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Emerging High Risk Behaviors for Exposure to Tuberculosis

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Emerging High Risk Behaviors for Exposure to Tuberculosis 2008 Volume 3, Number 2 In This Issue… Emerging High Risk Behaviors for • Headlines Exposure to Tuberculosis Drug-use along with several other medical, • Regional News circumstantial, and social or lifestyle factors has long since been associated with a higher incidence of TB infection • Related Links and higher risk for disease regardless of the prevalence of TB infection in the community. TB programs target high- • Upcoming Trainings risk groups such as substance abusers in order to better implement control and prevention measures such as • In The Works screening and preventative therapy; however as trends shift, certain groups not considered at risk may eventually • TBit be identified as a high priority, and vice versa. The “drug- use” category demonstrates these current shifts, as the • Introducing activities of drug-users can change quickly in response to • Case Presentation social, economic, or legal factors. Perhaps the most fluid areas within this high-risk group are the points at which drug-use converges with low-risk groups, such as young To Contact Us healthy adults or upper middle class university students. It is at these convergence points that public healthcare Mailing address: workers must be prepared for the shifts that pose a Heartland National possible increased risk of TB to a new group of people. TB Center Currently much of the increased risk associated with 2303 SE Military Drive drug-use is due to overlapping social and lifestyle factors including homelessness, imprisonment, mental health San Antonio, TX 78223 issues, and alcohol abuse. Injection drug users are also at an increased risk of HIV infection, and many substance Telephone Number: abusers in general suffer from malnutrition. These 1-800-TEX-LUNG environmental and medical conditions not only result in an (800-839-5864) increased risk for infection but may also increase the risk for progression to active disease. In addition, new evidence suggests a more direct link between drug use Fax Numbers: and TB. A case-control study of TB in London reveals a correlation between smear-positive TB and crack cocaine Administration use. It is hypothesized that the damage caused by (210) 531-4590 smoking crack cocaine (known as crack lung) impairs lung Medical Consultation function and may increase susceptibility to infectious diseases.1 (210) 531-4500 However the risk of disease transmission is not limited to injection-drug and hard-drug users. Often overlooked, www.HeartlandNTBC.org shared water pipes used for smoking drugs such as Continued on Page 2 Page 2 HNTC Staff Continued from Page 1 Medical Director marijuana or tobacco also have the potential for spreading infectious diseases. The danger in these practices is that Barbara Seaworth, MD they are often considered less harmful and have less strong (210) 534-8857 associations with additional health risk behaviors.2 Water [email protected] pipe or hookah smoking is a rising infection control concern because it is usually a social group activity in which each Assistant Medical Director participant inhales from and passes around a shared David Griffith, MD mouthpiece. The activity typically occurs in small, poorly (903) 877-7267 ventilated rooms and continues for at least an hour. Risks to UTHC Tyler employees of these facilities are likely even more significant [email protected] but have not been evaluated. Hookah smoking can easily be ignored as a disease risk factor due to its casual use and widespread popularity. Hookah smoking is common practice throughout much of Training and Product the world. It has been estimated that >100 million people Development worldwide smoke hookahs daily.3 In much of the world this Director, Education & practice is more than a drug-use behavior, rather it is a Training cultural, familial, ritualistic, and symbolic custom. However Mary Long, MSPH its popularity has spread throughout different countries, (210) 531-4545 economic classes, and age groups. In the United States [email protected] hookah smoking is a popular social activity with adolescents and young adults, especially from middle and upper income Education Specialist families. One recent study revealed that non-Arab-American Laura Muraida youth generally perceive hookah smoking to be less harmful than cigarettes,4 although the contrary has been proven.5 At (210) 531-4509 universities hookah smoking is a common method of [email protected] socialization for both foreign-born and domestic students. As many disease investigators know university students can be Education Specialist a highly transient group with many contacts, but little Jessica Quintero contact information, and the casual group nature of smoking (210) 531-4568 hookah can complicate such situations. [email protected] The implications of these findings can be alarming; however it is crucial for public healthcare workers and health Nurse Educator educators to be aware of such trends. While hookah smoking Position Available is a recognized site of TB transmission in the Middle East it Education Specialist has not been reported in the United States as a site of Position Available transmission. Yet in recent cases of TB in young adults Apply at UT Health Science (university students), contact investigators have noted Center at Tyler occasional hookah use as a social activity. The Advisory Council for the Elimination of Tuberculosis states that, “local Web Site & Content public health officials should identify community groups Coordinator among whom TB and transmission of infection occur. Eddie McHam Identifications of these groups requires collecting and (210) 531-4520 analyzing a) data on newly reported cases available as part of TB surveillance, b) data not routinely collected and/or [email protected] analyzed, and c) data from tuberculin screening programs.”6 In taking these steps local health departments can adequately target emerging and locally defined high-risk populations or areas. Continued on Page 3 Page 3 HNTC Staff Continued from Page 2 Medical Consultation Researched by: Alysia Thomas and Laura Muraida, Heartland Nurse Consultant National TB Center Catalina Navarro, RN, BSN Written by: Laura Muraida, Heartland National TB Center (210) 531-4569 FOOTNOTES: [email protected] 1 Story, A.; Bothamley, .G and Hayward, A. Crack Cocaine and Nurse Consultant Infectious Tuberculosis. Emerging Infectious Diseases. 2008; Vol. 14, No. 9: 1466-1469. Debbie Onofre, RN, BSN 2 (210) 531-4539 Knishkowy, B and Amitai, Y. Water-Pipe Smoking: An Emerging Health Risk Behavior. Pediatrics. 2005; 116: e113-e119. [email protected] 3Ibid 4 Nurse Consultant Weglicki, L.S.; Templin; T.N.; Hill Rice, V.; Jamil, H. and Hammad, Position Available A. Comparison of Cigarette and Water-Pipe Smoking by Arab and Non-Arab-American Youth. American Journal of Preventative Apply at UT Health Science Medicine. 2008; 35, 4: 334-339. Center at Tyler 5Knishkowy, B. and Amitai, Y. 6Bloch, A.B. Screening for Tuberculosis and Tuberculosis Infection in High-Risk Populations: Recommendations of the Advisory Council for Administration the Elimination of Tuberculosis. MMWR. 1995; 44(RR-11): 18-34. Director of Administrative REFERENCES: Services WHO Study Group on Tobacco Product Regulation. Waterpipe Stephanie Ott Tobacco Smoking: Health Effects, Research Needs and (210) 531-4542 Recommended Actions by Regulators. [email protected] White Rabbit Administrative Specialist By Jefferson Airplane Delfina Sanchez One pill makes you larger (210) 531-4528 And one pill makes you small [email protected] And the ones that mother gives you Don't do anything at all Go ask Alice Administrative Specialist When she's ten feet tall Sally Santellanes And if you go chasing rabbits (210) 531-4572 And you know you're going to fall [email protected] Tell 'em a hookah smoking caterpillar Has given you the call Administrative Specialist Recall Alice When she was just small Alysia Thomas (210) 531-4549 When men on the chessboard [email protected] Get up and tell you where to go And you've just had some kind of mushroom And your mind is moving slow The VISION of the Heartland is to Go ask Alice I think she'll know provide excellence, expertise, and innovation in training, When logic and proportion medical consultation, and Have fallen sloppy dead product development to And the White Knight is talking backwards reduce the impact of And the Red Queen's "off with her head!" Remember what the dormouse said; tuberculosis in our region. "FEED YOUR HEAD Submitted by Michelle Hulse, MD; Minnesota Page 4 Regional News Minnesota Tuberculosis (TB) Awareness and Treatment ECHO-TV Program By Elizabeth Kingdon, Minnesota Department of Health Minnesota Department of Health's (MDH) Refugee Health and Tuberculosis Programs are pleased to offer a show about tuberculosis (TB) for the public. This show was produced by the ECHO-TV (Emergency and Community Health Outreach) collaborative. Developed as an educational and outreach tool for persons at elevated risk for TB, the DVD contains seven versions of a 20-minute show that originally aired on public television in Minnesota in March 2008. There are seven versions: English, Hmong, Khmer, Lao, Somali, Spanish, and Vietnamese. Each version was taped using bilingual and bicultural hosts and healthcare providers. Content was written by MDH TB Program staff. All non-English programs are subtitled in English. Although the content of the shows varies slightly, each version has these key messages in common: • People from countries where TB is common should get tested for TB. • TB is curable and preventable. • If you have TB it's important that you take all of your medicine and follow the advice of a medical professional. • Anyone can have TB so there is no need to be ashamed if you have the disease. This content is available in DVD and web streaming formats. A limited number of DVDs are available at no cost to organizations in the United States that serve populations at elevated risk for TB.
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