and quickly develop TB disease.
Since HIV infection weakens the immune system, people with LTBI and HIV infection are at very high risk of developing TB disease. All HIV-infected people should be given a TB test to find out if they have LTBI. If they have LTBI, they need to start treatment as soon as possible to prevent them from developing TB disease. If they have TB disease, they must take medicine to cure the disease. Among people with latent TB infection, HIV infection is the strongest known risk factor for progressing to active TB disease. The chance of developing extrapulmonary tuberculosis also is increased in HIV-infected patients.
TB disease can be cured in people with HIV infection. There are a number of treatment options for HIV-infected persons with active TB disease. Without treatment, as with any other opportunistic infection, HIV and TB can work together to shorten the life of the person infected. It is critical for HIV-infected patients to be closely monitored by a physician during any type of treatment to make sure they are not hurt by side effects from taking TB and HIV medicines together. Monitoring is also vital to make sure the TB medicines are not interacting with patients’ HIV medicines in a way that could weaken the strength of the HIV medicines. The most important factor in the treatment of HIV-related tuberculosis is committing to the treatment regimen.
|
Multi-Drug Resistent Tuberculosis
|
Multi-drug Resistant TB (MDR TB) is tuberculosis disease in which the TB bacterium is resistant to both Isoniazid and Rifampin, the two strongest anti-tuberculosis medications. TB can become resistant to antibiotics when the drugs are misused or mismanaged, when patients do not complete their full course of treatment; when health-care providers prescribe the wrong treatment, the wrong dose, or length of time for taking the drugs; or when the drugs are of poor quality. Treating MDR TB is complicated and involves the use of second-line medications that carry greater risk of side effects and adverse reactions. Patients taking these drugs must be monitored closely throughout the course of treatment. The regimen usually requires at least 18-24 months and must be individualized based upon the patient’s medical history. Treatment for patients co-infected with HIV can be more complicated, usually further lengthening treatment time.
Extensively drug resistant TB (XDR TB) is a relatively rare type of MDR TB. XDR TB is defined as TB which is resistant to isoniazid and rifampin, plus resistant to any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin). Because XDR TB is resistant to first-line and secondline drugs, patients are left with treatment options that are much less effective.
| Directly Observed Therapy |
Multi-drug Resistant TB (MDR TB) is tuberculosis disease in which the TB bacterium is resistant to both Isoniazid and Rifampin, the two strongest anti-tuberculosis medications. TB can become resistant to antibiotics when the drugs are misused or mismanaged, when patients do not complete their full course of treatment; when health-care providers prescribe the wrong treatment, the wrong dose, or length of time for taking the drugs; or when the drugs are of poor quality. Treating MDR TB is complicated and involves the use of second-line medications that carry greater risk of side effects and adverse reactions. Patients taking these drugs must be monitored closely throughout the course of treatment. The regimen usually requires at least 18-24 months and must be individualized based upon the patient’s medical history. Treatment for patients co-infected with HIV can be more complicated, usually further lengthening treatment time.
Extensively drug resistant TB (XDR TB) is a relatively rare type of MDR TB. XDR TB is defined as TB which is resistant to isoniazid and rifampin, plus resistant to any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin). Because XDR TB is resistant to first-line and secondline drugs, patients are left with treatment options that are much less effective.
Fulton County reported more new tuberculosis cases in the state of Georgia for 2006. However, TB rates, for the third consecutive year, continued to decline in Fulton County through 2006. The number of newly reported TB cases in 2006 was 72. This represents a 17.1% decline in number of reported TB cases from the 88 reported in 2005. Since 2000, reported TB cases in Fulton County have declined by 60.2%. A portion of the decline can be attributed to the systematic use of providing TB treatment through directly observed therapy (DOT), which is considered the standard of care for providing tuberculosis treatment. During 2006, 91.8 % of all patients receiving treatment in Fulton County for active TB disease received treatment through DOT.
TB in Fulton County continues to disproportionately affect Blacks and African Americans. During 2006, 73.6% (53/72) of TB cases diagnosed for Fulton County were among Blacks. Of the total 72 reported cases in 2006, 68.0% (49/72) were US-born African-Americans. However, this does indicate a decrease in the percentage reported from 2005 where 78.4% (69/88) of cases occurred among Blacks. The percent of cases occurring among US-born African-American remained constant from 2005 to 2006 where in 2005, 67.1% (59/88) of cases represented US-born African-Americans. However, it does denote a 6 point decline, percentage wise, from 2004 where 73.2% (85/116) of all TB cases were among African-Americans. In 2005 the state of Georgia launched the HALT TB campaign which is a public health education campaign directed to address the disproportionate amount of TB occurring in the African American community.
The percentage of patients with both active TB disease and HIV infection has slightly decreased from 2005 to 2006, but is still an increase over 2004 numbers; during 2004, 25.8% (30/116); in 2005, 29.5% (26/88), and in 2006, 27.7% (20/72) of TB cases were also co-infected with HIV. Fulton County offered HIV testing to 99% of all tuberculosis patients receiving clinical services; 90.5% were tested (105 of 116), 9.5% declined (11 of 116); the 11 who declined were mostly children. Patients with TB/HIV co infection accounted for 25% (30 of 116) of all Fulton County tuberculosis cases in 2004. This proportion has remained the same since 2002. Strategies to control the spread of HIV will have the added benefit of reducing the spread of tuberculosis, therefore should be a part of TB elimination strategies.
Historically, most of the reported TB cases in Fulton County have been among US-born persons. However, the proportion of TB cases in Fulton County is slightly increasing among non US-born persons. This reflects the current trend that has increasingly been seen across the country over the past 13 years where the percentage of TB cases accounted for by non US-born persons has increased. In the US, this percentage of cases in the non US-born has increased from 22% in 1986 to 55% in 2005. This trend is now slowly presenting itself in Fulton County --- in 2004, 21.5% (25/116); 2005, 28.4% (25/88), and in 2006, 25.0% (18/72) of reported TB cases were among non US-born persons. There is no specific group, such as refugees, that account for the non US-born cases as they represent countries from all over the world.
2005 TB data for Fulton County and state of Georgia, released by the Georgia Department of Human Resources Division of Public Health, shows that Georgia's number of TB cases decreased in 2005 to 505. Health officials at the Fulton County Department of Health and Wellness, which administers the TB Control Program countywide, attribute the decline in TB cases to the systematic use of Directly Observed Therapy (DOT) for TB treatment and an aggressive awareness campaign called H.A.L.T. TB.
The H.A.L.T. campaign, which stands for "Hear, Act, Learn, and Treat" TB, was launched in 2005 in collaboration with the state Division of Public Health. The grant-funded awareness campaign included printed educational materials about tuberculosis and advertising on bus shelters and park benches. Educational videos, shown in Fulton County health centers, are also a part of the H.A.L.T. campaign. Fulton County Department of Health and Wellness saw a 95 percent completion rate of TB treatment through Directly Observed Therapy (DOT). DOT regimen coupled with diligence in tracing contacts and educating clients through the H.A.L.T. campaign has led to this unprecedented reduction in reported TB cases.
STD/HIV/TB Mobile Unit – through a mobile location, the unit identifies all possible contacts that could benefit from an exam and offers treatment to infected and/or potentially incubating patients. The unit also provides counseling to as many people as possible about the risks of HIV and TB, and provides each individual the opportunity to take an HIV or TB test.
|
Public Health and Department of Corrections Working Together
|
The transmission of Mycobacterium tuberculosis in correctional facilities presents a public health problem for correctional-facility employees and for inmates and the communities into which they are released. A primary reason for the high risk of TB infection and TB disease in correctional facilities is the disproportionate number of inmates who have risk factors for exposure to TB or, if infected, for development of active disease. These risk factors include infection with HIV, substance abuse, and being a member of a lower socioeconomic population that has poor access to health care.
With this in mind, Fulton County tries to strengthen collaborations among local, state, and federal correctional facilities by providing inmates with treatment for tuberculosis and/or monthly clinical visits to ensure progress toward completing treatment. Additionally, Fulton County has assigned liaisons with all three levels of correctional facilities in Fulton County; they communicate regularly with to facilities to access any questions or problems surrounding TB. Fulton County also monitors trends at the correctional facilities, over time, and document problems and solutions while using data to drive decisions on interventions.
Children are primarily exposed to tuberculosis through infectious adults, with whom they are in contact. Children who present with active TB disease are an indicator of current TB transmission in their environment because they will not likely have been latently infected. Therefore, during TB investigations involving children the goal is to find the source rather than, as with adults, find contacts.
Children with tuberculosis disease tend not to be as contagious as adults, because they usually have smaller lung lesions and do not cough as much. Additionally, confirming the diagnosis of TB in children by culture can be difficult due to difficulties producing adequate sputum samples as well as typically having lower levels of TB bacteria than adults. Tuberculosis diagnosis in children usually follows detection of an adult case and relies on tuberculin skin testing, chest radiograph, and observation of clinical signs and symptoms. The early signs and symptoms of TB disease are broad and not specific to tuberculosis. Some examples include failure to thrive, weight loss, fever and lethargy. Frequently children have no symptoms at all. It is, therefore, not uncommon for the child to be misdiagnosed initially. These issues, coupled with the fact that children are especially vulnerable to rapid progression from infection to active tuberculosis disease add a sense of urgency when investigating cases involving children.
|
Clinic Hours and Locations
|
|
ALDREDGE
HEALTH CENTER
|
ADAMSVILLE
HEALTH CENTER
|
CENTER FOR
HEALTH & REHAB
SERVICES
|
|
99 Jesse Hill Jr. Drive
Atlanta, GA 30303
(404) 730-1401 STD Clinic
Ryan White Clinic:
404-730-1430
TB Clinic: 404-730-1450
Hours:
Monday & Tuesday only plus
Night Clinic: 8a-11a and 1p-6p
Wed-Fri – 8a-11a and 1p-3:30p
Ryan White-appointments only
Services:
STD/Ryan White/TB Clinic,
Dental Svs for Ryan White Only
404 730-1478
|
3699 Bakers Ferry Road
Atlanta, GA 30331
(404) 699-4215
General Hrs: 8:30a-5:00p
Services: TB Clinic,
STD-(Mon & Tues)
8a-11m & 1p-3:30p
walk-ins accepted
Ryan White-appointments only
|
265 Boulevard SE
Atlanta, GA 30318
(404) 730-5835
Hrs: 8:30a-5:00p
Services:
STD/Ryan White/TB Clinics
|
Fees are charged on a sliding scale depending on current annual income and health insurance status.
From the North: From I-75 and I-85 go south toward Atlanta. Take axit 248A for Martin Luther King Jr. Drive toward state Capitol. Stay in the right lane and turn right at Jesse Hill Jr. Drive. Go about 0.2 mile. Aldredge Health Center is at the corner of Jesse Hill Jr Drive and Gilmer Street, across from Grady Memorial Hospital.
From The South: From I-75 and I-85 go north toward Atlanta. Take axit 248A for Martin Luther King Jr. Drive. Turn left toward State Capitol. Stay on the right lane and turn right at Jesse Hill Jr. Drive. Go about 0.2 mile. Aldredge Health Center is at the corner of Jesse Hill Jr. Drive and Gilmer Street, across from Grady Memorial Hospital.
Back to Top
|
.jpg)
