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Posted 2009-07-04 15:04:43
I hope this is not in bad taste, as I do not write it to be in bad taste after the passing of the esteemed Seonai (R.I.P.) However, this entire incident made me think about Tuberculosis. Growing up in the West, I simply did not think of the illness, as I had thought it had been eradicated or there were treatments available that would cure it. Basically I have never heard of anyone still coming down with tuberculosis in the United States. Now that I have learned that another person, with a Western background, has caught it and succumbed to it, I am nervous as to what implications that may have on me.
Are there vaccines for Tuberculosis? I was born in Thailand, and given (according to my parents) a Tuberculosis vaccine that is given in infancy. The United States apparently never gave this vaccine, due to claims that it does not work. Are there vaccines available? And is the vaccine I had as an infant still effective? Are there other means to prevent catching tuberculosis?
How dangerous and likely is it to get the disease? Are there just alot of people in Thailand that have tuberculosis? So do I have to be careful when I go out for catching it? Is it airborne? Basically, just tell me what I have to do to avoid it. Any information on the disease would be greatly appreciated.
Posted 2009-07-26 08:29:42
Yes there are vaccines, and frankly there is a lot of research regarding TB vacines etc.
From what I can remember, the vaccines do not last for a life time, secondly the do work and do not work. What I mean is, the vaccines seem to be more effective for preventing TB of the brain, but not in other parts of the body.
I think I remeber reading that vaccines given at "adulthood" are not effective.... but that is a vague memory.
In my opinion, it is likely you could become exposed to TB while in Thailand. I think the odds are 30% of the population are carriers, and maybe more. I have been told by one physician, that 90+% of all medical workers in Thailand are TB carriers.
I happen to be a TB carrier, and I do work in the medical field, although I am not for sure where and when I got exposed to it. I know for a fact I was around a person with TB in Thailand, but I also lived in Taiwan, and worked in a clinic right on the Mexican border for several years. So it is hard to say.
It is air borne, and it is only air borne if a person becomes physically ill from TB. If a person is not ill from TB, they are not contagious. 90% of all those that are exposed to TB will become carriers, and contain the disease sucuessfully in their bodies and never become ill from it. The remaining 10% that do become ill, 50% of those become ill within 2 years after initial exposure.
TB is the number one transmitibal bacteria killer in the world.... (FYI)
For the most part, it is treatable & curable, but I would also say one must diagnose the disease ASAP. The new Gold Standard test to find out if you have been exposed to TB is called the Quanti Feron Gold test. The cost around 5K baht, and not every hospital is aware of it. The folks at Vichayut are aware of it. I visit that hospital for bi-anual chck ups for TB. Thus far, not problems.e
OK I got you started, if you want more information, others can provide, or use google.
Posted 2009-07-26 13:58:09
It is another immune system related disease - which is why there is this strong correlation with HIV.
Google it and get checked if you are that concerned
Posted 2009-07-26 14:31:35
much more prevalent then u think in the states; my mother was a respiratory therapist in maryland and a large amount of her elderly clients were actually tb patients; the others were emphasyma and lung cancer; some asthma, copd....
she was exposed and tested positive; treated, now free.
in israel, with the influx of ethiopian jews and the ex soviet union groups coming over, tb resurfaced with a vengeance. however, near my kibbutz is a psychiatric hospital that was originally, in the 1950's, actually a tb hospital.
my son and daughter's asthma clinic is in the tuberculosis and skin diseases center in jerusalem, the center was also set up in the early1900's for the large amount of tb victims coming over from europe later from n. africa ... the center is very active to say the least as in e. jerusalem and in gaza, tb is still prevalent due to poor sanitation, poor diet , stress and preventive screening (lack of money and wars bring out the best in tb also)
my daughter (the older one) has to undergo twice yearly screening since she , as a teacher/soldier , works with the two groups in which tb is prevalent.
our kibbutz nurse (one of them) had tb, not in the lungs but in some other organs (kidney i think); treated for quite a while, but successful.
in israel in the past all children received the tb vaccine. it no longer is given. my mother states what was stated by dakar- not considered effective enough to use.
your chance of dying in a car accident in thailand will certainly be much much higher.
just to put things in perspective.
as a side not: seonai was a heavy drinker, smoker, and a non compliant patient as far as most of us knew of her. not to blame or anything, but these three factors are often the reason why people die of diseases that can be treated, albeit over long periods of time.
Posted 2009-07-26 16:49:59
My son had a BCG (TB vaccine) at 7 weeks old as we were going to Thailand. It is no longer a compulsory vaccine in UK but was when I was a child & was vaccinated in the school at 11 years old.
As we are a Thai/UK mixed family it was given to my son but tbh I would have given it to him anyway.
When Seonai first moved in with us when she got sick in Phuket & had to come back to UK 3 years ago I & my husband (who also had BCG as a child) were tested in case we caught it & the vaccine was found to be still present in our bodies. Well worth having imo, in UK now with influx of eastern European & some African nations TB is on the rise.
Posted 2009-07-26 21:08:33
As others have stated, TB is back on the rise in the US. Thanks for a disregard for a potent desease, complacentcy that antibiotics have created, HIV and a porous border system, TB is running freely again.
The popular TB antibiotic is INH which for some, it is not tolerated by the liver, and for me it is not tolerated by my liver. So if I ever do get sick from TB I have to take some creative cocktails of antibiotics to hopefully cure the disease. One of the main issues with the drugs is that the drugs must be taken for around 9 months to a year.... and the drugs are very potent.
Senoi (sp) from what I read was ill from TB for around a year before it was ever identified. I beleive she stated she saw several doctors and they never investigated TB during this time. My point is, if you have a respritory illness, do not fool around, have it investigated to rule out TB.
I kid you not, the doctors here all think I am too paranoid about TB, but to be honest.... it does scare me. I don't want to "out" like that. It has taken me a long while to live in peace with the fact that I am a carrier. I think the doctors think nothing of it due to the fact that only 10% do get sick from it.... that may be true, but I certainly do not want to be one of the 10%.
Posted 2009-07-27 00:24:54
Is there nothing you can do knowing that you are a carrier, Dakhar?
Posted 2009-07-27 07:12:51
You're very correct about this. I just retired as a school principal in one of the largest districts in the US. We screened all new employees for TB (the only disease screened for), and while there was not a large number of people found to have the disease, there was enough that it was practical to screen for.
Posted 2009-07-27 21:34:05
We had the vaccine given to us at school in our early teens. First they did an allergy test to see if you had antibodies to it by injecting some of the dead TB bacterium under your skin and waiting a month. If you had previously been exposed to it, a red raised patch would appear at the injection site. In a class of 30 children, only one person had this reaction (I think he had spent some time in India) and this meant he didn't need the subsequent vaccine. Outwardly he appeared healthy, so presumably he had beaten the illness. The rest of us had no reaction, so needed the vaccine.
As to whether the vaccine actually works, I have read conflicting reports. And as was stated previously, I'm not sure how long the protection lasts.
Posted 2009-07-28 06:46:39
"They" say live a "healthy life style..." Fairly open statement....
But something that most people are not aware of, medications that are designed to reduce inflamation,(NSAIDS) TB carriers should not take. Apparently these meds allow the TB bacteria to become "active." I don't know the science behind it, but due to this, I can not take any meds for minor colon inflamation I get from time to time. I just tough it out.
I try to get an adequate amount of sleep in order to maintain my "defense" system. (at least 6hrs if I can) But really I just live pretty normally. I do not smoke or drink.... the truth is, TB seems to be a matter of luck really, because I have read A LOT of cases where people seem to be just like me, and "Poof" it just happens. One case I read, a woman was involved in a minor car accident, and her seat belt impacted her one of her breast fairly hard.
Shortly there after, an onset of TB occured in her breast. TB is known to do this, in other words attack areas of trauma...
Regardless, I wish there was newer break throughs regarding the treatment, because as I mentioned before I can not tolerate INH (we tried). For those that can not tolerate the drug, there are few options & all the drugs are very potent. Ex Streptomycin, injection only.... makes you go deaf....
But in addition to this topic, consider HIV. If one is a TB carrier and contracted HIV.... that person can not combat TB any longer and that person will be spreading TB all over the place. This is why there is a very high amount of TB in Africa today. Some hospitals consider just walking through a HIV ward in a hospital as "TB exosure."
The one person I know for a fact that had TB that I was around in Thailand appeared to be a healthy person with a healthy life style, strong, active beautiful etc. But she had a persistant cough, and in my opinion it was only getting worse. This had been going on for about a year. She would go see a doctor, they would give her a antibiotic, her cough would go away for a while and then come back shortly after the antibiotic was finished. I told her she needed to go get checked for TB & I wrote this down on a piece of paper. She took the paper to a doctor and she was tested her for active TB, she tested positive.
Strangely enough she was instructed to take INH for 6 months rather than the standard 9. She is fine now, I have never seen her since this occurance but she has called me so I know she is doing fine now. But what bothers me is, she looked healthy and strong, if her TB could turn active.... it seems like it could happen to anybody. (A time bomb)
Posted 2009-07-28 08:56:17
Wow, an awful lot (in fact, looks like all!) comments here from utterly unqualified persons. Better, more informative and (hopefully) accurate information is available from medical establishments on the internet. Beware of information from opinion offerers.
I have a friend who got TB. She was put on pills she had to take for six months. Apparently, if you do get TB you MUST complete the course of pills even when you feel better, which is much sooner than six months, or the TB could come back but worse be immune to the treatment. She's OK now but gets tired easily, not surprisingly having a scar on her lungs.
Posted 2009-07-28 10:12:14
The only post that I see that is fairly inacurate is the post regarding waiting 1 month after the injection (Montoux) test. I think the wait period is in the range of 3 days or so. Regardless it certainly is not a month.
If you think my statements are inacurate, go ahead and correct them, rather than insulting those that have bothered to take the time to post here, correct the statements and offer references... if you can....
FYI: I do have a doctorate degree in the medical field.
The 6 months medication regimine is a combination drug program and to the best of my memory is the shortest regimine out there and is not very popular due to the bad side effects. (it may be more popular in Thailand though)
The suposed safer regimine is 9 months and the regime (if memory serves me well) a single antibiotic with probably vitamin B
But you are correct in that, YOU do have to finish the medication even after you feel well. I wish your friend all the best... and as Senoi (sp) has stated before, TB is not the same for everyone, TB makes up it's own set of rules. RIP
Besides my doctors in Thailand and my 2 brother-in-laws MDs from the states, I also consulted with Sheryl and GunnyD regarding TB, both of them frequent this web. I also spent a lot of time surfing the net, and reading through my pharmacology text books.... so to say I am unqualified to write about TB.... seems a liitle "off the mark."
Posted 2009-07-28 11:43:03
There is a wonderful book "The Forgotten Plague" - How the battle Against Tuberculosis Was Won and Lost by Frank Ryan MD. My friend gave it to me before I left for Manila. I actually just found a bank receipt from 1998 I used as a page marker so hopefully it isn't out of print. Dr. Jack Adler the Director of the Tuberculosis Elimination at Mt. Sinai praised it and said it was timely. This book puts all of the scientific mumbo jumbo in context and traces the ravages of TB and how the treatment was discovered, implemented and how it has now failed. It was an exciting read for me, but it might put some to sleep by page 100. I suggest you have a look.
I do not share an upbeat position on this subject. Perhaps I am ignorant because this isn't my specialty, but the news continues to be grim. The standard course of treatment can indeed take 6 months, but it can also take as long as 2 years if it is a resistant strain. Of more concern to me is the the growing position of multi drug resistant TB which has rendered isoniazid (INH) and rifampin (RIF), ineffective. I took my pharmacology courses during the era when isoniazid figured prominently in my textbook. That should tell you how dated I am. And now I see that they have a new strain XDR TB for Extensively Drug Resistant. Hardly reassuring. You then have to take a bunch of drugs which all have their own unique ADRs, none of which is appealing. My understanding is that the course of treatment is a fluoroquinolone, and one or more of drugs like kanamycin, amikacin, and capreomycin which gets injected.
I do not agree with the belief that having latent but non-infectious TB is ok. (Not that anyone said that.) In fact it downright scares the crap out of me which is why I have been tested and had the chest xray after so much time in Asia. Just because the TB is not active doesn't mean that it won't become active. All it needs is the right conditions such as a stressed immune system through either physical or emotional stress. I appreciate that they usually treat inactive TB by administering the conventional TB medications. However, therein lies one of the reasons the dam_n bacteria has mutated. It's hard to know if we have really killed it off or if it just hasn't gone into a long dormancy, much like other spore life cycles. I liken it to people with HIV on treatment where the viral load isn't detectable. The virus is there lurking and waiting. I'm certain that the longer we prolong our life expectancy the more likely we will see the appearance of diseases like TB. It's sort of like the fact that with older men, by the time they are in their 90's they are more likely than not to have prostate cancer, although a slow growing form. Anyway, those are just my own fears on TB and certainly can't be held up as demonstrated true. One thing I do know is that the best course of action is to get tested so that you at least have a fighting chance. I also believe that a responsible person that sticks with his or her treatment program can most likely beat the illness. I have to believe that because the alternative is despair.
Posted 2009-07-28 12:08:36
I agree with you, and when one considers that 30+% of the worlds population are carriers of TB, it is a very scary thing. That said,t he physicians living in areas of the world where TB is very prevalent don't seem very concerned at all. Either that is their idea of "bed side manners" or they really don't care, I can't say for sure.
But there is a good doctor at Vichayut that I work with, I am glad I found him. I went to several hospitals, including Bum. and the doctor there dx INH without a base line liver test.... and I asked about that and she said it was not needed. The truth is, there is debate on that, and I would rather err on the side of caution.. So I went to Vichayut, the doctor there did a base line.... but eventually we discovered I can not tolerate INH. So I carry the time bomb