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All You Need To Know About Tuberculosis (TB)
Tuberculosis (TB) is an infectious disease that usually affects the lungs. It is sometimes fatal. Symptoms include coughing, phlegm, and more. Doctors may prescribe antibiotics for TB.
In the past, tuberculosis (TB), or "consumption," was a major cause of death worldwide. Following improvements in living conditions and the development of antibiotics, the prevalence of TB fell dramatically in industrialized countries.
However, numbers started to rise again in the 1980s. The World Health Organization (WHO) describes it as an "epidemic". It reports that it is 13th leading cause of death globally and "the second leading infectious killer after COVID-19".
The WHO estimates that in 2020, nearly 10 million people worldwide developed TB and 1.5 million people died from the disease, including 214,000 people who also had HIV.
A majority of the people affected were in Asia. However, TB remains a matter of concern in many other areas, including the United States. The same year, doctors reported 7,174 cases of TB in the U.S., according to the Centers for Disease Control and Prevention (CDC).
Currently, antibiotic resistance is causing renewed concerns about TB among experts. Some strains of the disease are not responding to the most effective treatment options. In this case, TB is difficult to treat. Keep reading to learn more.
A person may develop TB after inhaling Mycobacterium tuberculosis (M. Tuberculosis) bacteria, primarily from person to person.
When TB affects the lungs, the disease is the most contagious, but a person will usually only become sick after close contact with someone who has this type of TB.
TB infection (latent TB)An individual can have TB bacteria in their body and never develop symptoms. In most people, the immune system can contain the bacteria so that they do not replicate and cause disease. In this case, a person will have TB infection but not active disease.
Doctors refer to this as latent TB. An individual may never experience symptoms and be unaware that they have the infection. There is also no risk of passing on a latent infection to someone else. However, a person with latent TB still requires treatment.
The CDC estimates that as many as 13 million people in the U.S. Have latent TB.
TB disease (active TB)The body may be unable to contain TB bacteria. This is more common when the immune system is weakened due to illness or the use of certain medications.
When this happens, the bacteria can replicate and cause symptoms, resulting in active TB. People with active TB can spread the infection.
Without medical intervention, TB becomes active in 5–10% of people with the infection. According to the CDC, progression occurs within 2–5 years in about 50% of these people.
The risk of developing active TB is higher in:
Learn more about pulmonary TB, which primarily affects the lungs, here.
Latent TB: A person with latent TB will have no symptoms, and no damage will show on a chest X-ray. However, a blood test or skin prick test will indicate that they have TB infection.
Active TB: An individual with TB disease may experience a cough that produces phlegm, fatigue, a fever, chills, and a loss of appetite and weight. Symptoms typically worsen over time, but they can also spontaneously go away and return.
Early warning signsA person should see a doctor if they experience:
TB usually affects the lungs, though symptoms can develop in other parts of the body. This is more common in people with weakened immune systems.
TB can cause:
A person with latent TB will have no symptoms, but the infection can show up on tests. People should ask for a TB test if they:
A doctor will ask about any symptoms and the person's medical history. They will also perform a physical examination, which involves listening to the lungs and checking for swelling in the lymph nodes.
Two tests can show whether TB bacteria are present:
However, these cannot indicate whether TB is active or latent. To test for active TB disease, the doctor may recommend a sputum test and a chest X-ray.
Everyone with TB needs treatment, regardless of whether the infection is active or latent.
Find out what to expect from a tuberculosis skin test here.
Learn more about how to read TB skin test results here.
With early detection and appropriate antibiotics, TB is treatable.
The right type of antibiotic and length of treatment will depend on:
Treatment for latent TB can vary. It may involve someone taking an antibiotic once a week for 12 weeks or every day for 9 months.
Treatment for active TB may involve taking several drugs for 6–9 months. When a person has a drug-resistant strain of TB, the treatment will be more complex.
It is essential for people to complete the full course of treatment, even if symptoms go away. If a person stops taking their medication early, some bacteria can survive and become resistant to antibiotics. In this case, the person may go on to develop drug-resistant TB.
Depending on the parts of the body that TB affects, a doctor may also prescribe corticosteroids.
M. Tuberculosis bacteria cause TB. They can spread through the air in droplets when a person with pulmonary TB coughs, sneezes, spits, laughs, or talks.
Only people with active TB can transmit the infection. However, most individuals with the disease can no longer transmit the bacteria after receiving appropriate treatment for at least 2 weeks.
Ways of preventing TB from infecting others include:
In some countries, children receive an anti-TB vaccination — the bacillus Calmette–Guérin (BCG) vaccine — as part of a regular immunization program.
However, experts in the U.S. Do not recommend BCG vaccination for most people unless they have a high risk of TB. Some of the reasons include a low risk of infection in the country and a high likelihood that the vaccine will interfere with any future TB skin tests.
People with weakened immune systems are most likely to develop active TB. The following are some issues that can weaken the immune system.
HIVFor people with HIV, doctors consider TB to be an opportunistic infection. This means that a person with HIV has a higher risk of developing TB and experiencing more severe symptoms than someone with a healthy immune system.
Treatment for TB can be complex in a person with HIV, but a doctor can develop a comprehensive treatment plan that addresses both issues.
TB can become a complication of HIV. Learn about other HIV complications here.
SmokingTobacco use and secondhand smoke increase the risk of developing TB. These factors also make the disease harder to treat and more likely to return after treatment.
Quitting smoking and avoiding contact with smoke can reduce the risk of developing TB.
Other conditionsSome other health issues that weaken a person's immune system and can increase the risk of developing TB include:
Some medical treatments, such as an organ transplant, can also impede the functioning of the immune system.
Spending time in a country where TB is common can also increase the risk of a person developing it. For information about the prevalence of TB in various countries, people can use this tool from the WHO.
Without treatment, TB can be fatal.
If it spreads throughout a person's body, the infection can cause problems with the cardiovascular system and metabolic function, among other issues.
TB can also lead to sepsis, a potentially life threatening form of infection.
An active TB infection is contagious and potentially life threatening if a person does not receive appropriate treatment. However, most cases are treatable, especially when doctors detect them early.
Anyone with a high risk of developing TB or any symptoms of the disease should consult a doctor as soon as possible.
TB is a reportable disease to each state's department of health. State sanctioned regulations and treatment plans can provide care for patients regardless of immigration status, insurance coverage, or socioeconomic status.
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Bovine TB And 10% Tree Cover Rule Debated At FW's Question Time
Bovine TB, controversial plans for 10% tree cover on all farms and what English farmers can learn from their Welsh colleagues were debated by an expert panel and a live audience at the Royal Welsh Winter Fair.
Farmers Weekly podcast and projects editor Johann Tasker chaired the 75-minute event at the Royal Welsh Showground in Builth Wells, Powys, on Monday 27 November.
The panel included NFU Cymru president Aled Jones, Prof Glyn Hewinson, a world-renowned expert on bovine TB, Llyr Gruffydd, Plaid Cymru shadow rural affairs minister, Anne-Marie Harries, an award-winning artisan preserve maker who farms in north Pembrokeshire, and Kim Waters, founder and trustee of the Welsh Rivers Union.
See also: Red Tractor and food security scrutinised at FW's Question Time
Below, we've pulled together some of the best questions from the evening. A recording of the event is available on the Farmers Weekly podcast.
Farm support Is it about time we scrapped farm subsidies?NFU Cymru president Aled Jones said historically subsidies had enabled farmers to supply the public with quality food at affordable prices, and this remains the case today.
Therefore, he did not think Wales would ever be in a position where there were zero subsidies for farmers.
He said many countries have some form of support for agriculture, whether direct or indirect, and he still fundamentally believes in it.
When that support is taken away, as in New Zealand in the 1980s, it creates difficulties.
"I would say that farm support will be with us and will have to be catered in such a way that it guarantees the supply of sustainably produced food. That's the argument that we have with Welsh government and that will be the crucial element of gaining that support going forward."
Llyr Gruffydd said the farming sector delivers many things to society, from sustainable food production, to tackling climate change and biodiversity loss.
Therefore, he said it was "absolutely right" that the taxpayer should contribute, so everyone can enjoy and share the benefits.
Kim Waters said he fully supports farm support and wants to see more offered to allow farmers produce more food.
"I will not buy New Zealand lamb. I will not buy Brazilian beef when these are produced sustainably here.
"And we only produce it sustainably if farmers are supported and subsidised," he added.
Chairman Johann Tasker asked the audience if they felt subsidies should be scrapped. No one raised their hands.
NFU Cymru president Aled Jones © Richard Stanton
Food securityHow do we best communicate to the consumer the importance of a robust domestic supply chain to deliver both food security and the public good?
Mr Jones said a recent NFU Cymru-commissioned independent consumer survey found 82% said supporting agriculture to produce food was a good use of public funds.
The same survey revealed that 67% of respondents believed food security should be promoted.
"When you consider the fragility of global food security, people are beginning to realise how pressured and stressed the whole global food supply is," he added.
"If we are to maintain that public good of food supply, we must invest in robust, sustainable systems for years to come."
Mr Jones linked food security to stability in communities and said global governments had a collective responsibility to invest in food resources in their own countries.
Anne-Marie Harries, business owner at Farmers Food at Home, Llanreithan, Pembrokeshire, said more people are looking to buy sustainable, locally sourced food produced with low food miles. "Ultimately, that's what people want these days."
Award-winning artisan preserve maker and north Pembrokeshire farmer Anne-Marie Harries © Richard Stanton
Mr Gruffydd said during Covid people reconnected with local food production and the pandemic reminded people that investing in local economies and making it easier for smaller businesses to compete is vital.
But he said much more could be done to invest in local producers and the onus was on government and policymakers to try to facilitate and create an environment "that helps communities to keep the local pound as local as possible".
Audience viewEdward Morgan is a manager from Castell Howell Foods, a food wholesaler which supplies food to more than 1,000 schools, every hospital in Wales, and further afield.
Mr Morgan said consumer demand for food is high, but as intermediaries in the supply chain the company is seeing a "disconnect" as demand seems to be outpacing supply.
With more emphasis on environmental policies and farmers struggling with difficulties such as bovine TB, he fears primary agricultural suppliers in Wales could lose the capacity to supply the volume of food they require, forcing companies to source more produce from overseas.
© Richard Stanton
Sustainable Farming Scheme When are we likely to see some real clarity on the SFS for Wales?Mr Gruffydd said the Welsh government is due to launch a consultation on the latest iteration of the Sustainable Farming Scheme (SFS) before Christmas, possibly by mid-December.
But he fears a "glaring omission" will be any details on finance and the levels of payments farmers can expect to receive for completing different actions.
The Welsh government's Brexit and our Land consultation (2018) did not mention the word "food" in any of its 66 pages, Mr Jones noted.
But the Agriculture (Wales) Bill, passed in August, did at least contain Sustainable Land Management objectives, including food production.
Mr Jones agreed that clarity from the Welsh government over the budget is crucial. "We are trying to design something for the future. Without a budget, we cannot pilot. We cannot undertake any studies," he said.
"It's as if we are building an aeroplane in the sky without an airway to land it on. I think that's a very scary position to be in. "
The Welsh government seems to have given the "badge" of sustainable food production, without having the volume of food production, he added.
Plaid Cymru shadow rural affairs minister Llyr Gruffydd © Richard Stanton
Bovine TB Given the apparent benefits of reducing bovine TB incidence in areas where there has been a reduction in badger numbers, why does the Welsh government not want to use this course of action?Prof Hewinson said he could not answer on behalf of the Welsh government, but pointed out that not culling badgers was included in the Labour administration's manifesto, and they had been elected.
On the science, Prof Hewinson said it is true that, epidemiologically, badgers play a role in bovine TB transmission, "not always, but sometimes".
And when they do, as evidenced in the randomised badger culling trial, the incidence of bovine TB in cattle does reduce.
But he argued that in every TB "hotspot" that has been analysed, the primary cause was cattle movements – specifically, infected cows carrying TB into new areas.
Then cattle-to-cattle transmission starts, followed by cattle-to-badger and badger-to-cattle transmission.
Prof Hewinson said TB was a "complex issue" and there is a fine balance between economics, disease control and politics.
He said the Welsh government was elected on a platform of not culling badgers, which was probably why there was no cull in Wales.
Therefore, he said, it was important for people to focus on what can, rather than what can't be done, under this administration.
The most important aspect was vets working with farmers, and with government and academics as partners in a much more collaborative way.
Professor Glyn Hewinson, a world-renowned expert on bovine TB © Richard Stanton
Mr Gruffydd accused the Welsh government of "going round in circles" on its TB policy over the pdast 12 years.
He urged the Welsh government to look again at the science and evidence on badger culling and make it available for use in Wales, as part of other options.
NFU Cymru president Aled Jones said the Welsh government's TB policy was sure to fail if it did not tackle the reservoir of disease in wildlife.
He said stopping cattle-to-cattle transmission of TB is paramount, but the testing regimes are inefficient. Therefore, developing better diagnostic tools to detect TB is essential.
But he added: "I still say that there's a welfare issue. If we will not address TB within wildlife, you allow animals to suffer a horrifying death.
"That's the reality. Cattle are taken away before they suffer clinical disease."
Mr Jones dismissed suggestions that the Welsh electorate had voted against badger culling, simply because it had not been debated within the public.
"There's a lack of understanding about what TB means. So, for Labour to have said it was in the manifesto and people have voted us in on the back of it, was wrong."
Audience viewNeil Howey, a veterinary surgeon from Cheshire, one of the badger cull areas, questioned whether aspirations to be TB-free according to the current definition is achievable, given limitations around testing and the spread of the disease.
Water protection What would be a workable solution to nitrate vulnerable zone (NVZ) regulations?Aled Jones said the full terms of the Welsh government's Control of Agricultural Pollution Regulations are not yet in place.
But by next August, five months of slurry storage will be required on farms in Wales for any slurry produced by livestock (six months for pigs and poultry).
There will also be a complete ban on slurry spreading between 15 October and 15 January. And these closed periods are inflexible.
Mr Jones called for a more considered approach within the regulations, noting that the environment, soil temperatures and rainfall patterns are very different on farms across Wales.
"I think we need to get into a more considered approach. Farmers have never farmed according to the calendar.
"They have always farmed according to the season and also their particular farm circumstances," said Mr Jones.
Mr Gruffydd said he proposed the annulment of the NVZ regulations in the Senedd.
He said the Welsh government rightly recognised the need to protect water quality, but had come up with wrong regulations when other solutions were available, such as agricultural colleges developing technologies that inform farmers when the time is right to spread slurry.
Audience viewWelsh dairy farmer Chris Hanks said the regulations were "being forced on farmers" by the Welsh government.
But low farmgate milk prices mean many dairy producers will struggle to find the funds to invest in items such as pasteurisation of slurry, phosphate removal of slurry and slurry storage facilities on farm.
Tree cover target Does the panel agree with the Welsh government's plans to enforce all farms in Wales to have a minimum 10% tree cover to access public funding?Kim Waters said he did not like the prescriptive nature of the policy, but said everything should be done to support the sensible use of trees within farming systems that support sustainability.
Mr Jones said there was an argument for "the right tree in the right place for the right reason", but the issue had polarised the industry.
Although he could see the benefits of planting trees in some areas for flood alleviation and providing shade for livestock, more consideration must be given towards the effect on food production and the viability of farm businesses.
Kim Waters, founder and trustee of the Welsh Rivers Union © Richard Stanton
Mr Jones said he hoped the Welsh government would introduce some flexibility in its approach in the next consultation on the issue, due to be launched in mid-December.
Mr Gruffydd said he was not surprised there had been a negative reaction to the policy from farmers, as to meet the 10% target many would have to plant trees on productive land and potentially undermine the viability of their businesses.
Farms were also being bought by investors for large-scale tree planting which was having an impact on rural communities, he added.
Mr Gruffydd said there were other ways of capturing carbon on farms, such as a "hedges and edges" approach, which creates shelter belts and wildlife corridors, improves soils and mitigates flooding.
Collaboration What can English farmers learn from Welsh farmers?Aled Jones said one of the best Englishmen to tread on Welsh soil was Sir George Stapledon at Aberystwyth University.
"He instilled the science of grassland management throughout Wales. The legacy of that work has probably infiltrated the whole industry in Wales," he added.
Mr Jones said over the past decade, Welsh farmers have enjoyed multiple successes at the British Grassland Society awards simply because this expertise is there.
"So what we do well in Wales, I think we could teach in Wiltshire," said Mr Jones, turning to Mark Jeffery, the English farmer who asked the question.
Prof Hewinson said the pilot Pembrokeshire TB project, where farmers and vets are working together to empower themselves to make better decisions on how to manage their cattle, was a really good example of people working in partnership to better control their herds, which the English could take a leaf from.
Ms Harries said Welsh pride was important and another area the English could learn from. "That's one thing as specialist food producers we shout a lot about is Welsh food production. Loud and proud."
Mr Gruffydd said English farmers could learn a thing or two about shearing sheep from their Welsh colleagues. "We could teach the English how to shear sheep. We have won a few world cups recently in this," he added.
Apply for a place at the next Farmers Weekly Question Time at the Great Yorkshire Showground in Harrogate on 11 January 2024.
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Towards A World Free Of Tuberculosis: The ADVANCE-TB COST Action
Tuberculosis (TB) is caused by Mycobacterium tuberculosis. For decades, it has been among the top 10 reasons of death globally, and the number one infectious killer. Furthermore, it is still associated with significant stigma in the eyes of the public. TB generally affects the lungs, but it can also affect other organs. Most infections do not progress to active disease with symptoms, in which case it is known as latent TB (LTBI). It is estimated that 1.7 billion individuals (23% of the world's population) have LTBI.
During the SARS-CoV-2 pandemic, COVID-19 briefly overtook the leading role among infectious killers, diminishing attention to TB. Moreover, global TB control was unfortunately neglected and, according to the World Health Organization, tuberculosis mortality increased for the first time in over 10 years from 1.4 million deaths in 2019 to 1.6 million deaths in 2021. According to the recently released World Health Organization TB Report 10.6 million people fell ill with TB in 2022 with 1.3 million deaths and 410.000 new multidrug-resistant TB cases diagnosed.
Despite global commitments to end TB by 2030, the epidemic shows no signs of slowing down. Earlier this year, the UN General Assembly organized a high-level meeting on the fight against tuberculosis. Furthermore, the UN announced the creation of the TB Vaccine Accelerator Council at the World Economic Forum in Davos, to speed up the licensing and use of effective novel vaccines against TB.
Current challengesTuberculosis is a curable and preventable disease. However, to successfully control TB we need better diagnostic tools, more effective therapy (especially for drug-resistant TB), and a new vaccine.
The only licensed TB vaccine used worldwide is The Bacillus Calmette-Guérin (BCG) vaccine developed a century ago. It does not ensure lifelong protection but it does protect from severe TB forms during childhood. Several vaccine candidates are in clinical trials, aiming at either protection from TB infection or limiting the progression from LTBI to active TB, but a long road still lies ahead. TB Vaccine Pipeline currently provides information on vaccine candidates in clinical development.
A major challenge for TB control is that there is currently no test or biomarker able to identify the 5 -15% of infected individuals who have an increased risk to at any point in their lifetime progress from LTBI to active TB disease. Further studies for the characterisation, understanding, and identification of patients with a higher risk of disease progression are needed, especially in vulnerable populations (i.E. Children, and HIV patients). It is important to identify and treat infected individuals early as LTBI cases can become active cases and thus be infectious to others, facilitating dissemination and transmission.
Tuberculosis is curable when treated with the correct antibiotics for the correct period of time. However, in some cases, TB bacteria develop resistance and do not respond to the standard drugs. This results in longer treatment periods often accompanied by undesirable side effects and poorer outcomes. Moreover, the cost of treating a patient with drug-resistant TB is significantly higher than treating one with pan-susceptible TB.
Furthermore, TB is often associated with stigmatization, and socio-economic determinants play an important role in the course and severity of the disease. This highlights the importance of identifying individuals with specific risk factors to improve prevention and disease control strategies.
The main challenge, here, is how to improve the management, diagnostics, and treatment of patients with TB by better integrating clinical knowledge and research. Our project tries to address these challenges by facilitating and encouraging collaboration between key players such as hospitals, NGOs, academic institutions, and small/medium enterprises through a structured, coordinated, and open European research network.
Introducing ADVANCE-TBLaunched in September 2022, the ADVANCE-TB COST Action aims to address the complexity of TB management. ADVANCE-TB is a research network that offers opportunities for collaboration between clinicians, academic researchers from interdisciplinary backgrounds, industry, and non-governmental organisations to advance the global control of TB.
The network has more than 134 members coming from 42 different countries worldwide and keeps growing. Innovators will be connected to clinical research sites in different settings to plan and implement emerging approaches for TB management, and to tackle the stigma perceived by the public.
"Our Action brings together researchers from interdisciplinary backgrounds to improve tuberculosis management. The network has members affiliated with clinical sites, research institutions, academia, small and medium enterprises, and non-governmental organizations distributed around the globe, and our efforts are devoted to combat TB from different perspectives." Dr Alicia Lacoma, Chair of ADVANCE-TB
Tuberculosis: curable and preventableADVANCE-TB will enable a detailed review of tuberculosis by country, highlighting bottlenecks and differences in management.
The network is also working to find better ways to prevent, diagnose, and effectively treat TB. In addition, they will help visualise the stigma regarding the disease, and the impact that TB has on patients and their families. To end TB, we need a multi-sectoral approach involving not only the general health sector but also stakeholders and advocacy groups, among others. "With ADVANCE-TB we hope to take action and move forward in this direction" adds Dr Alicia Lacoma, Chair of the network.
Looking ahead"After four years, the tasks developed within our network will provide scientific evidence on how multifaceted aspects of TB could be improved, while increasing its awareness. The multidisciplinary background of the members as well as the diverse profiles of the participating institutions is invaluable to achieve such an objective." explains Alicia. "In addition, the network will secure its consolidation by participating in forthcoming international call applications in the TB field."
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