TB transmission is the most common and must be watched out

Indonesia ranks second as the country with the most TB cases in the world, following India. The latest data from the Ministry of Health of the Republic of Indonesia reports that there were 442,000 TB cases in Indonesia in 2017, an increase from 2016 of 351,893 cases. The increasing number of TB cases in Indonesia is influenced by the lack of public awareness and limited information about this disease. That is why it is important for you to know how TB is transmitted, so that you can avoid the risk of infection from someone who is sick.

Recognize the characteristics of the bacteria that cause tuberculosis

Before knowing how TB is transmitted, you need to know in advance how the bacteria that cause tuberculosis can live and reproduce in the body.

Tuberculosis is a highly contagious infection caused by bacteria Mycobacterium tuberculosis . TB bacteria have characteristics like other types of bacteria in general, namely:

• Able to survive in low temperatures, between 4 and minus 70 degrees Celsius for long periods of time.
• Germs exposed to direct ultraviolet light will die within a few minutes.
• Fresh air usually kills bacteria in a short time.
• The bacteria will die within a week if there is sputum which is between 30-37 degrees Celsius.
• Germs can sleep and do not develop in the body for a long time.

When the TB bacteria enter your body, the bacteria do not necessarily develop into a disease immediately. In most of the cases, the germs will sleep and do not develop within a certain period of time. This condition is called latent TB.

How are TB bacteria transmitted?

Knowing the nature of the bacteria that cause TB will also help you understand the places at risk. That way, TB transmission can be minimized.

Mycobacterium tuberculosi s is spread from one person to another when a person with TB secretes phlegm or saliva from their mouth that contains these germs into the air — for example, when coughing, sneezing, talking, singing, or even laughing.

According to data from the National Tuberculosis Control Guidelines issued by the Indonesian Ministry of Health, in one cough a person usually produces around 3,000 sputum sparks, also known as droplet .

Depending on how the environment is, the germs that come out of a cough with TB can stay in damp air that is not exposed to sunlight for hours.

As a result, everyone who is close to and has direct contact with TB sufferers has the potential to inhale it and eventually catch it.

Reporting from the CDC, there are four main factors that determine the likelihood of TB transmission:

• The vulnerability of a person, which usually depends on the condition of the immune system
• How many droplet (sputum splash) bacteria M. tuberculosis that came out of his body
• Environmental factors that can affect numbers droplet and the ability to survive bacteria M. tuberculosis in the air
• Proximity, duration, and how often a person is exposed to bacteria M. tuberculosis in the air

The risk of TB transmission due to the four factors above will be higher if:

• Concentration level droplet nuclei: more and more droplet that is in the air, the easier it is for the TB bacteria to be transmitted.
• Room: Exposure to bacteria in small, closed rooms increases the risk of transmitting TB.
• Ventilation: The potential for TB transmission is greater if exposed in a room with poor ventilation (bacteria cannot leave the room).
• Air circulation: poor air circulation also causes droplet bacteria can survive in the air longer.
• Improper medical handling: certain medical procedures may cause droplet spread of bacteria and increase the risk of transmitting TB.
• Air pressure: air pressure under certain circumstances can cause bacteria M. tuberculosis spread to other places.

Place of transmission of tuberculosis

According to a journal from the National Institute of Health in 2013, the mode of transmission of TB can generally occur when the patient talks for about 5 minutes, or coughs just once. During this time, droplets or sputum droplets that contain bacteria can be released and remain in the air for approximately 30 minutes.

TB transmission occurs when someone inhales droplet which contains bacteria M. tuberculosis . The bacteria will then enter the alveoli (air sacs where oxygen and carbon dioxide are exchanged). Most of the bacteria will be destroyed by macrophages produced by white blood cells.

The remaining bacteria can lie dormant and do not develop in the alveoli. This condition is known as latent TB. While the bacteria are asleep, you cannot pass TB bacteria to other people.

If the immune system is weakened, latent TB can progress to active TB disease. This is when the bacteria will spread to other parts of the body and can spread to other people.

In general, the mode of transmission of TB can occur in 3 places, namely in health facilities, homes, and special places, such as prisons.

1. Transmission in health facilities

TB cases in health facilities are very common, especially in developing countries, such as South Africa and Southeast Asia.

This condition is generally caused by the fact that health facilities, such as hospitals or puskesmas, are too crowded with people, so the risk of transmission is higher.

Still from the same journal, disease transmission in hospitals or other health facilities is 10 times higher than in other places.

2. Transmission at home

If you live in the same house as someone with TB, it will be easier for you to get infected. This is because you are exposed to bacteria for a longer duration. It is also possible that bacteria live longer in the air in your home.

It is estimated, the likelihood of someone contracting TB if they live with sufferers can be up to 15 times greater than transmission outside the home.

3. Transmission in prison

In prison, both prisoners and officers have a high enough risk of contracting pulmonary TB. The risk is higher in prisons in developing countries.

Generally, conditions in prisons that are not equipped with adequate ventilation make air circulation worse. This is what causes TB transmission to occur more easily.

Based on a study in the journal South African Medical Journal regarding TB cases in prisons in South Africa, the percentage risk of transmitting TB in prisons can be as high as 90 percent.

It is important for you to know that the mode of transmission of TB only occurs through airborne spread. This means, you will not get it just by touching someone who has this disease.

Even so, you need to know that the TB bacteria are not transmitted through:

• Food or water
• Through skin contact, such as shaking hands or hugging with TB sufferers
• Sit on the toilet
• Share a toothbrush with someone with tuberculosis
• Wearing clothes for people with tuberculosis
• Through sexual activity

It's another story if you are close to the sufferer and accidentally breathe air containing droplets from the sufferer's body. Droplet it can spread through the air when a person sneezes or coughs, possibly even when speaking.

Unfortunately, the stigma regarding the mode of transmission of TB disease is still quite high in developing countries, especially those that have not received in-depth education about TB.

As a result, many people still believe that transmission can occur through food, drink, skin contact, or even heredity.

Exposure factors increase the risk of TB transmission

Reporting from the Central for Disease Control and Prevention , The exposure of a person to TB bacteria is determined by several factors, namely:

• Proximity or distance between sufferers and healthy people: the closer the contact distance between healthy people and sufferers, the greater the chance of being infected with the TB bacteria.
• Frequency or how often you are exposed: the more often a healthy person interacts with a patient, the more likely you are to get TB.
• Duration or duration of exposure: the longer a healthy person interacts with a patient, the higher the risk of TB transmission.

Therefore, you need to be careful when interacting with people who show symptoms of TB such as:

• Persistent cough (for more than 3 weeks).
• Hard to breathe
• Frequent night sweats

For people with active pulmonary TB, you can put healthy people at an increased risk of contracting them if:

• Do not cover your nose and mouth when you are coughing.
• Not undergoing TB treatment appropriately, for example not taking the appropriate dose or stopping before it runs out.
• Having a medical procedure such as a bronchoscopy, induction of sputum, or receiving aerosol drugs.
• There are abnormalities when checked with chest radiographs.
• The results of the TB examination, namely the sputum culture showed the presence of bacteria M. tuberculosis.

Then, how do you prevent TB transmission?

Knowing how to prevent TB transmission is very important to maintain health and prevent the spread of the disease more widely.

Here are various things you can do independently to avoid spreading TB:

• Get the BCG vaccine, especially if you have a baby under 3 months of age
• Avoid the factors that put you at risk of contracting TB.
• Avoid close contact with people with tuberculosis.
• Make sure your house has good air circulation and gets enough sunlight, so it's not damp and dirty
• Choose a healthy and nutritionally balanced diet so that your immune system is maintained.
• Live a healthy lifestyle by exercising regularly and avoiding smoking and alcoholic beverages.