TB Today

22 03 2010

For many of us, the words “TB” and “tuberculosis” conjure up black-and-white images of sanatoriums and large, antiquated medical equipment. Or maybe we hear those words and think, “That can’t happen to us.”

But it does. One of our staff members recently caught up with an old friend of hers, a 30-something woman living in the U.S., and discovered she’d undergone treatment for latent TB. Being who we are, we couldn’t resist the opportunity for an interview!

Abandoned sanatorium for tuberculosis

Abandoned sanatorium for tuberculosis

When/how did you find out you had latent TB?

Two and a half years ago, I was registering to be an on-call chaplain. For that type of position, you have to have a yearly TB skin test, and mine came up positive. The test is a skin prick—if you’re positive, it reacts. I immediately felt something, and the pricked area swelled up like a bad spider bite.

What were the first thoughts you had?

I was freaking out a little, because TB has such a stigma attached to it. There’s a place in Seattle that is on the site of a former tuberculosis sanatorium—a friend of mine remembers standing outside, waving to her father in the window.

I think I might have contracted TB in the mission field. It’s fairly common for mission workers or hospital workers to have it. My sister has latent TB also, possibly from working in the inner cities.

What did you do first?

You’re required to report to your local health department if you have a positive skin test, so I did. They scheduled me for treatments.

What was the treatment process like?

I had to go to the health department twice a week to take 3 pills—they watch you take them. I only missed one treatment. It was a day that I had the stomach flu and a funeral, and the health department was calling me. They were very on top of things!

It was a 9-month course of treatment. The drugs make you feel lethargic, and they upset my stomach and gave me heartburn-like symptoms. I chose the twice weekly treatment because it was less inconvenient, and also, by the third day, I’d feel better, which was better than feeling bad every day for 9 months.

I could taste the pills for months afterward every time I drove by the health department. Pregnancy is a lot easier!

Were your friends or family concerned they might be infected?

My husband was concerned at first! Also, a relative of a friend with a son who has medical issues was very concerned about my husband being around her son, even though I’m not even symptomatic.

Another acquaintance of mine who also had latent TB began to have health problems and was concerned that my TB had activated hers, but it turned out she had other medical issues that were unrelated.

It was odd, people not understanding that people with latent TB are not contagious.

Did you have any specific concerns about TB and pregnancy?

You’re not supposed to get pregnant while on the drugs. But other than that, it hasn’t been a concern for me.

Do you ever worry you’ll develop active TB?

Taking the drugs made it less likely that I’ll get it. Night sweats, coughing—they tell you to watch out for those symptoms. I’m glad I did the treatment now, when I’m more physically capable, instead of having it be an issue at some later time when I’m not as healthy. But I don’t worry about it.

Is your life today affected by having latent TB?

No. I just keep my letter on hand stating that I’ve done the treatment so I can provide it when a convalescent center or someplace requires routine testing. I’m surprised at how TB is much more common than we think it is!

When a person has latent TB, it means that the body’s immune defenses hold the TB bacilli, preventing them from multiplying. However, any number of factors – age, cancer, steroids, to name a few – can suppress the immune system, allowing the bacilli to multiply, causing active TB disease. Treating latent TB reduces the chances of this happening by over 90%.

If you or anyone you know has been exposed to active TB disease (not latent TB), you should get tested for TB. To learn more and to help prevent the spread of TB, visit the World TB Day website.

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Thinking of Pregnancy? Think Preconception Care.

13 01 2010

In the 1980s, prenatal care entered the public mainstream as a way of improving maternal and infant health outcomes.

Prenatal care intervention now reaches most American women for the duration of their pregnancies.  However, nationally, maternal and infant health outcomes haven’t continued to improve, and some problems have worsened for reasons that continue to be preventable.

Because prenatal care usually doesn’t begin until week 11 or 12 of a pregnancy, preconception care as an intervention is gaining attention as a way of continuing to improve maternal and infant outcomes.

Preconception care attempts to identify and modify medical, behavioral and social factors that put a woman’s health and the health of her future pregnancies at risk for negative outcomes.

According to the American College of Obstetricians and Gynecologists (ACOG), preconception care screens for risks and provides health promotion, health education, and interventions to address identified risks to women in their reproductive years.

With preconception care, a woman has the opportunity to change and modify her behaviors or risk factors prior to becoming pregnant, thereby improving the chances for positive outcomes during the first weeks of pregnancy when the fetus is most susceptible to developing certain problems before many women even realize they are pregnant.

Preconception care can be of great benefit to women who are at risk for negative pregnancy outcomes resulting from infectious diseases.  For example, ensuring that women are vaccinated for rubella provides protection against the mother transmitting congenital rubella syndrome to her infant.

Providing hepatitis B vaccination prevents transmitting hepatitis B infection to infants and protects the woman from risks that may come with hepatitis B infection, such as liver cancer, liver failure, cirrhosis or death.

Preconception screening and treatment for sexually transmitted diseases (STDs) reduces the risk of having an ectopic pregnancy, infertility, or chronic pelvic pain from sexually transmitted chlamydia and gonorrhea.

Preconception screening and treatment also reduces fetal risk for death or physical or developmental disabilities such as mental retardation and blindness that can occur as a result of fetal exposure to STDs.

Additionally, preconception screening for HIV/AIDS provides an opportunity for prompt treatment and information so that women or couples can make early decisions about pregnancy timing.  These interventions have a record showing evidence-based effectiveness in improving pregnancy outcomes.

What does this mean for you?  If you are a woman in your reproductive years, talk to your doctor about your reproductive life plan.  Your doctor can work with you to evaluate your health risks and provide recommendations and information so that you can make choices to positively affect your health and future pregnancies for years to come!

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Pregnancy and H1N1 Vaccine

2 09 2009

So you’re pregnant, and you don’t want to get flu, but you also want to know that whatever goes into your body isn’t going to hurt your baby. Here’s info on H1N1 and the vaccine to help you make the best decision for you and your baby.

Is vaccination safe for pregnant women and their unborn babies?

Killed virus vaccines, such as the flu vaccines in shot form, are so safe that any risk to the unborn baby is nearly unmeasurable. FluMist, however, is live and cannot be given to pregnant women. (It can be given to other members of the family who are eligible to receive it.)

What about thimerosol?

As a pregnant woman, you can ask for a thimerosol-free vaccine, because providers are being directed to reserve thimerosol-free doses for pregnant women (and younger children) who are concerned about thimerosol. It should be noted that many studies conducted by independent bodies have shown that thimerosol does not pose any danger.

Should I get both the H1N1 and seasonal flu vaccines?

Pregnant women can get both vaccines. It’s recommended that you get each vaccine when it becomes available. The seasonal flu vaccine will be available sooner than the H1N1 vaccine, which should come out mid-October.

Should I wait until later my pregnancy to get vaccinated?

Pregnant women can receive the flu vaccines at any time during pregnancy, including the first trimester. In fact, it’s recommended that pregnant women receive the vaccine early on, since respiratory issues later in pregnancy can be more serious.

You can start the 2-dose H1N1 vaccination series during pregnancy and finish it after your baby is born. Babies ages 0-6 months cannot get the flu vaccine, so if the mother gets the vaccine during pregnancy, it can help protect her baby.

Other concerns…

The vaccine is safe for women planning on natural childbirth. Disease is a natural process, but so is building immunity.
Alternative/online education could be an option for pregnant teens enrolled in schools experiencing outbreaks (because teens are generally considered higher risk for H1N1 as it is). If you are a pregnant young adult attending college, you can continue attending even if cases of H1N1 are reported. You should definitely get vaccinated and wash your hands – a lot.

Patients receiving treatment for infertility can get the flu vaccines. There is zero evidence that flu vaccine harms development of the unborn baby’s brain.

Pregnant healthcare workers need the H1N1 vaccine. If the flu is very active around them, their job description may need to be adjusted.

What should I do if I’m pregnant and get exposed to H1N1?

If you are exposed to a KNOWN case of H1N1, tell your provider; you may need medication. If 5 kids in your child’s school have it, this is not the same as being directly exposed.

Check with your provider to see if immunization is right for you and your family.

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H1N1 – early September

1 09 2009

Flus Gonna Lose logo

What’s H1N1 doing right now?

The flu virus has been circulating in the southern hemisphere, which is winding down its winter flu season. The good news is that it hasn’t mutated. In the U.S., we can expect to see H1N1 cases along with the regular seasonal flu.

Is there a vaccine?

This year, people ages 6 months or older will be able to get an H1N1 vaccine in addition to the regular seasonal flu vaccine. The H1N1 vaccine has gone through trials to determine safety and appropriate dosage. The testing process involves administering the vaccine, waiting 3 weeks, then taking a blood sample to measure antibodies to see if the dosage of vaccine was adequate.

You will probably need 2 doses of H1N1 vaccine for it to be effective. The H1N1 vaccine will have multiple formulations, as does the seasonal flu vaccine:
•    10-dose vial (which contains thimerosol)
•    Single-dose vials (thimerosol-free)
•    Preloaded syringes (thimerosol-free)

Some people are saying the H1N1 vaccine was developed too quickly. Is that true?

People who are concerned that the H1N1 vaccine was developed too quickly can take comfort in knowing the H1N1 vaccine preparation process is the same as it is for the seasonal flu vaccine and it is made by the same manufacturers. So far, any reactions in the trials for H1N1 vaccine have been the same as for the regular seasonal flu vaccine (soreness, redness). Any serious events that might occur may not appear during the vaccine trial time period because they are so rare.

Who should get the H1N1 vaccine?

People who should get the H1N1 vaccine are:
•    Pregnant women
•    Household contacts and caregivers for babies 0-6 months
•    Healthcare and emergency medical services personnel
•    People ages 6 months through 24 years
•    People ages 25-64 years of age who have health conditions putting them at higher risk of complications from influenza

As with the seasonal flu vaccine, people with egg allergies cannot get the H1N1 vaccine.  Check with your provider to see if immunization is right for you and your family.

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H1N1 and Pregnancy

13 05 2009

Some pregnant women are experiencing severe complications from H1N1 infection, including pneumonia, dehydration and premature labor.

In otherwise healthy individuals, flu of any strain or type can be harder on pregnant women than women who are not pregnant.

CDC is recommending that providers immediately start treating with antivirals if they suspect a pregnant woman in their care is infected with H1N1.

The worrisome part to this – and there’s always a worrisome part – is that not a lot of testing has been done to see how these drugs will affect the pregnant woman or the fetus.

Most providers don’t like to prescribe meds for pregnant women and many of their patients don’t want to take meds while pregnant.

But, the risk of harm appears to be greater with infection than with taking the meds, so please consider taking antivirals if you suspect you have influenza.

If you’re pregnant and you think there’s a remote chance you might be infected with H1N1, call your provider immediately.

Dr. Anne Schuchat, Interim Deputy Director for Science and Public Health program at CDC, said yesterday that, “…experts who have looked into this situation really strongly say that the benefits of using antiviral drugs to treat influenza in a pregnant woman outweigh the theoretical concerns about the drugs.”





Flu and Newborns

5 11 2008

In September of 2008, the New England Journal of Medicine printed an article by Dr. Mark Steinhoff and colleagues titled Effectiveness of Maternal Influenza Immunization in Mothers and Infants.

The study and its results present a compelling case for vaccination of pregnant women to protect both mothers and infants against influenza.  In the article, Dr. Steinhoff et al. note, “Inactivated influenza vaccine is recommended for pregnant women but is not licensed for infants younger than 6 months of age.”  If a pregnant mother doesn’t get vaccinated, this leaves the infant unprotected during the first six months of life. 

This study found that if a mother is vaccinated while pregnant, the “inactivated influenza vaccine reduced proven influenza illness by 63 percent in infants up to 6 months of age.”

The study needs to be replicated, as it was rather small.  However, the findings are strong enough that, if pregnant, it makes it worth an expectant mother’s time to talk with an OB/GYN or family healthcare provider to see if vaccination is an appropriate precaution to take.