Ready-to-Use Presentation for Healthcare Providers on Tuberculosis (TB) - First Nations and Inuit

This presentation has been developed for community healthcare providers (such as nurses working in public or community health, community health workers and/or community health representatives) involved in the delivery of education or information about tuberculosis to community members and/or clients.

In the ready-to-use presentation you will find information on:

• The history of TB in Canada;
• Basic information on TB;
• The good news story about TB today: It can be cured with proper medication and support; and
• How individuals and communities can be involved in protecting their friends and families from TB.

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Table of Contents

• Objectives of this presentation
• The most important message about TB today
• TB history in Canada
• TB history in Canada
• TB: then & now
• TB around the world today
• TB in Canada
• Basic information about TB
• How is TB spread to others?
• TB germs are more likely to spread to others when…
• Once the germs are in the body
• Types or stages of TB
• Types or stages of TB
• Symptoms of TB disease
• Find TB early: TB can be treated & cured
• Groups at risk for having TB infection
• People most at risk of developing TB disease
• TB in children
• Tests used to look for TB
• TB disease: treatment
• TB disease: treatment
• Contact tracing
• TB Infection: Treatment
• What can I do?
• What can I do?
• Remember…

Slide 1

Tuberculosis (TB)

Important Information about TB

Slide 2

Objectives of this presentation

Members of the audience will gain an understanding of:

• The history of TB in Canada
• Basic information about TB
  • Types or stages of TB: latent/sleeping infection vs. active disease
  • How TB passes from one person to another
  • What the symptoms are when someone is sick with TB
• The good news story about TB today: It can be cured with the proper medicine and support
• How individuals and communities can be involved in protecting their friends and families from TB

Slide 3

The most important message about TB today

TB can be CURED and PREVENTED

Slide 4

TB history in Canada

• The "Sanatorium Age" in Canada began in 1896. Sanatoria care included rest, fresh air, good nutrition and isolation to prevent the spread of TB.
• Sanitoria were large institutions or treatment centres that specialized in the diagnosis and recovery of patients with  tuberculosis.

Slide 5

TB history in Canada

• Many of the people who were sent to sanatoria and their families did not understand why the separation was happening.
• Sanatoria care saved many lives, but many people also died in hospital far away from their communities and families. Many spent years in hospital and lost language, culture, family and community life.
• These memories may be the only knowledge of TB that older community members have.

Slide 6

TB: then & now

• Then…
  • The discovery of good TB antibiotics in the 1950's & 1960's made TB curable.
  • TB Sanatoriums were no longer needed so they closed their doors.
• Now…
  • Hospitalization is usually only needed for the first part of treatment, until the person is no longer infectious. The remainder of treatment is usually taken at home, in the community.^{Footnote 1}

Slide 7

TB around the world today

• 1/3 of the entire world's population is infected with the TB germ.
• Approximately 8 million people get sick with TB disease every year.

Slide 8

TB in Canada

Reported tuberculosis incidence rates by origin - Canada: 2001-2011

Source: Public Health Agency of Canada. Tuberculosis in Canada 2011 - Pre-Release. Ottawa (Canada): Minister of Public Works and Government Services Canada; 2012

Important Notes: Aboriginal populations include North American Indian, Status and Non-status Indian, Inuit and Métis

Data are provisional and subject to change

Slide 9

Basic information about TB

• TB is caused by the bacteria or germ called Mycobacterium tuberculosis.
• TB bacteria are too small for the eye to see.
• They can be seen at the lab using a special microscope.

Slide 10

How is TB spread to others?

• TB germs are coughed into the air by a person that has TB germs growing in their lungs or airways. Sneezing, talking, and singing can also spread the germs into the air.
• The germs are very tough and can float in the air for up to several hours.
  • While they are in the air other people may breathe them in. Breathing TB germs into the lungs is the main way TB gets into the body.

Slide 11

TB germs are more likely to spread to others when…

• Long periods of time are spent with a person that has infectious TB (hours, not minutes)
• The person with infectious TB lives or hangs out with others in small, overcrowded and poorly ventilated spaces
• The person that is sick with infectious TB is coughing a lot and has been sick with TB for some time

Slide 12

Once the germs are in the body

One of three things can happen:

1. The immune system kills the TB germs and the person does not become infected with TB or…
2. The immune system is unable to kill all of the germs but it can put them to "sleep" or make them inactive for a while - this is called Latent TB Infection (LTBI) or Sleeping TB or…
3. The immune system is unable to kill the germs or put them to "sleep" so they stay "awake" or active. They are growing and multiplying causing sickness - this is called active TB disease.

Slide 13

Types or stages of TB

• TB infection (Latent TB Infection or LTBI, sleeping TB)
  • The TB germs are in the body but they are not causing sickness and cannot be spread to others
  • Can progress to disease soon (weeks or months) or later (years) after infection

Slide 14

Types or stages of TB

• TB disease (active TB)
  • TB disease may develop soon after infection (weeks or months) or years later.
  • The TB germs are causing sickness and can be spread to others if the TB is in the lungs or airways
    • The germs most often stay in the lungs and cause illness there but they can also be in other parts of the body

Slide 15

Symptoms of TB disease

• Bad cough lasting more than 3 weeks
• Coughing up phlegm
• Sometimes coughing up blood
• Fatigue - feeling weak or very tired
• Fever
• Lack of appetite (don't feel like eating)
• Weight loss (without trying)
• Sweating at night
• Pain in chest

Anyone with the above symptoms should see their health care provider.

Slide 16

Find TB early: TB can be treated & cured

The longer a person is sick with TB disease…

• the sicker they may become.
  • Advanced TB can cause severe sickness and sometimes death.
• the more likely they are to pass it on to family and friends.

Slide 17

Groups at risk for having TB infection:

• People who have shared breathing space with someone who has infectious TB (contacts)
• People who have lived in communities or countries where there is a lot of TB
• People who live or have lived in crowded living arrangements (homes, shelters, elders lodges, jails)
• People who work in places with crowded living arrangements
• Some health care workers

Slide 18

People most at risk of developing TB disease

• Those recently infected with TB (especially in the last 2 years)
• Children (especially under the age of 5)
• Past TB disease not treated properly or treated before the 1970's
• Taking medications that weaken the immune system
• People with certain health conditions such as:
  • HIV/AIDS
  • people with organ transplants
  • kidney failure
  • some cancer and cancer treatments
  • diabetes
  • being underweight

Slide 19

TB in children

• Children can get sick very quickly with serious types of TB.
• TB infection in children is a very urgent matter.
• Children with TB disease do not usually spread the germs to others.
• The best way to protect children from serious types of TB is to prevent them from coming into contact with TB.
  • find adult cases of TB disease early so they do not spread TB germs to children.

Slide 20

Tests used to look for TB

• Questions about TB Symptoms and health history
• Chest X-ray(s)
• TB skin test (TST, Mantoux test)
• Physical exam (checking the lungs and also breathing)
• Sputum (cough or phlegm) samples for examination at a laboratory
• Blood tests

The doctor or nurse might use some or all of these tests when checking for TB

Slide 21

TB disease: treatment

Treatment time varies, usually lasting anywhere from 6-9 months.

• TB germs are very tough. Multiple antibiotics are needed over many months to completely cure TB.
• Most of the treatment can be taken from home.
  • Patients may need to be in hospital during the first part of treatment until they are no longer infectious but can then take the remainder of the treatment at home, in their community.^{Footnote 2}
• Treatment is most often given by Directly Observed Therapy (DOT).

Slide 22

TB disease: treatment

Important point:

• It is very important to take all of the medicine and doses given by the health care provider, even if feeling better.
  • If not, the TB may come back and the antibiotics used to treat it might not work on the germs anymore. This is called drug resistant TB.
    • Drug resistant TB is more complicated and difficult to treat.

Slide 23

Contact tracing

• When a case of infectious TB is found in the community, the community health staff will check some family, friends and other community members for infection and disease.
  • This process is called contact tracing.
• Community members most at risk of becoming sick with TB will be checked first. Decisions on who needs to be tested are made by the health care provider(s).

Slide 24

TB Infection: Treatment^{Footnote 3}

• Persons with TB infection (sleeping TB) may be offered antibiotics to prevent TB from becoming active disease.
  • Those most at risk of developing disease are the most likely to be offered treatment.
• An antibiotic (usually one but sometimes two) is used to treat TB infection and the treatment can last anywhere from 6 to 9 months. It is very important to take all of the medications properly.

Slide 25

What can I do?

• Talk to your healthcare provider about your own risk for TB.
• Be TB aware - know the symptoms of disease and be aware of them in yourself and others.
  • If you have symptoms, get checked as soon as possible. The sooner TB is found and treated, the less it can spread to family and friends.
• Share what you have learned about TB with family and friends in your community

Slide 26

What can I do?

• Healthy people with healthy lifestyles have strengthened immune systems.
• They may still develop infection but are less likely to develop active TB disease (the kind of TB that makes a person sick).
  • Avoid misusing drugs and alcohol
  • If you have diabetes, try to keep it well controlled
  • Have a healthy, well balanced diet
  • Maintain an active lifestyle

Slide 27

Remember…

• Those affected by TB need the support of their family, friends and the entire community.
• We all share the air. With the proper medications and support, TB can be cured and we can all work together to stop the spread.

Together Let's Stop TB