TB outbreak in the Bahamas?

[Sid at SailAway]

Wow! This turned into an interesting thread indeed. Thanks for all the info and education. Having sorted through all this, our plans will remain the same. Christmas in Staniel Cay. I will be careful though...

[zeehag]

Originally Posted by surf_sail

To the OP:
I apologize this thread has denigrated into a bit of a flame war which isn't helpful for you. Hopefully you received some useful information. But in short I wouldn't worry so much. The risk is still way lower than many other things. TB also exists in the US, so unless you want to live in a bubble you can't avoid it entirely. One more thing I'll note is that none of the TB tests (TBT & IGRA) are 100% sensitive in immuno compromised people (or anyone for that matter). TB can also be "the great mimicker" so diagnosis can be a serious challenge. Prevention is your best bet. TB can really only be spread through people coughing so avoid those people. Of course it can also be spread even if someone is asymptomatic but In theory it should be much harder to spread. Hopefully you won't be in that close of contact with the locals. Talk to your MD, but I wouldn't expect to get a lot of practical advice. The doc that prescribed Humira likely isn't an infectious disease specialist nor a travel doc.

To Zeehag:
I don't know what your problem is, but it would be good that when chiming in on serious topics you strive to a) provide accurate information (especially when you claim to have expertise being in the medical field), b) not contradict yourself, and c) try to write in understandable English. A few quotes from you to illustrate what I mean:

To point a)
"most folks in first world nations have been vaccinated as kiddos. should be minimal issues for those of us who were-"
And:
"have a titre drawn to see if you are protected and go from there"

This blatantly false and dangerous misinformation if taken by itself. First, few Americans are immunized as children. There is no evidence the vaccine provides protection in adults, and you can't get your "titre" drawn to see if you're protected.

ALSO:
"if it is good enough for us [nurses presumably], it is good for someone needing extra coverage for adventures into areas wherein these potential difficulties lie"

This is also incorrect. You fail to understand the risk of disseminated TB in immunocompromised individuals. The risk is they may get a fatal infection long before they are treated or tested.

Point b)
FIRST you say:
"YOU get to speak with your physician to see if you are able to be given preventative medications."
THEN you say:
"is it not clear that i am saying that we didnot receive vaccines? there are treatments for exposure. for some reason you are focused on vaccine."
AND then you say:
"OMITTED my words AFTER CONVERSION. there is a span of time between conversion and actual contracting of illness. that is when the anti tb meds are given "

It's crazy that someone might be confused here when at first you write about preventative/prophylactic treatment and then you claim you never said that.

Also when you say:
"OMITTED my words AFTER CONVERSION"
Please do point out in which prior post you actually said AFTER CONVERSION (also editing your prior post doesn't count)

On point C, I was going to provide examples, but since most of your text is written like a 5 year old why bother...

P.s. I'm glad you provided some links to source information in your last post (after editing), but it would be good if you actually read it before providing false/dangerous information.

is a flame war only in your own head.
my info is what was done and is still done when folks are exposed to tb.
for the record, you really should read the who info, as it is in opposition to yours.
i suggest that you read the info posted in the linkies instead of dissing it as it is from world health organization. donot wish to believe that which is public info by world health organization, that is your own choice. perhaps you believe it to be fake news. in that case, have fun.
as for the importance of all immunosuppressed individuals consulting their personal physicians before travel, if that is going to kill or harm anyone i would love to watch.
seems to me that you are imparting false information in conflict with professional sources. that is your business but first do no harm. as you have yet to swear that oath, perhaps you need to stop misinforming.
btw, the time period between conversion and actually acquiring the disease is appropriate for administering prophylaxis(antibiotics), as has been the practice for decades.

[surf_sail]

Originally Posted by zeehag

is a flame war only in your own head.
my info is what was done and is still done when folks are exposed to tb.
for the record, you really should read the who info, as it is in opposition to yours.
i suggest that you read the info posted in the linkies instead of dissing it as it is from world health organization. donot wish to believe that which is public info by world health organization, that is your own choice. perhaps you believe it to be fake news. in that case, have fun.
as for the importance of all immunosuppressed individuals consulting their personal physicians before travel, if that is going to kill or harm anyone i would love to watch.
seems to me that you are imparting false information in conflict with professional sources. that is your business but first do no harm. as you have yet to swear that oath, perhaps you need to stop misinforming.
btw, the time period between conversion and actually acquiring the disease is appropriate for administering prophylaxis(antibiotics), as has been the practice for decades.

Lol. Happy to discuss the specifics of where I contradict the WHO. Also, actual reading of my post would make it clear that I don't have an issue with the provided info only your understanding of it.

Sid for your information what Zeehag says about treating TB before disease is present is mostly correct but completely misses the point:

When someone tests positive on a TB test (in the US we almost exclusively use the blood based IGRA test because it's easier and shouldn't get a false positive due to prior vaccination) it means the patient has already been infected with TB. However, if there is no sign of active disease (typically you only look for pulmonary involvement using a chest x-ray) then it is assumed that the patient has a latent TB infection and is treated with 6-12 months of INH to clear it. A latent TB infection means you are infected but your immune system is keeping the mycobacterium in check (potentially indefinitely). In the US we treat latent TB anyways to prevent disease if the immune system were to fail in the future (due to illness, stress, medical treatment, getting older, etc.).

The problem of course is that patients that are immunocompromised may never end up in the latent phase (because the immune system can't control TB to begin with) and progress directly active disease or worse the disseminated form of TB rapidly after exposure. So as you can see relying on the INH as prophylaxis (if you can call it that) after infection is dangerous and not a good option for immune compromised patients.

[weavis]

Originally Posted by zeehag

is a flame war only in your own head.
my info is what was done and is still done when folks are exposed to tb.
for the record, you really should read the who info, as it is in opposition to yours.
i suggest that you read the info posted in the linkies instead of dissing it as it is from world health organization. donot wish to believe that which is public info by world health organization, that is your own choice. perhaps you believe it to be fake news. in that case, have fun.
as for the importance of all immunosuppressed individuals consulting their personal physicians before travel, if that is going to kill or harm anyone i would love to watch.
seems to me that you are imparting false information in conflict with professional sources. that is your business but first do no harm. as you have yet to swear that oath, perhaps you need to stop misinforming.
btw, the time period between conversion and actually acquiring the disease is appropriate for administering prophylaxis(antibiotics), as has been the practice for decades.

The sad thing Zeehag, is that you are incorrect on a lot of points.
If you dont keep up with the actual medics in the field, you are not in the know.

as for the importance of all immunosuppressed individuals consulting their personal physicians before travel, if that is going to kill or harm anyone i would love to watch.

These people are at the most risk. 30-40% more likely to contage.

btw, the time period between conversion and actually acquiring the disease is appropriate for administering prophylaxis(antibiotics), as has been the practice for decades

Uum. Up to 50% of people are now TB antibiotic resistant. My opinion? More. Not only that but the resistant ones spread the disease quicker.

In fact, given what I know about TB and dealing with it, I pretty much concur with most of the statements by the guy you are disagreeing with.

WHO information is a little behind except for those of us who worked for them and rewrote the directives. Some directives are not altered for a long time. Its hard to rewrite when there is not much to offer in the light of A/Bs not working is there?

I rarely get involved in medical discussions on CF. I just usually look after my patients and do the best for them. I also dont discuss my views on medical treatments, but here I see the heat rising and I decided to offer some verifiable things for you to look up.

You decide. As long as you are not my patient its not for me to dissuade you.

[hellosailor]

"administering prophylaxis(antibiotics), as has been the practice for decades."
Uh, this ain't 1950 and penicillin is no longer the universal cure-all.

Prevention--as in, thorough cleaning, decontamination, and isolation--are vastly preferred to antibiotics, and the use of antibiotics is actually denigrated in many cases, because there are now so many antibiotic-resistant bugs and every inappropriate use only increases the number of them. For a number of bugs, there are no longer ANY effective antibiotics. The list gets longer every year.

With the spread of resistant malaria, and Zika, and chicken-whatever you call it... There are good reasons why folks did a European tour and avoided the plague-infested areas of the globe. There still are good reasons why immuno-compromised folks should simply stay clear of areas with greater disease risks.

Heck,Typhoid Mary KNEW she was healthy, too. Spanish Flu, Yellow Fever, Polio, these things are actual memory for many living people, not just something in the distant past. And cholera has killed how many, this year alone, in Yemen?

The OP is doing the safest thing, by enquiring about simply staying out of disease areas.

[alansmith]

Sid, I am not a M.D. But I have been a microbiologist for 40 years and work in the hospital laboratory. I have a master's level education. Nurses are the front line staff in the medical field and deal face to face with the patients. They are also the staff that are most at risk for contagious diseases. When a patient arrives in the emergency room sick as a dog puking and hacking their lungs out it is usually the nurse who is first to understand what the problem might be. When you have worked in an emergency room for many years like Zeehag has....they have seen each possible scenario hundreds of times. Their education usually is 2 year R.N. or 4 year R.N. degree. A medical doctor has a 4 year rigorous B.S. degree. Then they go for 4 years of medical school. Then they can go another 4 years to get a speciality internship in Emergency Room medicine, Surgery, Internal Medicine...etc. So, you can understand, perhaps, how eruptions occur between different levels of experience and education within the medical field. I have seen nurses that are far superior to medical doctors in their knowledge of diagnostic and general medicine. I have seen nurses that I would not trust to hang a Ringer's lactate solution.

In the laboratory we call TB...."AFB"....it is the acronym for Acid Fast Bacillus. AFB organisms have even been recovered from mummies 6k years ago. CDC believes that over 60 percent of the world is infected with TB. The scary thing is that they are tough hombres and getting tougher. Antiobiotic resistences have become a real problem. Researchers are struggling to come up with new antiobiotics or combinations. It ain't going well.

Sid, most people who are carriers of TB are active or they have it can't spread it (latent...but can change to active). Just so you know....there are other forms of Tuberculosis. Just for edification...TB ....it's actual name is Mycobacterium tuberculosis. I think 80% of cases are of the pulmonary type. When a person is sick with it they have night sweats, coughing can be violent, coughing can be bloody, they can loose weight (another wasting disease).....sometimes it is associated with lower income people due to living conditions and environmental issues. But I have seen 3 doctors in my career convert positive due to exposure to sick patients.

I don't think you will have much to worry about travelling to the Bahamas. AFB when coughed out by a sick individual can become a problem for someone who breathes in that air born microorganism. If you touch a door knob and someone's dried sputum is on it...you don't wash your hands before eating....your chances of getting pulmonary AFB is very little. Being in a room ...like a health care professional like a Nurse, M.D., Respiratory Tech...when someone is in crisis mode....that is when the shizzle hits the fan. Being on a boat...almost no chance...In a bar and the bartender is coughing his brains out....leave immediately...smile.

Have fun...This isn't Ebola, or SARS, or Plague....you are healthy...and the chance of you being exposed is very small. I wouldn't change my plans....but that is just me...

[Clamdigger]

Originally Posted by Sid at SailAway

Wow! This turned into an interesting thread indeed. Thanks for all the info and education. Having sorted through all this, our plans will remain the same. Christmas in Staniel Cay. I will be careful though...

Yeah Sid, you be careful ...when you're lying down on the beach trying to catch some rays, because you're more likely to get your fingers nipped by some of those iguanas

In the late 1980's I helped relocate iguanas to some of the other Cays in the Exumas. But of course not all of them were transferred

[paolodig]

Originally Posted by Sid at SailAway

I'm a little concerned because I use Humira which lowers my immune system. Don't want to take any undue chances..

Which is humira?

[mrm]

Originally Posted by paolodig

Which is humira?

It is (I assume you asked 'what is') a trade name for Adalimubab - a selective immune system suppressant, acting against TNF-alpha (tumor necrosis factor alpha). It is used to treat patients with autoimmune diseases (various forms of arthritis, Crohn's disease, etc.).

Other similar drugs are Etanercept (trade name Enbrel) and Infliximab (trade name Remicade).

[weavis]

Originally Posted by Clamdigger

Yeah Sid, you be careful ...when you're lying down on the beach trying to catch some rays, because you're more likely to get your fingers nipped by some of those iguanas

In the late 1980's I helped relocate iguanas to some of the other Cays in the Exumas. But of course not all of them were transferred

Aaah. So its your fault is it?

[zeehag]

you worry about 100 cases of tb in exumas when in usa over 9000 new cases have been reported to march 2017. wake up. you stand more chance of contracting tb in usa in a hospital emergency room than on an island vacation.
but that is ok as the sky is falling.
https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6611.pdf

[YPSILANTI]

Dont worry about it unless your imune system is seriouslly compromised. I live in South Africa and am surrounded by folk who have TB. We live in the country with the highest HIV rate in the world and also in the province that has the highest HIV rate in our country. That decrees that our province has the highest HIV and TB rate globally. Most HIV patients contract TB here due to a compromised immune system. We are not at any risk. As stated, you must be extremely susceptible and in VERY close contact with an infected person. You wont get TB. You face a higher risk of a bee sting. Enjoy your visit.

[hellosailor]

zeehag-
You're not coming across as on point here. Originally you said "i hope they have isolated their source of infectiuon, as 11 ish percent of population with tb is significant."
Presumably you meant that some 11 percent of the population in the Exuma district, or in the Bahamas in general? has active TB.
I think we can agree without any fancy research that 11% of the US population does NOT have active TB, so the risk of meeting an active carrier in the Exhuma district may be somewhat higher than in the general population of the US.
And to say the risk of contracting it in a US emergency room is higher, is totally off the mark. The OP isn't planning to go spend a week in an ER (none of us do, I know) and the few good ER's practice some basic hygiene, sometimes. "ER" is totally out of context here. General population is what should be compared.
Now a little web work shows that perhaps 25-30% of the world has already been infected with TB and has some passive, inactive, carrier status which may or may not ever be problematic or symptomatic. That's HUGE.
The statistics sound like what you hear after every interview with the neighbors, after a massacre: "He was such a nice boy, who knew...." TB is all around us, generally invisible and not harmful. Unless, like the nice boy, something goes very wrong. In which case you get drug-resistant TB which requires either a six-month course of four drugs, or a TWO DAMNED YEAR course of the last-chance drugs. And if you are immune compromised...ah, yeah, the odds apparently change from "generally easily cured" to "may be dead before you know it".

Hey, if the OP has personally decided they don't want to take unnecessary health risks, and the Exuma district is a disease hot spot...What's to debate? Lederhosen aren't close enough to Bermuda shorts? The bartenders are less hygienic in Lucerne? The tiki bars are harder to find in Singapore?

Decisions, decisions.

[Fishbones]

I am curious as to where this information regarding the TB Outbreak came from. I have a home on Long Island. I and my neighbors, fishing guides, charter airline pilots regularly do day trips to the Exumas. Have not heard a word about this topic.