FLU MANIA MAY INCREASE TB

Saturday 15th August New Delhi 2009 HCFI: Azadi from TB should be the mantra said Dr KK Aggarwal President, Heart Care Foundation of India, BSNL Dil Ka Darbar, MTNL Perfect Health Mela and Director, IMA AKN Sinha Institute. TB is one of the leading causes of mortality in India- killing -2 persons every three minute, nearly 1,000 every day, 3.7 lac every year. Estimated incidence is 1.8 million new cases annually, 0.8 million new smear positive cases annually, 75 new smear positive PTB cases/1lakh population per year. Estimated 5% of TB patients are HIV infected.

In the current flu mania TB may further increase
1.    TB cough patients will go for flu check and if negative may go for TB check.
2.    TB cough patients may line up with flu suspects and transmit the infection to them.

WHY TB IS SPREADING IN INDIA
1. NO TB isolation rooms. Negative pressure is employed to prevent the escape of droplet nuclei. To accomplish this goal, doors must be kept closed and negative pressure should be verified daily. There must be at least six air exchanges per hour; 12 or more exchanges per hour are preferred and are required for any renovation or new construction. Air should be exhausted to the exterior, far removed from any intake vents; if recirculation to general ventilation is unavoidable, HEPA filters must be installed in the exhaust ducts.
2. NO respiratory protection masks available in the hospitals. These masks must filter particles 1 micron in diameter with at least 95 percent efficiency (N95) given flow rates up to 50 L per minute, must fit to a person's face with less than 10 percent seal leakage, and should be available in several sizes to optimize fit. Al health care workers should be fit-tested in order to determine the most appropriate mask size with periodic repeat fit testing. Health care workers who are unable to use an N95 mask due to poor fit (eg, bearded individuals and those in whom facial structure precludes a tight seal) should use a powered air purifying respirator (PAPR). Multiple sizes of N95 masks should be available close to AII rooms to ensure proper usage.

Masks should be worn under the following circumstances:
    1. Persons entering a TB isolation room when the patient is present
    2. Persons present during a cough-inducing or aerosol-inducing procedure on such patients, such as bronchoscopy, induced sputum collection, or administration of aerosolized pentamidine
    3. Persons in other settings where administrative and environmental controls are unlikely to be protective (eg, in emergency transport vehicles).
    4. These devices are designed to filter air before it is inhaled; thus, patients with known or suspected TB should not wear these masks. Instead, when required to be outside TB isolation rooms, such patients should wear surgical masks, which are designed to prevent the respiratory secretions of the person wearing the mask from entering the environment.   
    5. RNTCP Program is for early detection and treatment- The focus should change to prevention.

More about TB
TB especially multi drug resistant is more dangerous and contagious than swine flu. Respiratory secretions are of two sizes less than and more than 5 microns. The ones, which are more than 5 microns like H1N1, are heavy and con not remain suspended in the air and immediately settle down on the surface and are called droplet infections. They need contact precautions and three feet air precautions. Surgical three- layered mask is sufficient to prevent infections spreading to others.

The ones smaller than 5 microns are called droplet-nuclei infections, are lighter, can remain suspended in the air and move from one place to other with the air movement and needs air born precautions including N95 mask, air born isolations rooms with 6 exchanges per hour, HEPA filter exhausts, closed rooms etc.