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New cases of Tuberculosis (TB) are still being reported in Singapore, and parents need to be aware of how TB is spread, what to do and where to seek medical treatment.
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.
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.
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.
Transmission depends on:
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.
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:
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.
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.)
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).
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*.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Latent Tuberculosis Infection (LTBI) is not a disease and persons with LTBI do not spread TB to others.
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.
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.
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.
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.
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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This article was last reviewed on
Friday, September 13, 2019
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