Tuberculosis Rates: Bolivia Vs. Us Comparison

Tuberculosis (TB) is an infectious disease that affects the lungs and is caused by bacteria. It is present in all countries and age groups, with 1.3 million people dying from it in 2022. In the same year, Bolivia had an incidence rate of 108 cases per 100,000 people, which has been declining since 2003. In comparison, the US is one of the largest contributors to funding the fight against TB and has a lower incidence rate of TB than Bolivia. This raises the question of whether Bolivia has a lower rate of tuberculosis than the US, and if so, what factors contribute to this difference.

Bolivia's tuberculosis (TB) rates in 2022

Tuberculosis (TB) is an infectious disease that affects the lungs and is caused by bacteria. It spreads through the air when infected people cough, sneeze, or spit. In 2022, Bolivia had an incidence rate of 108 cases of tuberculosis per 100,000 people. This number has been declining at a moderating rate since 2003, when the incidence rate was 168 cases per 100,000 people.

Bolivia is a high tuberculosis incidence country, with a large private for-profit health sector. A study in the city of Cochabamba found that TB drugs were available in private pharmacies, but the private sector contributes little to managing TB in the country. The study found that only 25 out of 100 pharmacies sold at least one TB drug, and only 16 sold isoniazid, a first-line treatment. Pharmacists agreed to stop selling the drugs and to refer clients to the public sector.

The World Health Organization (WHO) reports that globally, TB is the second leading infectious killer after COVID-19, and it is present in all countries and age groups. About a quarter of the world's population is estimated to have been infected with TB bacteria, but only 5-10% of those infected will develop the disease. TB is curable and preventable, and global efforts to combat it have saved an estimated 75 million lives since 2000. However, multidrug-resistant TB remains a public health crisis and a health security threat.

TB rates in the US

Tuberculosis (TB) is an infectious disease that affects the lungs and is caused by bacteria. It can also affect the kidneys, brain, spine, and skin. TB spreads through the air when infected people cough, sneeze, or spit. It is preventable and curable, usually with antibiotics.

In 2022, there were 8,331 reported TB cases in the United States, a rate of 2.5 cases per 100,000 persons. This number has been steadily decreasing since 1992, with the exception of 2021 and 2022, when reported cases increased but remained lower than pre-pandemic levels. Up to 13 million people in the United States are estimated to be living with latent TB infections.

TB is curable and treatable, but it can be fatal without treatment. Those with compromised immune systems, such as people living with HIV, undernutrition, or diabetes, or people who use tobacco, are at a higher risk of falling ill. In 2022, there were 1.3 million TB-related deaths worldwide, including 167,000 people with HIV.

To prevent the spread of TB, it is important to seek medical attention if you have symptoms like a prolonged cough, fever, or unexplained weight loss. Getting tested for TB infection is crucial, especially for those at increased risk, such as individuals with HIV or those in close contact with people who have TB. If prescribed treatment, it is essential to complete the full course to prevent drug-resistant strains of TB from developing.

TB treatment in Bolivia

Tuberculosis (TB) is a notable health concern in Bolivia, with a higher prevalence and incidence of the disease compared to other South American countries. The long-term treatment for TB involves a combination of drugs, often leading to adverse drug reactions (ADRs) that impact treatment adherence.

To address this, Bolivia has implemented strategies to strengthen its pharmacovigilance system and improve patient care for TB. These strategies include:

• A new local case report form (CRF) implemented alongside the CRF established by the Unidad de Medicamentos y Tecnología en Salud (UNIMED).
• Training and follow-up on drug safety monitoring and ADR reporting for health professionals involved in TB treatment.
• Specific training on pharmacovigilance for health professionals in rural areas.
• Close medical follow-up and monitoring of ADRs to improve treatment adherence.
• Collaboration with the local Pharmacist's Association to stop selling TB drugs and refer clients to the public sector.

These interventions aim to improve the reporting and management of ADRs, enhance patient safety, and increase treatment adherence.

In terms of treatment success rates, Bolivia has made notable progress. According to a study in São Paulo, Brazil, Bolivian immigrants had a higher cure rate of 71.6% compared to Brazilians at 63.2%. This indicates that Bolivia's TB treatment strategies may be effective, contributing to better health outcomes.

TB treatment in the US

Tuberculosis (TB) is a serious health condition that requires proper diagnosis and treatment. In the United States, there are several recommended treatment regimens for TB, and the duration of treatment can vary from 4 to 9 months depending on the regimen and the patient's condition. Here is an overview of TB treatment in the US:

Diagnosis

To diagnose TB, a healthcare provider will typically perform a physical examination, which includes listening to the patient's breathing with a stethoscope and checking for swollen lymph nodes. They will also inquire about the patient's symptoms and risk factors. If TB is suspected, further tests will be ordered. These tests may include skin tests, blood tests, chest X-rays, and laboratory tests on mucus samples.

Treatment Options

The US Centers for Disease Control and Prevention (CDC) outlines various treatment regimens for TB disease. The duration and specific drugs used in each regimen depend on factors such as the patient's age, weight, HIV status, drug resistance, and the presence of cavitary pulmonary TB.

Drug-Susceptible TB Treatment Regimens:

• 4-Month Rifapentine-Moxifloxacin Regimen: Recommended for individuals aged 12 and older with a body weight of 40 kg or above. It consists of high-dose daily rifapentine and isoniazid, along with moxifloxacin.
• 6- or 9-Month RIPE Regimen: This is the preferred regimen for patients with newly diagnosed pulmonary TB. It includes the drugs pyrazinamide, rifampin, isoniazid, and ethambutol. The duration of treatment depends on the patient's condition and response.

Directly Observed Therapy (DOT):

DOT is a program where a healthcare worker visits the patient at home to ensure they take their medication as instructed. This helps improve treatment adherence. The CDC also recommends video DOT (vDOT) as a viable alternative to in-person DOT.

Medication Side Effects

Most people can tolerate TB medications without serious side effects. However, it is important to be vigilant for any adverse reactions. Side effects may include light-colored stools, jaundice, dizziness, tingling in hands or feet, easy bruising, unexplained weight loss, fatigue, and sadness or depression. Patients experiencing these or any other concerning symptoms should consult their healthcare provider.

TB prevention

Tuberculosis (TB) is an airborne disease that is quite common in many parts of the world, including Bolivia, but rare in the United States. It is spread when someone with active TB of the lungs or throat coughs, sneezes, or speaks, releasing TB bacteria into the air which can then be inhaled by others. While most people exposed to TB bacteria do not develop an infection, those with weakened immune systems are at a higher risk of developing TB disease.

Preventative Measures for Individuals:

• Avoid close contact with infected individuals: If you know someone has active TB disease, it is best to stay away from them as much as possible until they are no longer infectious. This is especially important if you have a weakened immune system.
• Hand hygiene and respiratory etiquette: Wash your hands often and cover your mouth and nose with a tissue when coughing or sneezing. Dispose of tissues in a closed bag and wash your hands afterward.
• Ventilate indoor spaces: TB bacteria can remain in the air for several hours, especially in indoor areas with poor air circulation. Opening windows and using fans can help circulate fresh air and reduce the concentration of TB bacteria.
• Follow treatment protocols: If you have latent TB, it is important to follow the recommended treatment protocol to prevent it from becoming active TB disease. Treatment options typically include a combination of antibiotics such as isoniazid and rifampin, taken daily or weekly for several months.
• Take all medications as directed: Whether you have active or latent TB, it is crucial to take all medications exactly as prescribed by your healthcare provider. Stopping treatment early or missing doses can be dangerous and may lead to drug-resistant TB.
• Maintain a strong immune system: Eating a nutritious diet and exercising regularly can help keep your immune system strong, making it more effective at fighting off TB bacteria.
• Get vaccinated: The Bacillus Calmette-Guérin (BCG) vaccine is the only vaccine used for TB prevention and is often given to infants and young children in countries with high TB rates. While it is rarely used in the US due to the low prevalence of TB, it may be recommended for healthcare workers who are frequently exposed to TB patients.

Preventative Measures for Healthcare Settings:

• Infection control plans: Healthcare facilities, especially those serving high-risk populations, should have infection control plans in place to minimize the risk of TB exposure and spread. This includes administrative measures, environmental controls, and the use of respiratory protective equipment.
• Screening and education: Facilities should implement screening protocols for healthcare personnel and provide education on TB prevention and control.
• Protective gear: When working in healthcare settings, especially in countries with high TB rates, follow protocols for wearing protective gear such as masks and gowns to reduce the risk of exposure to TB bacteria.

Frequently asked questions