Shrouding tuberculosis myths in silence and the burden of stigma around the disease makes it difficult to stop the spread of the debilitating disease.
An overwhelming silence surrounds this sickness; a silence, accompanied with a sense of horror, disgust and disbelief, as this illness is often perceived as a poor man’s disease and commonly thought of as a ‘dirty disease’ – something to be looked down upon, something to be shameful about.
Tuberculosis has been present in humans since ancient times and although it is now curable and preventable, the social stigma, still prevails! Many misconceptions about the disease still exist. Many lives are lost every day, simply because of the myths and misconceptions surrounding TB. It is therefore vital that we understand some facts about TB and dispel any false myths or beliefs, associated with it.
Fact – Poverty is an important risk factor for catching TB. Certain people like the underprivileged, homeless or those living in congested, unsanitary or poorly ventilated conditions (where other people may have active TB) are at a greater risk. In addition, they may suffer from malnutrition, have a lowered immunity, have limited access to healthcare, lack the awareness.
But, the fact is we all breathe in the same air and TB is an airborne disease. Besides, one can come in contact with the common man at public places (e.g. a cinema hall, enclosed waiting rooms) and events, while using public transport like a bus/ train or possibly even at home home (a domestic worker, a visitor)
Why just the common man, as a matter of fact, you can get TB from people you may think are the unlikeliest of all – a family member, a friend, colleague/ co-worker, who may not even be aware of their own TB status. In fact, those living/ working in fully air-conditioned homes/offices are more at risk to catch TB (if there is an infectious person around) if the AC duct is just re-circulating the same air.
With our stressed and unhealthy lifestyles, our immunity can come down and the chances of developing the disease can go up.
Fact – People often associate TB with HIV. While it is true that you are more at risk of getting TB when infected with the HIV virus and at high risk for progression to TB disease once infected; there are many other conditions which predisposes one to a weak immunity and thereby a TB infection – cell phone radiation destroys sleep, sleep deprivation threatens immunity. A fast paced lifestyle, demanding jobs, stress/negative emotions, fast food, smoking, can all wreck immunity.
Babies, young children, the elderly people, often have weak immune systems. Those with underlying medical conditions like diabetes, kidney disease, organ transplants, head and neck cancer, those on medical treatments such as corticosteroids, specialized treatment for rheumatoid arthritis or Crohn’s disease, silicosis, can also have a weakened immunity. Similarly substance abuse, alcohol abuse, injecting illicit drugs, low body weight people are also more at risk.
Fact- Tuberculosis does not ‘run in the family’. It is not a hereditary/ genetic disease like diabetes. It is a contagious disease which can only spread through the air; from one sick and untreated person, to another – e.g. a family member with TB disease can infect another family member while living in close proximity, in the same household.
People who spend more time with a TB patient are definitely at a greater risk of being exposed to TB bacteria – family members of those with TB, living in the same household or a healthcare worker like a doctor/ nurse/ hospital staff, treating/ attending to an infectious person.
However, the risk of infection does not just depend on the duration of time spent with an infectious person. Sometimes, a single contact, be it even for a few minutes can be enough – while traveling on a packed bus/ stuffy train, if an infectious person close-by coughs or sneezes, you can easily inhale the bacteria and get infected (this does not mean, that you be wary of everyone and think that anyone who coughs or sneezes has TB!)
Moreover, TB bacteria can survive for hours in the air, in small places, which are damp, dingy with stagnant air.
Fact – Hospitalization may be an exception in some cases – if the patient is severely affected or has complications of TB. Patients with pulmonary TB or only those with a cough need to stay away from work /school and public places, for the first few weeks of treatment.
So long as the patient stays in a well-ventilated room, takes the medicines religiously (and most importantly completes the treatment), observes certain precautions – like covers mouth while coughing and sneezing – they pose no risk to anybody. (Family/ visitors of patients might be advised to wear a micro-filtration mask, just as a precaution.)
Fact – Tuberculosis germs do not thrive on surfaces. You cannot possibly get tuberculosis from shared plates/glasses/spoons/forks nor does sharing food, a toilet seat, shaking hands with a person with TB, sitting on or touching unclean surfaces like currency notes/ coins give you the disease.
TB is a communicable disease which spreads from person to person, and air is the only medium. You need to be exposed to TB droplets emitted in the air ‘live’. It is only when an untreated person with active lung TB coughs or sneezes and it is only when you inhale the dispersed germs, that you can catch it. This is the only condition for TB bacteria to spread.
Fact- The only commonly accepted benefit of the BCG vaccination (which is a weakened live strain of the TB bacteria) is that it offers protection to children from serious forms of tuberculosis. Benefit in adults is highly contentious and many TB experts dispute whether the vaccine offers any TB protection at all! In the US, BCG has never been an accepted vaccine.
Although treatment of TB is fairly long (usually about 6-9 months, with many side effects) if followed faithfully, it is completely curable. But sometimes, patients tend to forget and miss their daily dose!
Most TB patients also start to feel better in a few weeks of treatment, and as soon as that happens they stop their medication altogether! They risk a relapse or develop a drug resistance.
There are also times when the TB bacteria that one is infected with do not respond/ are resistant to the TB drugs. It is only then that complications can occur, and this can prove deadly.
Fact – India is a country with a high burden of TB and as per the TB statistics for India, about 40% of the Indian population has already been infected by TB bacteria (this includes the affluent!). As TB has spread into every corner of the country, across all classes, the rich are just as susceptible to get exposed to someone with active TB.
It is just that we rarely ever hear about the well-to-do people or the people in our social circles who are ill with this disease. Such is the status of TB, that one tends to hide it, keep it a secret; for there is too much social stigma attached to it. A stigma which can make us choose – to rather remain silent, for the impairment of social status that it can bring on, and for the fear of being shunned.
So, with the population pressure, no matter how socio-economically well-off you may be, the fact is – we are all vulnerable to the disease!
TB occurs in every part of the world and even though the majority of TB cases and deaths are in developing countries, it continues to threaten even the developed nations; making it a global public health concern. Worldwide migration of people, particularly those moving from countries with high prevalence of TB to developed countries, only increases the risk of spread.
Air travel now being widely accessible, it results in increasing number of infectious diseases carried by travellers. Travel to high burden TB countries, in a confined space like the aircraft, increases the risk of infection from contagious travelers, to other passengers and crew.
Moreover, as TB rates have fallen in many developed countries, attention to this public health threat has declined. The capacity to respond, due to fewer incidences of TB has weakened.
Consequently, developed nations have limited expertise, fewer specialists and resources to diagnose and manage TB patients, especially those infected with the dangerous form of multi-drug-resistant TB (MDR-TB)
Fact- A person can only spread the disease when they have active TB disease in their lungs. Active TB is a condition in which your body’s immune system is no longer able to fight off the TB bacteria – so you feel sick and start to show symptoms of TB disease.
People with latent TB do not spread the disease. Latent TB is when you have TB bacteria in your body, but your immune system stops them from growing/multiplying, from getting activated. When you do not have any symptoms of TB, you cannot spread the disease to others.
However, any infected person, anyone with latent TB infection, can develop TB disease with a weakening of their immune system.
When a person with active TB in their lungs, sneezes or coughs, they expel and disperse infectious aerosol droplets/TB germs into the air. Just like the common cold, during normal breathing, a healthy person nearby only needs to inhale a few of these germs to get infected.
However, the likelihood of transmission/infection from one person to another depends upon numerous factors –
TB in any other part of the body like the brain, abdomen, kidney or spine, is usually not infectious. A useful thumb rule is – if the patient does not have a cough, there is no risk of infection.
Fact – Having a TB infection and having the TB disease are two different things. When you inhale and get infected with the TB bacteria, it only means you have asymptomatic/ latent TB. You can still look/feel perfectly healthy. You will have the TB bacteria in their body, which can lie dormant for years or perhaps even a lifetime because your immune system is able to fight it off. It does not necessarily mean you will fall sick.
Most people do not know they have been infected with TB bacteria. It is only when their immunity fails for whatever reason, that the TB bacteria in their body get activated. They start to develop symptoms, fall sick and it is only when they fall sick that it means they have the TB disease.
There is a very small chance of a relapse or reactivation in people, with a past history of inadequately/ incompletely treated TB. If you are unlucky to breathe in TB bacteria again, another time, you can get re-infected.
Tuberculosis is treatable, but what about the social stigma? It continues to discourage people. It deters many from seeking treatment or completing the full course of treatment. Any lack of awareness means, those with active infection are more likely to become seriously ill, and are unknowingly infecting several of us – it could be you or me.
Breaking the silence on tuberculosis myths, and the stigma around TB, can save lives!
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