Questions for MD-TB Case Study PDF

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Saleana Caraballo MDR-Tuberculosis: A Case Study for Non-Science Majors Focused on Social Justice Part I Questions 1. Who is at risk for contracting and developing TB, and why?

Everyone is at risk of contracting and developing TB because it is transmitted via aerosol droplets. Therefore, breathing the same air in an enclosed space as an infected individual would allow transmission to occur. Those who have weakened immune systems or underlying health problems are also at risk as they cannot fight off the disease to their full potential. 2. How do antibiotics stop or slow bacterial growth? What do they target? Antibiotics stop/slow bacterial growth by cutting off the nutrient supply to the bacteria which prevents it from multiplying and growing. Antibiotics target the bacterial cell wall in order to stop/slow down the growth of the bacteria. 3. What are the scientific factors that influence the development of drug resistant TB?. Scientific factors that influence the development of drug resistant TB are incomplete/inadequate treatment, virulence of organism, HIV infection, multi-drug transporters, and genetic factors of the host. 4. What is XDR TB and what social factors contributed to the increase in cases? XDR TB is a type of tuberculosis that is multidrug resistant; This type of TB is resistant to the first-line and three out of six second-line antibiotics for the disease. Social factors contributing to the increase in XDR TB cases are travelling, coughing and coming into close proximity to infected individuals for periods of time. 5. Why has the NYCDOH chosen to employ dots to minimize the development of drug resistance? What are the major components of the dots program and how do they address the scientific and social factors which influence the development of drug resistance?

The NYCDOH has chosen to employ dots to minimize the development of drug resistance in order to help fight MDR TB which was resistant to all previous TB drugs and save lives. The DOTS program provided second-line antibiotics to individuals infected with MDR TB that were more toxic, less effective and more costly. The program proved to be a success in saving lives which convinced the World Health Organization to overturn their 1999 guidelines of recommending no treatment for patients suffering from MDR TB proving that there was a way to treat this strain of TB. 6. Why are people on the margins of society more susceptible to developing drug resistant infections?

People on the margins of society are more susceptible to developing drugresistant infections because of the lack of medical care they possess. The

lack of medical care means that they do not have access to the proper antibiotics to treat their disease making the medications they do have available become less effective or null/void over time thus leading to drugresistant infection. 7. What do these percentages and rates mean; how many cases are there per year?

The percentages 4%, 19%, and 15% are the percentages of MDR cases that were infected with XDR per year in certain places. For the U.S., 4% of MDR cases were infected with XDR per year. In Latvia, 19% of MDR cases were infected with XDR per year, and in South Korea, 15% of MDR cases were infected with XDR per year. There are approximately 99,000 cases of MDR TB per year. 8. Are there new treatments on the horizon for XDR TB? Why are pharmaceutical companies reluctant to develop drugs to combat this kind of TB? How are public health organizations shaping the future of drug development? There are no new treatments on the horizon for XDR TB. Pharmaceutical companies are reluctant to develop drugs to combat this type of TB because they gain little benefit from producing the drug since it is rare; The Greenlight Committee ensures that this necessary drug is sold are 99% less than the open market price. Public health organizations are shaping the future of drug development by finding ways to create new treatments and vaccines for diseases/infections that are currently unknown or undiscovered. 9. Can I vaccinate my child for TB? Yes, there is a TB vaccination for children. 10. If my child is vaccinated, is he/she protected from MDR TB? If your child is vaccinated, he/she is protected from TB so long as all required medication/injections were taken. Part II Questions: Read the references at the end of Part II, as well as others you may find, and develop both a pro and con argument for instituting a public health infrastructure that can meet the demands of the newly proposed bill. In preparing your statements, reflect on the challenges that Aisha alludes to in the first paragraph. (Make sure to cite your references Pro Argument: Instituting a public health infrastructure that can meet the demands of the newly proposed bill could help reduce the risk of TB infection in many Americans while also positively influencing medical and economic aspects in America. Putting in place a public health infrastructure that will tends to the needs of both Americans and immigrants can help reduce the risk of TB infection by catching the disease before it is spread. Through recognizing that “tuberculosis is not constrained by national boundaries,” new methods of diagnosis and treatment can prevent the spread and ultimately eliminate the threat of TB amongst Americans and immigrants wishing to enter the country (Geiter). Immigrants being allowed in the U.S. after undergoing testing and, if necessary, treatment can positively impact the U.S. economy. Immigrants are known to work the most undesirable jobs to Americans that consist of low wages, such as farming jobs (Cosman). By instituting a public health infrastructure that allows

immigrants to safely enter the U.S. and work to help farmers produce goods that then enter the market for consumption, U.S. economy can thrive. Con Argument: Instituting a public health infrastructure that can meet the demands of the newly proposed bill could be dangerous and costly for the United States. The TB disease has potential to become active and inactive sporadically as well as become resistant to antibiotics for TB (Debi’s story). This can prove to be dangerous and even fatal as immigrants that test for TB and are deemed inactive cases can still be a threat to the health of many Americans. Like in Debi’s story, a young American girl fought TB and was deemed inactive, but later her TB case became active again threatening her life as well as the lives around her. Additionally, a public health infrastructure can prove to be very costly and damage the U.S. economy. Immigrants are not protected under the U.S. rights to be covered by health insurance, so healthcare can become a costly disaster. Because hospitals in the U.S. are required to see any patient of any legal status for any type of emergency, immigrants can be seen for any medical reason including TB whether they have the funds to pay for the care or not (Cosman). This can lead to the closings and bankruptcies of hospitals. https://www.jpands.org/vol10no1/cosman.pdf https://www.nap.edu/read/9837/chapter/1 https://science.education.nih.gov/supplements/webversions/infectiousdiseases/activities/activity 3_debi-story.html Part III Questions: 1. How does the Mantoux ppd skin test work? Can you hypothesize as to why vaccination might compromise this screening test? The Mantoux ppd skin test works by injecting tuberculin into the skin then waiting 2-3 days to see if the injection site turns into a hard little bump showing that TB is present and the person tests positive. Vaccination may compromise this screening test because of the weakened/dead form of TB used in the vaccine can trigger a false positive in the screening test. 2. Specifically, how does Quantiferon-TB Gold differ from the Mantoux PPD test in terms of test sample, time, cost, and information?

Quantiferon-TB Gold testing involves culturing bacteria and genetically analyzing it or growing the bacteria in the presence of antibiotics whereas the Mantoux PPD testing is an injection. The Quantiferon-TB Gold testing is a lengthier process taking months whereas the PPD test takes 2-3 days, and it is more costly compared to the PPD test. Quantiferon-TB Gold testing reveals the drug resistance profile and genetic/molecular information about the M. tuberculosis whereas the PPD test tells us if TB is present or active. 3. When a person is diagnosed with LTBI, why don’t they feel or look ill? What is happening in the body of the infected individual?

When a person is diagnosed with LTBI, they don’t feel or look ill because the disease is inactive and lies dormant in the body. The body fights the bacteria to stop them from growing. 4. Explain how old age, smoking, and HIV infection influence the progression of TB infection.

Old age and HIV influence the progression of TB infection because the immune system is weakened and unable to efficiently fight off the bacteria of TB when

it enters the body. Smoking influences the progression of TB infection by increasing susceptibility to TB due to an impaired immune system and immune response. 5. Compare the prophylactic approaches described in the Ending Neglect book to those targeting adolescent immigrants. Which do you think might be more successful and why? Compare the risks involved with each approach. 6. Can you hypothesize as to why the studies referenced in the Institute of Medicine text reported that only 75% of the patients in the study completed treatment?

The studies referenced reported that only 75% of the patients in the study completed treatment because of how many people living in poverty or uninsured do not have the health coverage to afford or continue with treatment. 7. Can you suggest methods or approaches that could result in better compliance with the drug regimen in adolescents?

Children should be fully vaccinated at a young age to reduce the risk of contracting TB from exposure. Some methods that could result in better compliance in adolescents could be to assess the medication or the control of the disease. Another method could be to talk about incompliance history with adolescents to become more aware of their incompliance and assess it. 8. Extend Aisha’s thinking and answer her question, “Could prophylactic treatment of LTBI in the immigrant population promote the development of XDR TB?”

Prophylactic treatment of LTBI could promote the development of XDR TB in the immigrant communities since it tends to promote constant reactivation of TB. Since it is difficult to gain access to drugs in order to treat TB for immigrants and they tend not to be covered by health insurance, immigrants tend not to get treated for TB thus promoting the progression of XDR TB. 9. Do you think there are any issues of social justice or human rights that need to be addressed before a study on children is approved? Who oversees the ethics of such studies? Should minorities in the U.S. be targeted in public health campaigns? Yes, before a study on children is approved, it needs to be determined that children can accurately understand and consent to the specifics of the study. Also, children need to be made aware of the risks and understand those risks. The ethics of such studies are overseen by the institutional review board. Minorities in the U.S. should be targeted in public health campaigns since they are more at risk of developing TB due to coming from high risk countries increases the chances of having LTBI which can progress to TB....