Improving health equity focus of new TB guidelines

The Ministry of Health has released new Guidelines for Tuberculosis (TB) Control in New Zealand 2019, an important step towards eradicating the disease and improving health equity.

New Zealand is classified by the World Health Organization as having a low incidence of TB, but the disease is still recognised as a public health threat in New Zealand.

The Ministry’s Director of Public Health Dr Caroline McElnay says TB is a bacterial infection that most commonly affects the lungs, but can also affect the lymph nodes, bones, joints and kidneys.

“The good news is that TB can be treated – usually with a combination of antibiotics – but it’s really important people finish the course of antibiotics.

“While TB is spread through coughing, sneezing or spitting, it is not as infectious as measles, colds or influenza. The disease can stay inactive in someone’s body for many years before it develops. Historically there has been a stigma around TB, however TB can be treated. It is important to diagnose active TB early to reduce risk to others and enable treatment to begin as early as possible.”

Every year globally 10 million people are diagnosed with TB and 1.5 million deaths are reported.

Between 2011 and 2015, 78 percent (1102 cases) of people newly diagnosed with TB in New Zealand were born overseas. Of the 312 people with TB born in New Zealand, half identified as Māori.

As a country, we’ve signed up to the WHO’s End TB Strategy, which aims to eliminate the disease by 2035.

“To do this, we need New Zealand’s health professionals at all times to maintain a high degree of suspicion when a patient, who’s either had TB before, has been diagnosed with latent TB infection, has lived in at-risk countries, or is living in a high deprivation area, presents with symptoms compatible with TB.

“TB is often referred to as a disease of inequity as it’s closely linked to overcrowding and malnutrition. In New Zealand, half of all New Zealand born TB cases were living in the highest deprivation quintile. Māori and migrant communities are disproportionately affected. That’s why these guidelines are so important,” says Dr McElnay.

“Disease rates were highest for adults in their twenties, both for those born in New Zealand and those born overseas.”

Dr McElnay says more than half the total number of TB cases globally occur in south east Asia and the Western Pacific – both areas close to New Zealand and where most of our TB cases come from.

The guidelines are aimed at practitioners. They update treatment regimes and also provide a definition of those groups of people who would benefit from latent TB infection screening and treatment.

Additionally, they recognise that TB care should be provided in the context of multi-disciplinary teams, while all children should be treated in consultation with a paediatric expert in the disease.

The guidelines are an update of 2010 advice and were prepared by ESR and TB experts around New Zealand.

View the Guidelines for Tuberculosis Control in New Zealand 2019.

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