ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
Tuberculosis in Cuba: Control and Opportunity for Elimination
1. Tuberculosis in Cuba
Control & Opportunity for Elimination
Kathryn Cicerchi, Colorado School of Public Health
May/June 2015
2. Tuberculosis
Infectious disease caused by mycobacterium
tuberculosis
Can be acute, sub-acute or chronic in nature
Most commonly attacks lungs
Can attack any part of the body, such as kidneys,
spine, brain
Can be fatal if not treated properly
Two types of infection:
Latent
Active
Sources: CDC, WHO 2015
3. Latent Tuberculosis
1/3 of the world’s population is infected, though
most are not ill and cannot transmit TB
Walled off by healthy immune system
Many with latent TB never progress to active
disease
Those who do:
Become sick within days of infection before immune
system can fight off
Can develop active TB years later when immune
system compromised (malnutrition, diabetes, HIV co-
infection)
Lifetime risk of progressing from latent TB to active
disease is 10% (WHO)
Sources: CDC, WHO 2015
4. Active Tuberculosis
Symptoms:
Coughing (sputum, blood)
Chest pains
Weakness
Weight loss
Fever
Night sweats
Spread person to person through droplets
Treatable with antibiotics
Associated with extreme poverty, lack of health
care, poor environmental and hygienic conditions
(overcrowding)
Sources: CDC, WHO 2015
5. TB in Cuba
TB mortality was high throughout Spanish colonial
period
1902: Tuberculosis was main cause of death
4,001 fatalities; 15.7% of total deaths
1907: Special TB wards set up in hospitals to treat
extreme cases. Sanitarium set up outside of
Havana for the poor.
TB mortality declined throughout 20th century
1943: Mortality rate was estimated to be 65 per
100,000
6. TB in Cuba
Before the Cuban Revolution in 1959, TB still
caused 1,000 deaths annually
Following the Revolution, an accessible, free,
universal health care system established
1962-1963: National Tuberculosis Control Program
founded as part of the system
7. National Tuberculosis
Control Program (NTCP)
1963-1971: Sanatorial care with continued
assessment and risk evaluation
By 1970: Cuba established decentralized labs
capable of sputum smear microscopy
By 1971: Outpatient basis with directly observed
treatment (DOT)
1982: Directly observed treatment, short course
8. National Tuberculosis
Control Program (NTCP)
Laboratories
Newborn vaccination
Active contact tracing
All TB cases systematically investigated
Contacts checked for respiratory symptoms
Contacts meeting certain criteria are treated
prophylactically with isoniazid
Local doctors perform all case finding,
treatments (DOTS), prophylaxis, community
education
9. NTCP Success
By 1991, TB incidence was 4.7 per 100,000
Down from 65 per 100,000 in 1965
Reduction in incidence and all serious forms of TB
In children under 15, 85% decrease
10. Re-Emergence of TB
Despite progress, TB began to re-emerge
worldwide in 1990s
Worsening social problems
Increased drug resistance
HIV co-infection
Abandonment of control programs
After the breakdown of the Soviet Union, TB
incidence in Cuba began to creep up beginning
in 1992
14.7 per 100,000
11. Re-Emergence of TB
Cuban Ministry of Public Health gave TB top
priority
In addition to prior tactics:
Improved surveillance
Mandatory notification system
Contact investigations beyond household level
Supervised control with annual courses for health
personnel
Emphasis on fighting childhood TB
12. Re-Emergence of TB
Following re-intervention, decrease from
14.7/100,000 in 1994 to 7.2 per 100,000 in 2003
13. Declining Mortality
0.4 per 100,000 in 1998 to 0.2 per 100,000
in 2007
Met the WHO’s Global Plan to Stop TB’s
2006-2015 target well in advance (2007)
15. Elimination
Cuba is on track to eventually eliminate
tuberculosis
Low rates of MDR-TB
Relatively low HIV co-infection
Efforts need to focus on adjusting indicators to be
more sensitive
Improve case detection by focusing on
vulnerable groups within Cuba
Increase quality of preventive services
Keep an eye on MDR-TB and HIV co-infection
17. References
Abreu, G., Gonzalez, J. A., Gonzalez, E., Bouza, I., Velazquez, A.,
Perez, T., . . . Sanchez, L. (2011). Cuba's strategy for childhood
tuberculosis control, 1995-2005. MEDICC Review, 13(3), 29-34.
Association of Schools of Public Health. (1907). Cuba: Tuberculosis in
Cuba. Free sanitarium for tuberculous patients to be
established. Public Health Reports (1896-1970), 22(24). Retrieved from
http://www.jstor.org/stable/4559252
Centers for Disease Control and Prevention (CDC). (2012, March 13).
Basic TB facts. Retrieved from
http://www.cdc.gov/tb/topic/basics/default.htm
Gonzalez Ochoa, E., Rosco Oliva, G. E., Borroto Gutierrez, S., Perna
Gonzalez, A., & Armas Perez, L. (2009). Tuberculosis mortality trends in
Cuba, 1998 to 2007.MEDICC Review, 11(1), 42-47.
Gonzalez, E., Armas, L., & Llanes, M. J. (n.d.). Progress towards
tuberculosis elimination in Cuba. The International Journal of
Tuberculosis and Lung Disease,11(4), 405-411.
18. References
Gonzalez, E. R., & Armas, L. (2012). New indicators proposed to assess
tuberculosis control and elimination in Cuba. MEDICC Review, 14(4),
40-43.
Marrero, A., Caminero, J. A., Rodriguez, R., & Billo, N. E. (2000). Towards
elimination of tuberculosis in a low income country: the experience of
Cuba, 1962–97.Thorax, 55, 39-45.
Navarrete, A. (1943). Present tuberculosis status in Cuba. CHEST, 9(2).
doi:10.1378/chest.9.2.175
Pan American Health Organization (PAHO). (n.d.). Tuberculosis.
Retrieved May 20, 2015, from
http://www.paho.org/hq/index.php?option=com_topics&view=article
&id=59&Itemid=40776&lang=en
World Health Organization (WHO). (2015, March). Tuberculosis.
Retrieved from http://www.who.int/mediacentre/factsheets/fs104/en/