You probably don’t think about tuberculosis in Australia much at all. You may know a little about it, like that it’s a disease that affects the lungs, and you may even know that it killed author George Orwell and composer Frederic Chopin! That’s because fortunately these days tuberculosis (TB) is generally preventable and more curable due to better treatment options, but it hasn’t disappeared yet. And while you don’t hear much about it, particularly in Australia, it still exists and still kills. In fact, according to the WHO TB is one of the top 10 causes of death worldwide.

What is Tuberculosis?

Tuberculosis (TB) is a disease caused by infection with the bacteria Mycobacterium tuberculosis. TB most commonly affects a person’s lungs, however, it can also affect other parts of the body and cause serious illness. TB is spread through the air when a person with TB disease of the lungs or throat coughs, sending the bacteria into the air, which is then inhaled by others who the person has been in close and probably frequent contact with. Only about 10 percent of people with TB infection will ever get TB disease.

Tuberculosis in Aged Care

While tuberculosis cases in aged care facilities in Australia and New Zealand are rare, they can happen. In most states in Australia and New Zealand tuberculosis is reportable to public health authorities, which means that they MUST be notified once tuberculosis has been detected and confirmed. Investigators from either public health or TB services will attend the facility and ensure the appropriate contact tracing and precautions are undertaken. Please consult your public health authority’s TB guidance if you suspect or have confirmed cases of TB in your aged care facility.

Tuberculosis in Australia

The Australian Government Department of Health’s The Strategic Plan for Control of Tuberculosis in Australia, 2016-2020: Towards Disease Elimination states that “the rates of TB in Australia remain enviably low in a global context.”

Together with a relatively small number of other countries where the incidence of TB is <10 per 100,000 people, Australia is in a position where TB elimination, defined as <1 case per million population, may be feasible by 2050.

It must be noted that there is an ongoing risk of imported cases from countries with high TB incidence. The international and public health communities have sought to shift focus from control of the TB epidemic towards elimination, following successes in pursuing elimination for other infectious diseases globally. Australia is now committed to pre-elimination targets (<1 case per one million people) by 2035, which has already been met in the Australian-born population, which represent 72% of the total Australian population.

Although Australia has maintained a low and stable incidence rate of TB since 1985, indicating effective TB control, there has been little progress in recent decades for incidence reduction, with the absolute number of cases increasing over this period. Migration, and to a lesser extent short-term residency, often from countries of high TB burden, ensures there is an ongoing potential source of new TB cases, including drug-resistant ones, in Australia.

In addition, although low in case numbers, the incidence of TB remains 6 times higher in the Indigenous Australian population compared with the non-Indigenous Australian-born population.

Where do we go from here?

It will be interesting and telling what effect the 33 actions of the Strategic Plan for Control of Tuberculosis in Australia, 2016-2020: Towards Disease Elimination have on the elimination of TB. We will have to wait for the review of the data and information to see how this informs the next strategic plan to manage tuberculosis in Australia.

In the interim, however, some groups such as Results International are taking the movement into their own hands. Their Australian grassroots campaign is focused on ensuring better funding for tuberculosis prevention and management following the 2018 UN High Level Meeting on tuberculosis.

Will a combination of improved policy and a higher financial commitment from government be enough to decrease tuberculosis rates in Australia? Only time will tell.

Infection control is about more than outbreak management, it requires constant vigilance and robust policies. Is your facility properly equipped to prevent outbreaks? Contact Bug Control now to find out how you can keep your staff and residents safe from infections.