Tuberculosis and the workplace
Tuberculosis (TB) is a disease caused by Mycobacteria tuberculosis (MTB). TB is highly prevalent in South Africa therefore it is not uncommon for employers and co-workers to find themselves in contact with infected individuals at the workplace.
What are the symptoms and signs of TB?
It is important to screen employees and ensure an early diagnosis of the condition in order to prevent transmission to others and to allow the infected person to be treated timeously. Some of the symptoms and signs include:
- Persistent cough associated with sputum production with or without blood
- Chest pain
- Fever and night sweats
- Loss of weight and poor appetite
- Lumps in the neck or in the armpits (lymph nodes)
What should you do if you suspect that an employee or co-worker has TB?
The individual should be referred to the occupational health clinic or local primary health care clinic where he/she can be investigated.
Sputum should be expectorated into specimen bottle and sent for a GeneXpert test and Ziel-Neelsen stain. A chest x-ray may be indicated. If the diagnosis is difficult to make a doctor may need to be consulted.
How long does the treatment course last?
Treatment usually lasts for 6 months. It includes 2 months of intensive phase where 4 drugs are administered in a fixed dose combination tablet. The dosage is calculated based on weight. The last 4 months, called the continuation phase, includes 2 drugs in a fixed dose combination tablet. The dosage is also weight dependant.
The individual will need to test his/her sputum after two months to ensure that the treatment has been effective.
Am I at risk of acquiring TB from my employee or co-worker?
TB is transmitted in airborne particles so if you have worked in close proximity or in a poorly ventilated room with an individual who has untreated tuberculosis you are at risk. If symptoms develop you should be tested for TB.
You have an increased risk of acquiring TB if your immune system is compromised. Illnesses that compromise the immune system include diabetes mellitus, HIV infection (especially those who are not treated), silicosis, and other chronic conditions e.g. renal disease or heart failure.
How long does it take for an individual with TB to become non-infective?
If the medication is taken appropriately and the TB is sensitive to the treatment, the individual should become non-infectious after 2 weeks.
How do you know if TB is drug sensitive?
The GeneXpert test is able to provide information on the sensitivity of rifampicin which is one of the main drugs used to treat TB. If the TB bacilli is sensitive to rifampicin is usually means that the TB is drug sensitive.
At times the diagnosis of TB is made without the GeneXpert. In these cases, sputum or infected tissue should be sent to laboratory for TB culture. Once TB is cultured, the sensitivity of most TB drugs can be determined. Another way to determine if TB is drug sensitive is clinical monitoring. The individual should be feeling much better after 2 months of TB treatment if the TB is drug sensitive.
How much leave does an employee need once treatment has been started?
The individual should be granted the sick leave for the first two weeks to ensure that the infection is not transmitted to his/her co-workers. Caution the individual to avoid contact with young children and people who may be at risk of getting TB during this infective period.
If an effective directly observed treatment – short course (DOTS) programme is available at the workplace the individual should be encouraged to delay annual leave especially during the intensive phase.
What are some of the common side effects of TB treatment?
Once treatment has been commenced, the individual has committed to taking four different drugs for 2 months. Each drug has its own set of side effects. Some common side effects to look out for are as follows:
- Nausea and vomiting
- Orange discolouration of urine and tears
- Painful feet (pyridoxine will always be added to the TB treatment to avoid this side effect)
- Problems with vision
- Jaundice (yellow eyes)
If the individual develops severe vomiting, jaundice, problems with vision, confusion or rashes after starting TB treatment, he/she should see a physician urgently.
Are TB and HIV linked?
Yes. According to WHO, people living with HIV have a 16-27 times greater risk of developing tuberculosis, the risk being higher in individuals with a CD4 count less than 200 cells/mm3.
It is imperative that an HIV test is done so that in the event of a positive result, antiretroviral therapy (ART) can be planned for and initiated once the individual is stable on TB treatment. Studies have shown that ART should be commenced within 2-8 weeks of starting TB treatment, and within 2 weeks if the CD4 count is less than 50 cells/mm3.
How can the workplace implement a TB control programme?
In order to curb the spread of this disease it is important that we all take responsibility for the prevention and control of tuberculosis. Some steps include; implementing measures to minimize transmission risk in the work environment, TB awareness and education, and implementation of a good screening programme for TB and HIV
More information can be found on the following websites:
South African Labour Guide
https://www.labourguide.co.za/health-and-safety/1374-tb-what-employers-should-know
Patient information pamphlets
https://www.cdc.gov/tb/publications/pamphlets/default.htm
National TB Guidelines
http://www.tbonline.info/media/uploads/documents/ntcp_adult_tb-guidelines-27.5.2014.pdf
