• Screening for TB, follow up of active cases and contact investigation.
• Administer and interpret skin test and provide consultation regarding results to people of all ages.
• Provide treatment of TB infection and disease.

ONEIDA COUNTY TUBERCULOSIS (TB) CLINIC

Many people think that TB is a disease of the past - an illness that no longer threatens us today. However, with one third of the world's population estimated to be infected with the bacteria that causes TB, this ancient disease is very much with us today.  Among infectious diseases, TB remains the second leading killer in the world, with more than 2 million TB-related deaths each year.  

There are two types of TB, Latent TB Infection (LTBI)  and TB Disease.  TB bacteria is spread through the air from one person to another, usually when a person with active TB disease coughs or sneezes. People nearby may breathe in these bacteria and develop latent TB infection.  Many people who have latent TB infection never develop the TB disease.  A healthy body walls off the TB infection and remains “asleep”.  A person with TB Infection feels well and is not contagious.  Other people, especially children and people with weakened immune systems, are at higher risk of the bacteria becoming active (and coming out of the protective “wall”) and cause TB disease.  

Active TB disease primarily affects the lungs but also can grow in the bones, spine, kidneys, brain or disseminate throughout the body.  Only pulmonary TB is contagious when an actively diseased person coughs or sneezes. Symptoms for active TB disease include one or more of the following: Cough for greater than 3 weeks; chest pain; discolored or bloody sputum; recurrent fever or night sweats; appetite and weight loss; generalized weakness and fatigue. These symptoms may progress quickly or extremely slowly. In non-pulmonary TB, unexplained pains in the bones or spine, headaches, or blood in the urine may result.

STOP TB POSTER

DIAGNOSIS AND TREATMENT OF 
LATENT TB INFECTION

Certain risk factors in a person or in their lifestyle may make them more likely to contract TB Infection:

•       Contact with a person with active TB Disease (usually those sharing the same household or other enclosed environments);

•       Foreign-born persons, including children, from areas that have a high TB incidence (e.g. Asia, Africa, Russia , Latin America, Eastern Europe );

•       Residents and employees of high-risk group living settings (e.g. correctional institutions, nursing homes, mental institutions, and shelters for the homeless);

•       Being homeless, or medically-undeserved; and

•       Injecting drug users and other heavy substance abusers.

There are also certain medical conditions proven to increase the risk of activating TB infection. The list below indicates that potentially any condition associated with a weakened immune system could increase your chances of a latent TB infection progressing to active TB disease. If you have a good immune system, your chances of your latent TB infection activating is 10% over a lifetime. Currently, there are studies underway investigating other conditions which may activate latent TB infection (ie. tobacco use).

Conditions that Increase the Risk of Progression to TB Disease include:

Treatment of Latent TB Infection (LTBI) is essential to controlling and eliminating TB in the USA . Treatment of LTBI substantially reduces the risk that TB infection will develop into disease from 10% to about 1-2%.

TESTING FOR TB INFECTION

TB testing is encouraged if a person has any of these recognized risk factors. TB testing is done using the Mantoux method. A small quantity (0.1 ml) of a solution containing a small but precise amount of protein derived from the TB bacteria is injected under the skin. You cannot get TB from the solution. Between 48 - 72 hours a trained person inspects the site for a firm lump (induration) just under the skin and carefully measures it (in mm).

To determine a positive skin test depends on your individual risk factors and the size of the reaction as explained below.

A reaction of 5mm or more is positive for:

•         HIV positive persons

•         Recent contact to a known Active TB case

•         Chest X-Ray with fibrotic changes consistent with old TB

•         Persons with organ transplants and other immunosuppressing conditions or treatments (ie. high dose prednisone)

A reaction of 10mm or more is positive for:

•         Immigrants from high-prevalence countries (link: TB Worldwide)

•         Injecting drug Users

•         Residents and employees of high-risk congregate settings (ie. jails/prisons, nursing homes, homeless shelters, hospitals, and other health care facilities)

•         Persons with clinical conditions that make them high-risk

•        Children under 4 years of age, or children and adolescents exposed to adults in high-risk categories

A reaction of 15mm or more is positive if:

•         No known risk factors.

If testing reveals you have a positive PPD, you must have a complete evaluation to determine if you have TB Disease or TB Infection.  The evaluation includes a complete medical history, physical exam, and chest radiograph (also known as a chest x-ray).  Depending on the result of your chest x-ray some additional tests may be ordered.

The Oneida County Health Department conducts medical evaluations on Tuesday – 9-11am or 1-3pm or Thursday – 9-11am.  CXR Clinic is Tuesday – 1-3pm.  Evening Clinics are held from 4-6pm the first and third Tuesday of each month.  Off-site evaluation and testing for certain high-risk groups is also possible. Please call 315-798-5747 for more information. Russian and Bosnian speaking staff is also available on site. TB-related information is available in different languages. 

List of TB Information in Other Languages

TREATMENT OF LATENT TB INFECTION

There are relatively few antibiotics that are effective in killing the TB germ and it takes 6 - 12 months of treatment to ensure a cure for active TB disease. It is much easier and safer to treat the latent TB infection. Active TB disease is not only much harder to cure (requiring 4 different drugs) but the scar tissue resulting from the disease remains after the germ is killed which can lead to permanent disability. Also, active TB is difficult to diagnose because it resembles other infective diseases of the lungs. This allows the germ an opportunity to be spread to close contacts, such as family, friends and co-workers.

There are several medicines (antibiotics) that are recommended to kill the Latent TB Infection before it has a chance to become active. The amount of medicines to treat LTBI is much less than those for Active TB disease.

The best treatment option is Isoniazid (INH). The usual dose for adults is 1 pill (300mg) Daily for nine months (270 doses taken within 12 months).

Side effects are uncommon and most don't notice any effect whatsoever. However, as with any medicine, a small number of people experience adverse reactions. We monitor our clients monthly or more as needed by asking focused questions and, if any problems are noted, getting the appropriate tests done with medical follow-up.

If a person is at risk for developing active TB and cannot tolerate INH, or if the person contracted the infection from a strain of TB known to be INH-resistant, then other medicines may be used. 

SIDE EFFECTS ASSOCIATED WITH ISONIAZID

Peripheral neuropathy - a numbness or tingling most often felt in the fingertips. In most cases, this is overcome by taking Vitamin B6 while on INH.

Liver Inflammation - a much rarer effect (1-2%) primarily affecting those with a history of alcohol/drug abuse, or chronic liver infections (Hepatitis B or C). Signs of this include: extreme fatigue (tiredness), muscle weakness, loss of appetite, coffee/tea-colored urine, pale stools, yellowing of whites of eyes and skin. The liver is a strong organ and has the ability to regenerate very quickly. There are blood tests that can give us a very accurate picture of how the medicine is affecting it.

DIAGNOSIS OF TUBERCULOSIS DISEASE

Pulmonary TB disease should be suspected in persons who have fever; chills; night sweats; fatigue; loss of appetite; weight loss; a productive, prolonged cough (duration of 3 weeks or longer); or hemoptysis (bloody sputum). Persons suspected of having TB disease should be evaluated with a medical history, a physical examination, a Mantoux tuberculin skin test, a chest X-Ray, and a sputum smear and culture. A positive culture for Mycobacterium tuberculosis confirms the diagnosis of TB. However, a positive culture is not always necessary to begin or continue treatment for TB. In addition, a negative tuberculin skin test does not rule out TB disease because the active disease inhibits the immune system reaction to the PPD solution.

Pulmonary TB is the most common form of TB in all persons, including HIV-infected persons. The symptoms of extrapulmonary TB depend on the site affected. For extrapulmonary TB, sometimes a biopsy is obtained to smear and culture for TB.

Active TB in Chest X-Ray & Lung

DIAGNOSTIC LABORATORY TESTS

The presence of acid-fast bacilli (AFB) on a sputum smear often indicates TB. Acid-fast microscopy is easy and quick, but it does not confirm a diagnosis of TB because some acid-fast bacilli are not M. tuberculosis. Acid-fast microscopy may also be negative in some persons with M. tuberculosis.  Therefore, a culture is done on all specimens to confirm a diagnosis of M. Tuberculosis.  Laboratories should report positive smears and positive cultures within 24 hours by telephone or fax to the Oneida County Health Department. 

For all patients, the initial M. tuberculosis isolate should be tested for drug resistance. It is crucial to identify drug resistance as early as possible in order to ensure appropriate treatment. Drug susceptibility patterns should be repeated for patients who do not respond adequately or who have positive culture results despite 2 months of therapy. Susceptibility results from laboratories should be promptly forwarded to the health department.

TREATMENT OF ACTIVE TB DISEASE

Active TB Disease must be treated for a long time (at least 6 months for most clients) compared with many other infectious diseases.

For most persons, the preferred regimen for treating TB disease consists of an initial 2 month phase of four drugs: isoniazid, rifampin, pyrazinamide, and ethambutol followed by a 4 month continuation phase of isoniazid and rifampin.  Medication is usually given daily for 14 days and then changed to 2/wk. for the remainder of treatment unless other problems arise. 

This regimen can be altered depending on the response of the client, the drug susceptibility patterns that emerge from the culture, the existence of other conditions (ie. HIV infection), and the extent of the disease. Thus every client is ensured close medical attention throughout the course of treatment. This approach to treating TB disease was developed to rapidly kill the TB germs as fast as possible and to prevent the emergence of drug-resistant strains of the TB bacteria.

DIRECTLY OBSERVED THERAPY (DOT)

Directly Observed Therapy (DOT) is the standard of care for treatment of all active TB disease clients in Oneida County . DOT means that a health care worker watches the client swallow each dose of TB medicine.

DOT provides personal support to the sick client in order to cure the TB disease and to prevent drug resistant strains from developing. Primarily, we wish to enlist the client cooperation and goodwill to ensure a full and final cure of the disease and to stop the spread of this infection to our community. However, if a client is unwilling to cooperate then we can enlist the aid of the courts and law enforcement to force the client to comply because of the risk to the community as stated in public health law. Fortunately, this is rarely the situation.

TB & HIV CONNECTION

If you have latent TB infection, the risk of developing active TB for a person with a good immune system is about 10% over the course of your life. Persons with HIV infection and TB may have atypical (unusual) chest X-Rays, and they are more likely to have extrapulmonary TB than are persons without HIV infection.

Again, any disease or condition that suppresses your immune system increases the chances of developing active TB.  HIV/AIDS is a potent activator of latent TB infection. The risk of developing active TB disease is 10% for every year of your life.

It is recommended that if you have HIV/AIDS, you should get tested for TB infection as soon as possible. The treatment of the TB infection is the same as for anyone testing positive for LTBI. Once you've completed the medicine, you've dramatically decreased your chances of suffering from active TB disease.

Links toTB & HIV Connection

THERE ARE TWO TYPES OF HIV TESTING:  CONFIDENTIAL AND ANONYMOUS

Confidential: Your name is used on your test and results.  You may get a copy of results for your own use whether personal or for immigration purposes.  The testing, the results and the chart are all kept in a highly confidential manner.

Anonymous: Your test and results do not have your name on them.  You cannot get a copy.  You cannot use the anonymous testing for immigration purposes.  All identification is done with an individualized code number.  Special arrangements are required for this kind of testing through New York State Department of Health.

If interested in getting tested, Oneida County Health Department offers confidential HIV testing on Mondays and Fridays from 9am-11am and on Wednesdays from 1pm-3pm.  If you are being followed in the tuberculosis clinic, you may also get a HIV test when here for your TB visit. 

 TB & BCG VACCINE

In many areas of the world where the incidence of TB is high, the use of the BCG vaccine is common.

It is not generally recommended in the US because of the low risk of infection with TB, the uncertain effectiveness of the vaccine to protect against pulmonary TB, and the vaccine's interference with tuberculin (PPD) reactivity.

WHAT IS THE BCG VACCINE?

BCG stands for Bacille Calmette-Guerín, named after the 19th century French scientists who developed it. It is a live bacillary vaccine from the form of TB that infects cows (Mycobacterium bovis) that has been weakened so that it causes only a minor infection but stimulates the body to produce an immune (protective) response to human TB (Mycobacterium tuberculosis).

WHAT DOES BCG VACCINE DO?

The proven effect of BCG is to prevent the worse forms of TB disease in children (ie. disseminated TB and TB of the brain or kidneys). The ability to prevent TB Infection is uncertain and diminishes over time. Several studies have indicated that BCG does not prevent infection or subsequent development of Pulmonary TB in adolescents or adults.

COULD MY BCG VACCINE CAUSE A 
POSITIVE SKIN TEST?

The BCG vaccine can cause a reaction though usually it is much smaller than what is usually called "positive", especially if the vaccine was given many years ago.

If you have a positive skin reaction you probably have TB infection.

This is very likely if:

•         the reaction is large

•         you are born & raised in a region where TB is common

•         you are a recent contact of a person with infectious TB

•         your chest X-ray shows evidence of previous TB disease

 INTERNATIONAL TB FACTS

Because of persistent public health efforts in the USA (especially due to treatment of latent TB infection and directly observed therapy for active TB disease), the rate of TB disease and deaths have been declining to its lowest point ever.

Yet, worldwide, the disease is reaching epidemic proportions.  The rates and numbers of new infections and causes of active disease are on the rise.

•        About 2-3 million people die from TB every year.

•      More than 8 million develop active TB disease each year.

•      One-third of the world’s population is currently infected with TB bacillus.

•      In USA , about 50% of TB cases are among the foreign-born.

•      TB and HIV are increasing together – HIV activates TB infection.

 Top 22 Countries with High Rates of TB

 TB Prevalence in India in 1999

CONTACT INFORMATION

The Oneida County Health Department conducts medical evaluations on Tuesday – 9-11am or 1-3pm or Thursday – 9-11am.  CXR Clinic is Tuesday – 1-3pm.  Evening Clinics are held from 4-6pm the first Tuesday of each month.  TB skin testing is offered on Monday – 1-3pm.

Please call 315-798-5747 for more information. 

You will be asked about insurance coverage as required by state law but, if your insurance does not reimburse us for our services, you will not be billed. There are no co-payments or surcharges.

We are located on 406 Elizabeth Street , Utica , New York located across the street from a playground. 

DIRECTIONS TO ONEIDA COUNTY HEALTH DEPARTMENT

From 90:  Take the thruway to exit 31 ( Utica ).  After paying at the toll, go straight (don’t bear right) to go to downtown Utica ( Genesee Street, South ).  At the end of the ramp, turn right onto Genesee Street .  Go straight, you drive through an area with various fast food restaurants.  You will then go over an overpass and come to the intersection of Genesee Street and Oriskany Blvd.   Continue to go straight on Genesee Street through two more lights, and at the 3^rd light you will take a left onto Elizabeth Street .  You will go down Elizabeth Street four blocks and our building is on your right.  The clinic is a red brick building with a sign in front that reads “Oneida County Clinic”

From Rome :  Take 49 East to the NY-12S/NY-5W/NY-8S  exit towards downtown Utica .  Take the NY-5SE/Oriskany Street West exit.  Continue to go straight on Oriskany Street .  Make a right onto John Street .  Go straight through the first light. Turn left at the next light onto Elizabeth Street .  Go through the next light.  We are located two blocks up on the right. The clinic is a red brick building with a sign in front that reads “Oneida County Clinic”.

LINKS RELATED TO BCG VACCINE

Centers for Disease Control - Fact Sheet on BCG
http://www.cdc.gov/nchstp/tb/pubs/tbfactsheets/250120.htm

NYC Department of Health & Mental Hygiene
Tuberculosis Control Program
http://www.ci.nyc.ny.us/html/doh/html/tb/tbbcg.html

BCG discussion by Families with Children from China (FCC)
http://www.fwcc.org/TB_BCG.htm

15 Year study in India on BCG vaccine
click on: Chingleput BCG Vaccine Trial Reports
http://www.trc-chennai.org/

LINKS TO SOURCES OF TB-RELATED INFORMATION GENERAL 
PUBLIC INFORMATION

Centers for Disease Control

http://www.cdc.gov/nchstp/tb/faqs/qa.htm

New York State Department of Health
http://www.health.state.ny.us/nysdoh/communicable_diseases/en/tb.htm

New York City Department of Health
http://www.ci.nyc.ny.us/html/doh/html/tb/tb.html

John Hopkins Center for TB Research - Easy to navigate
http://www.hopkins-tb.com/index.shtml

National Institute of Allergy and Infectious Diseases
http://www.niaid.nih.gov/newsroom/focuson/tb02/tb.htm

American Lung Association
http://www.lungusa.org/diseases/lungtb.html

Tuberculosis.net
http://www.tuberculosis.net/

INTERNATIONAL TB INFORMATION & TB INFORMATION IN 
LANGUAGES OTHER THAN ENGLISH

TB information in many languages
http://www.healthlinknm.org/refugee/resources/foreign/tb.htm
http://ush1.ush.vcu.edu/tb/lang.htm
http://www.lung.ca/tb/notenglish/
http://www.dhs.vic.gov.au/phd/language.htm

EthnoMed - TB information - many languages
http://ethnomed.org/ethnomed/clin_topics/tb/

Assc. of Asian Pacific Community Health Organizations
TB & other health information - many languages
http://www.aapcho.org/display.pl?template=pp_topic#top

International Union Against Tuberculosis & Lung Disease
http://www.iuatld.org/full_picture/en/frameset/frameset.phtml

Stop TB world wide perspective
http://www.stoptb.org/

Stop TB - Ukrainian language
http://www.tb.org.ua/

 BCG VACCINE & POSITIVE SKIN TESTS

Centers for Disease Control - Fact Sheet on BCG
http://www.cdc.gov/nchstp/tb/pubs/tbfactsheets/250120.htm

NYC Department of Health & Mental Hygiene
Tuberculosis Control Program
http://www.ci.nyc.ny.us/html/doh/html/tb/tbbcg.html

BCG discussion by Families with Children from China (FCC)
http://www.fwcc.org/TB_BCG.htm

15 Year study in India on BCG vaccine - click on: Chingleput BCG Vaccine Trial Reports
http://www.trc-chennai.org/

MEDICAL PROVIDER INFORMATION

Centers for Disease Control - TB Home
http://www.cdc.gov/nchstp/tb/

Centers for Disease Control - Direct link to Core Curriculum on TB
http://www.cdc.gov/nchstp/tb/pubs/corecurr/default.htm

National TB Center
http://www.nationaltbcenter.edu/

OSHA TB page
http://www.osha-slc.gov/SLTC/tuberculosis/index.html

HISTORY OF TB

National Institute of Allergies and Infectious Disease
http://www.niaid.nih.gov/newsroom/focuson/tb02/tb.htm

New Jersey Health Department
http://www.state.nj.us/health/cd/tbhistry.htm

TB & HIV CONNECTION

Centers for Disease Control
http://www.cdc.gov/nchstp/tb/pubs/pamphlets/tbandhiv_eng.htm

GLOSSARY OF TB TERMS

Acid-fast bacilli (AFB) - a class of bacterium of which TB is a member; they are recognized by their unusual staining properties. Seeing these bacterium in a slide of lung sputum is often called "smear positive".

Adverse Reaction - negative side effect resulting from the use of a drug (for example, hepatitis, nausea, headache). Also called a side effect.

Antibiotics - drugs that kill bacteria infecting the body. Not completing the recommended course of antibiotics can create bacteria that is resistant to these drugs.

BCG - bacille Calmette-Guerín; a vaccine to protect against TB, only proven to protect children from the worst forms of TB and it effectiveness decreases in time; may produce small (1-5 mm) skin reactions.

Biopsy - a small amount of body tissue or fluid is removed and then tested for signs of infection.

Cavity - a hole in the lung where TB bacteria have eaten away the surrounding tissue. If a cavity shows up on your chest x-ray, you are more likely to cough up bacteria and be infectious.

Chest x-ray - a picture of the inside of your chest. A chest x-ray is made by exposing a film to x-rays that pass through your chest. A doctor can look at this film to see whether TB bacteria have damaged your lungs.

Contact - a person who has spent time with a person with infectious TB.

Culture - a test to see whether there are TB bacteria in your phlegm or other body fluids. The bacteria from the sputum is put into a media to allow it to reproduce and test for vulnerability to certain antibiotics. This test can take 2 to 4 weeks in most laboratories.

Clinical Evaluation - an evaluation done to find out whether a patient has symptoms of TB disease or is responding to treatment; also done to check for adverse reactions to TB medications.

Continuation Phase - the period after the first 8 weeks of treatment, during which tubercle bacilli that remain after the initial phase are killed.

Daily Regimen - a treatment schedule in which the patient takes a dose of each prescribed medication every day.

DOT-Directly Observed Therapy - health care workers or another designated person watches the TB patient swallow each dose of the prescribed drug. The standard of care for treating active TB disease includes DOT.

Ethambutol - a drug used to treat TB disease. May cause vision problems. Ethambutol should not be given to children who are too young to be monitored for changes in vision.

Extrapulmonary TB - TB disease in any part of the body other than the lungs (for example, the kidney or lymph nodes).

Hepatitis - liver inflammation that can be caused by several drugs used to treat TB infection or disease.

HIV infection - infection with the human immunodeficiency virus, the virus that causes AIDS (acquired immunodeficiency syndrome). A person with both TB infection and HIV infection is at very high risk for TB disease.

Infectious TB - TB disease of the lungs or throat, which can be spread to other people.

Infectious person - a person who can spread TB to others because he or she is coughing TB bacteria into the air.

Initial Phase - the first 8 weeks of treatment, during which most of the tubercle bacilli are killed.

Intermittent Regimen - a treatment schedule in which the patient takes each prescribed medication two or three times weekly at the appropriate dosage.

Isoniazid - the drug most often used for preventive therapy and also used to treat TB disease. Sometimes referred to as INH.

Miliary TB - TB disease that has spread to the whole body through the bloodstream. Also called disseminated TB.

Multi Drug-Resistant TB (MDR TB) - TB that is resistant to isoniazid and rifampin and is more difficult to treat than drug-susceptible TB.

Mycobacterium tuberculosis - the species of bacteria that causes TB infection and TB disease.

PPD - purified protein derivative; see TB skin test.

Pulmonary TB - TB disease that occurs in the lungs, usually producing a cough that lasts longer than 2 weeks. Most TB disease is pulmonary.

Pyrazinamide - drug used to treat TB disease, usually during the initial phase of treatment; should not be given to pregnant women.

Rifampin - drug used to treat TB disease; also used for preventive therapy in people with a positive skin test reaction who have been exposed to isoniazid resistant TB. Rifampin has several possible side effects (for example, hepatitis, turning body fluids orange, drug interactions).

Streptomycin - an injectable drug used to treat TB disease; may cause hearing problems; should not be given to pregnant women.

TB skin test - a test that is often used to detect TB infection. A liquid called tuberculin (PPD) is injected under the skin on the lower part of your arm. It is inspected 2 - 3 days later for any reaction and, if so, carefully measured. If you have a positive reaction to this test, you probably have TB infection. Also called a Mantoux test or PPD.

Smear - a test to see whether there are TB bacteria in your phlegm. To do this test, lab workers smear the phlegm on a glass slide, stain the slide with a special stain, and look for any TB bacteria on the slide. This test usually takes 1 day.

Sputum - phlegm (mucus) coughed up from deep inside the lungs. Sputum is examined for TB bacteria using a smear; part of the sputum can also be used to do a culture.

TB infection - a condition in which TB bacteria are alive but inactive in the body. People with TB infection have no symptoms, don't feel sick, can't spread TB to others, and usually have a positive skin test reaction. But they may develop TB disease later in life if they do not receive preventive therapy.

TB disease - an illness in which TB bacteria are multiplying and attacking different parts of the body. The symptoms of TB disease include weakness, weight loss, fever, no appetite, chills, and sweating at night. Other symptoms of TB disease depend on where in the body the bacteria are growing. If TB disease is in the lungs (pulmonary TB), the symptoms may include a bad cough, pain in the chest, and coughing up blood.

Tuberculin - a liquid (PPD) that is injected under the skin on the lower part of your arm during a TB skin test. If you have TB infection, you will probably have a positive reaction to the tuberculin. See TB skin test.

Nicholas A. DeRosa
Director of Health

Oneida County Department of Health
Adirondack Bank Building
5th Floor
185 Genesee Street
Utica, New York  13501
(315) 798-6400
Email:  publichealth@ocgov.net

© 2002 Oneida County, New York, USA