Understanding Tuberculosis

TB is caused by bacteria that usually attack the lungs. It can also affect other parts of the body such as the kidneys, spine and brain. If not treated properly, TB can be fatal.

Fortunately, TB can be cured as long as it is promptly diagnosed and treated. This article can help you understand how TB can be best managed. Read on to find out exactly how to protect children and adults, and minimize their risk of contracting TB.

What is TB and how does it spread?

TB is an infection caused by Mycobacterium tuberculosis. It usually affects the lungs (pulmonary tuberculosis), but can also infect other parts of the body (extrapulmonary tuberculosis), such as the brain, lymph nodes, kidneys, bones and joints.

Transmissions of TB

TB is an airborne infection. When someone with active TB coughs or sneezes, TB bacteria is released into the air and can stay there for several hours. People nearby may breathe in these bacteria and become infected.

In this way, an untreated person will pass the infection on to 10 — 15 people each year. On average, 1 in 10 of those who are infected with TB will progress to active disease, while the rest will not have any symptoms. Individuals without the active disease will not be able to pass the infection to others.

Factors that affect transmission

Transmission depends on:

  • The amount of bacteria droplets in the air
  • The virulence of the bacterial strain
  • The size of the room
  • The ventilation of the room

People with active TB are most likely to spread the bacteria to people they spend time with every day, such as household and family members, friends or schoolmates.

However, after two weeks of effective treatment, the TB patient is no longer infectious and is considered to safe to the community as he or she is regular with the medications for the full course of treatment.

Progression to active TB disease

Active TB disease develops in about 10% of those infected, even if they have a healthy immune system. However, if your immune system is weakened, e.g. by other diseases, the chance of getting sick will be higher.

Hence, the risk of developing active TB disease is greater among:

  • Those who have naturally weaker immune systems
  • Those in close contact with untreated infectious TB cases
  • Those with underlying medical conditions

Protecting your students from TB transmission

The single most effective way to prevent TB transmission is to make sure that the student with active TB is diagnosed early and treated properly. By knowing the signs and symptoms of active TB, you can ensure that your students can get timely treatment and care.

The most common symptom of pulmonary TB (or TB that affects the lungs) is persistent cough for three weeks or more.

Other symptoms of pulmonary TB are dependent on the area of body affected.

Differences between Latent TB and Active TB

A person with latent TB infectionA person with active TB disease
  • Does not feel sick
  • Has no symptoms
  • Cannot spread TB bacteria to others
  • Usually has a positive skin test of positive TB test
  • Has a normal chest x-ray and a negative sputum smear
  • Should consider treatment for latent TB infection to prevents active TB disease
  • Usually feels sick
  • Has symptoms that may include: A bad cough that lasts three weeks or longer, pain in the chest, coughing up blood or sputum, weakness or fatigue, weight loss, no appetite, chills, fever, sweating at night
  • May spread TB bacteria to others
  • Usually has a positive skin test of positive TB blood test
  • May have an abnormal chest x-ray, or positive sputum smear or culture
  • Needs treatment for active TB disease

What to do if your student or any child you know has symptoms of TB

If your student, or any child you know has had a cough for three or more weeks, they should be referred to a medical practitioner for assessment. Someone who is diagnosed with TB will typically need to be on medical leave for the first two weeks of treatment, so he or she will not be able to attend school during that period.

After completion of the first two weeks of treatment, most children are able to return to school, posing no risk of infection to other students. However, they must continue to be on medication for at least six months in order to be fully cured of the disease.

The best way to ensure that a TB patient is properly treated and cured is for him/her to undergo supervised treatment (Directly Observed Treatment or DOT.)

Treating and curing TB

Once TB has been diagnosed it needs to be treated so the patient can recover and further spread of TB can be averted. Most cases can be treated on an outpatient basis. TB drugs are provided free to patients treated under DOT (Directly Observed Treatment) by the TB Control Unit (TBCU).

Directly Observed Treatment (DOT)

DOT involves taking TB treatment under the supervision of a trained nurse or other healthcare professionals. This ensures that the patient adheres to the treatment regimen, which increases his or her chance of being cured.

It is important that patients take the prescribed combination of drugs for the prescribed duration (6 - 9months) in order to make a full recovery. If the TB is not drug-resistant, and the full course of treatment is taken, more than 95% of all patients can be cured*.

A full course of medication is key

It is vital for teachers to ensure that students with TB complete their full course of medication. People often start to feel better after the first few weeks of treatment, and may stop or partially skip their treatment for the next few months.

Incomplete treatment is highly discouraged as the TB bacteria will grow resistant to the drugs that are first used. When this happens, it becomes necessary to use different drugs for a longer duration, and it becomes more difficult to achieve a cure. We should encourage and provide support for people with active TB to complete their treatment. Please refer to the school’s management on the support given to the students who are down with TB.

Frequently Asked Questions

  1. What are the guidelines in place for schools when a case of TB is reported?
  2. Teachers will alert the students’ parents should they notice that their students are not feeling well.

    In all cases of contagious disease, schools handle them very carefully and follow the guidelines given by the health authorities very closely/. For TB cases, schools will refer to the TBCU for advice, and the necessary measures to prevents the spread of the disease to the rest of the school community. This includes keeping affected staff and/or students away from school, contact tracing and sending close contacts for medical screening.

    Besides these, schools also work closely with the health authorities to communicate with parents to create awareness and understanding of the disease and preventive actions. Principals will also provide parents with updates, when available.

    The affected staff and/or student will only return to school when the attending doctor determines that he/she is no longer infectious.

  3. What precautionary measures are put in place by schools to prevents the disease from spreading?
  4. Affected schools work closely with TBCU/MOH on contact tracing and screening procedures, as well as preventive measures. Schools would also step up their vigilance and encourage their students to seek medical attention if they are unwell.

  5. Will a pupil be at risk from being in the same classroom as the infected patient, even if there was no direct contact?
  6. The risk of infection will depend on whether there had been close and prolonged contact with the TB patient before TB treatment was started. Pupils in the same class are generally classified as close contacts and will be required to undergo contact screening by TBCU.

  7. Why is there no screening for all students, even though there may be multiple TB cases in a school?
  8. The TBCU will carry out risk assessment to decide on the extent of contact screening in a school based on likely exposure history. Students who have been deemed to be close contacts will be notified by the TBCU for contact screening. Contact screening is not recommended for students who are not deemed to be close contacts, and are not at high risk of being infected.

  9. What should a parent do if he/she wants to be sure that his/her child has not been infected?
  10. As with any other infectious diseases, parents should refer their child for medical attention if he/she is unwell and is showing symptoms such as coughing and fever.

    We strongly advise parents to keep their children at home to rest if they display any symptoms so that they do not transmit their infection to others in the school.

  11. Are students with infected family members required to inform their schools?
  12. Currently, there is no requirement for students to do so.

    General control measures are in place to manage the contacts of active TB cases in schools, and the identity of the students or staff member is not critical to the control actions by the health authorities. Moreover, the identity should be kept confidential as this is medical information which should only be revealed on a need-to-know basis.

  13. Are teachers and staff of schools expected to report to the school if they are diagnosed with communicable diseases, in view that they may come into contact with large numbers of students?
  14. Yes, teachers and staff are expected to inform the school if they are diagnosed with communicable diseases. If the teacher and staff are diagnosed with communicable diseases, they should be given the appropriate medical leave by the doctors and not report to school. They are only allowed to return to school when they are certified to be fit for duties and are non-infectious.

  15. Do schools have procedures in place to ensure that staff or students who are visibly sick, e.g. prolonged coughing, do not come to work/school to minimize risk of infected to others?
  16. Staff and students are regularly reminded that they should practice social responsibility and avoid contact with others if they are unwell. For example, if a staff/student has been coughing for 3 weeks or longer, they should seek medical advice from doctors.

  17. Why does the school allow staff and students with latent TB to return? Will other students be infected by him/her?
  18. Latent Tuberculosis Infection (LTBI) is not a disease and persons with LTBI do not spread TB to others.

  19. Does the school inform all parents of non-affected students?
  20. As an affected school, upon advice from TBCU/MOH, will inform parents of classmates or close contacts of the affected student for the purposes of contact tracing and screening.

    General control measures are in place to maange the contacts of active TB cases in schools.

  21. Why are the names of the affected students of staff kept confidential from the rest of the school community?

    General control measures are in place to manage the contacts of active TB cases in schools, and for patient confidentiality, the identity of the affected students/staff will not be revealed.

  22. Does the school need to carry out a thorough disinfection of the school compound, particularly in the classrooms, to prevent the spread of TB?
  23. There is no need for special disinfection to be carried out. Fresh air and sunlight make is harder for TB germs to stay alive. Fresh air scatters the germs and sunlight ills it. As such, the maintenance of a clean and well-ventilated environment would be necessary.

  24. Would classes be cancelled if there is an infection in school?
  25. No. Individuals with infectious TB (i.e. active TB disease) are kept away from schools until they have been treated and rendered non-infectious (this generally takes two weeks). The affected staff and/or student will only return to school when the attending doctor determines that he/she in no longer infectious. Contacts of the TB case are not infectious even if they have been infected. There is therefore no need to isolate them from the rest of the school cohort.

  26. Are there special arrangements or exemptions for students taking examinations and are diagnosed with TB?
  27. For candidates who are hospitalized and have been certified as medically fit to sit for the examination, special arrangements will be made for them to do so at the hospital.

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