Tuberculosis patients monitored via Internet

County officials say it’s crucial to complete prescription

By Marissa Harshman, Columbian health reporter

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Physicians always stress the importance of completing antibiotic prescriptions. Heeding that advice is particularly important for people with tuberculosis.

So important that Clark County Public Health staff monitor residents with the disease, which includes actually watching them swallow an array of pills to treat TB.

Tuberculosis is a contagious disease caused by a bacteria, mycobacterium tuberculosis, that attacks the lungs or other parts of the body, such as the kidney, spine or brain, said Marni Storey, deputy director of Clark County Public Health.

TB is spread through the air from one person to another. However, not everyone with TB gets sick.

There are two varieties of tuberculosis: active disease and latent infection. A latent infection is when the bacteria is living in the body but not making the infected person sick. Active TB disease occurs when the immune system can’t stop the bacteria from multiplying in the body, according to the Centers for Disease Control and Prevention.

Untreated, TB can be fatal.

“It’s critical that they don’t miss doses,” Storey said. “People who miss doses can develop resistant tuberculosis.”

The monitoring of active TB cases traditionally meant public health staff had to drive to patients’ homes and administer the medications. Nearly three years ago, however, the health department launched a new technique.

Now staff uses Internet video chat programs, such as Skype and ooVoo, to watch tuberculosis patients take their medication. Currently, four Clark County residents are known to have active TB. Last year, there were nine cases in the county.

County public health nurse James Lanz and medical assistant Cheryl Mixer gave an informational presentation about the program to Clark County commissioners at their last board of health meeting.

The switch to Internet monitoring frees public health staff to shift their time to other communicable disease work and saves the department money on travel expenses. The department saves, over the course of a patient’s treatment, $250 to $625 in travel expenses and 26 to 65 hours of staff time, depending on where the patient lives and the length of the monitoring.

Identification, treatment

Health care providers are required to report diagnoses and suspected cases of tuberculosis to the health department. Health officials interview people with the illness to determine when, where and how the person may have become infected and whom they may have exposed. Tests determine how contagious the person is and guide their course of treatment, Storey said.

When people first develop TB, they usually experience symptoms such as a bad cough lasting three weeks or longer, weight loss, fatigue, coughing up blood, chills, fever and night sweats, Lanz said.

After a few weeks of medication, the patient usually starts to feel better. People are often reluctant to continue taking their medication once the symptoms subside, Lanz said, especially since TB treatment can last between six and 18 months and require up to 20 pills at a time.

“Once the medication starts to work, the side effects from the medication are worse than the actual disease, because you feel better,” Storey said.

Not completing the treatment could mean the person will develop a drug-resistant strain of TB and expose others to the mutated disease, she said. That’s why public health departments across the country monitor active TB cases and watch patients take their medications. Clark County, however, is unique in its use of the Internet for monitoring, according to health officials.

The treatment monitoring is credited for reducing the tuberculosis rate in the United States.

Sixty years ago, the TB infection rate was about 50 per 100,000 residents, or about 85,000 people. In 2010, the rate was down to about 3 per 100,000 residents, or 11,100 people, according to the CDC.

Marissa Harshman: 360-735-4546; http://twitter.com/col_health;marissa.harshman@columbian.com.