What tuberculosis is, how to protect yourself from it, and why one shouldn’t refuse tests
Last week marked World Tuberculosis Day. This day is another reason to remind you about the prevention of this disease and what it is. Despite that in our time fewer people die from TB in civilized countries, the problem has not been solved. In the conditions when the anti-vaccination movement is gaining momentum and parents refuse to do preventive studies of their children for susceptibility to tuberculosis (Mantoux tests, DST), the question becomes even more acute. In his author’s column for Realnoe Vremya, State Duma deputy from Tatarstan, Doctor of Medical Sciences Boris Mendelevich spoke about what kind of disease it is, how dangerous it is and whether it is possible to protect yourself from it.
Tuberculosis: figures and definitions
To begin with, I suggest that you traditionally define the terms and understand the scale of the disease. So, tuberculosis is a widespread infectious disease of bacterial etiology.
Most often it affects the lungs. But the cases are different, the infection can “take root” in almost all organs and tissues of the human body (with the exception, perhaps, of nails and hair, but this is not a living tissue). The disease can affect the bones, liver, kidneys, larynx, and even the eyes. As of 2020, tuberculosis is one of the top 10 causes of death in the world.
Of course, the prevalence of the disease varies from country to country. As strange as it may sound to us, civilized modern people, Russia is still among the countries with a high burden of tuberculosis. However, in recent years, a fairly large-scale and systematic work has been carried out to stop the “spread” of tuberculosis in the country. For example, over the past 20 years, half as many people fell ill as before, and the number of deaths was reduced by four times.
So it is assumed that next year the World Health Organisation will consider the possibility of Russia’s entry into a more prosperous category.
Why it is important not to give up Mantoux or Diaskintest
This success did not come out of the blue, but was the result of hard work. And all this work is very easy to negate, thoughtlessly refusing to diagnose — yourself and especially children. After reading anti-scientific information on the Web, many parents refuse the Mantoux reaction or the diaskintest — thereby leaving their own children in danger. And the frequency of such refuses is growing. This is a wake-up call for doctors.
Let me explain how this happens and why it is safe. The Mantoux reaction is the body’s response to the administration of tuberculin. Once again, I emphasise: tuberculosis bacteria are not introduced into the child’s body! Tuberculin is an extract from a bacterium, just a chemically derived substance that can in no way cause disease. But if the body has already encountered a tuberculosis bacterium, it means that it knows what tuberculin is, and gives it an increased immune response. This is how the Mantoux test works: if the reaction is strong, it means that the child should be checked for tuberculosis in more detail. If it is weak, it means that his body has not encountered a tuberculosis bacterium, which means that he or she is healthy.
Diaskintest works in much the same way: it contains proteins that cause an immune response in the body only to mycobacterium tuberculosis. That is, children are not injected with a pathogenic bacterium, but only a protein that produces an immune response.
Diagnosis of adults consists of a lung X-ray or fluorography once a year.
So why is it important for the medical community to find infected people quickly? The thing is that tuberculosis does not immediately show its signs. According to the World Health Organization, about one-third of the world’s population has latent tuberculosis. This means that people are infected with the bacterium, but are not yet sick. And it is precisely this stage that can be detected thanks to the diagnosis.
Is tuberculosis always contagious?
Tuberculosis is an infectious disease. But patients can be contagious and not contagious. This status may change, depending on the stage of development of the disease and how effective the prescribed treatment is.
In the open form of tuberculosis, the patient releases the causative agent of the disease into the environment. This mainly applies to pulmonary tuberculosis — microbes are released into the air when coughing and expectoration. If such cases are not detected quickly (often people think that they just have a chronic cold), then it is believed that one patient has time to infect up to 15 people. Based on practice, these are members of his family, close friends, possibly colleagues. But we must understand that the disease is transmitted not only by airborne droplets. You can get infected by not washing the spoon after the patient or, for example, by biting off the same product from which he bit.
In the closed form of tuberculosis, mycobacterium is not released from the patient’s body, which means that the infected person does not pose a threat to others. But his own health is still at risk. According to the WHO, an average of 45% of HIV-negative people with tuberculosis and almost all HIV-positive people die without proper treatment.
Forewarned means armed?
Timely diagnosis of tuberculosis is one of the ways to save the lives and health of tens of millions of people. At the same time, the detection of the disease does not differ dramatically in different countries. The question is mostly about coverage. For example, in Russia, any child can be diagnosed. In countries with a low burden of the disease, where it is extremely rare, for example, in the United States, Canada, and the United Kingdom, work is mainly carried out with at-risk groups.
Despite all the danger of tuberculosis, according to statistics, now in Russia there are more and more cases of refusal to diagnose. About what this can lead to, I wrote above.
And I think it is important to consider this issue from several angles. On the one hand, from the point of view of legislation, the refusal of tuberculin diagnostics (Mantoux test or diaskintest) does not restrict the child’s right to attend school and kindergarten, if the child has no contact with a tuberculosis patient and there is a conclusion of a phthisiologist about the absence of tuberculosis. That is, according to the law, a parent can refuse to conduct a Mantoux test for a child, but must receive the opinion of a phthisiologist.
On the other hand, there are also the rights of children who are not vaccinated for health reasons — simply those who have a medical exemption from vaccinations and tests. And now they can get infected from a child who did not pass a timely diagnosis. On the third hand, they can also get tuberculosis in other places.
Therefore, despite the general rather joyful trend, in Tatarstan the share of sick children in the general structure of patients does not decrease. More than 3,500 children with latent tuberculosis are detected in Tatarstan a year. At the same time, during 2020, all children and adolescents, with the exception of one, were identified prophylactically. And in 100% — with immunodiagnostics.
In this matter, in my opinion, the numbers are the best indicator. We must understand that tuberculosis is not always cured. In Tatarstan, more than half of patients suffer from a form of the disease with multiple drug resistance — when the disease is not affected by drugs. This can happen in several cases: when the patient initially contracted a drug-resistant form of tuberculosis, or if he received therapy improperly, for example, interrupted it.
In general, no one is 100% protected from tuberculosis. In this matter, it is important to be systematic and attentive to your health. In addition, I believe that the economic component is also significant: people should have such financial security that they can afford a varied and balanced diet, have the habit of doing physical education, etc. We must understand that medicine can do a lot, but it is important to improve the standard of living and well-being.
Personally, I immediately recommend that you see a doctor at the first symptoms. In this matter, it is better to be safe than to learn about the disease at a later stage. If each of us carefully treats our own health and the health of others, then it will be easier to maintain collective immunity — and, therefore, to resist tuberculosis.
By Boris Mendelevich