Last week I sat down with Mr. Girish Mehta of the Indian Circle for Caring, USA Inc. (ICC), Dr. Sucheta Doshi of the Indian Medical Association of New England (IMANE) and Kate Rose Bobseine of Massachusetts Department of Public Health (MDPH) to talk about Tuberculosis (TB).  Mr. Mehta, Dr. Doshi and Ms. Bobseine and their respective organizations have been working together to raise awareness about TB infection in the Indian community in Massachusetts.

Mr. Mehta, how did you end up working with Dr. Doshi and Kate Rose?  About 18 months ago I received a call from Dr. Doshi asking me if ICC was interested in working on a public health project about TB in the Indian Community in Massachusetts.  I knew that TB was a serious health issue in other parts of the world, but wasn’t aware that it was also an issue here in the United States.  But, I spoke with both Dr. Doshi and Kate Rose and learned that there are many cases of TB diagnosed in the US each year and that because TB is an infectious disease, if we work to prevent it, we will be keeping our families, friends and communities healthy.

Dr. Doshi:  I approached Mr. Mehta because the ICC is known for doing great work and for uniting the Indian community in Massachusetts to provide care to our community members. I knew that he would be able to get people excited about and interested in stopping TB in Massachusetts.  Plus, I am passionate about helping our community and knew that this would be a beneficial project. I want people to know that TB is treatable and preventable!  It is also important that our community know that anyone can get TB because TB germs do not discriminate based on income or education level.  

Why is it important to get tested for TB?  Kate Rose?  It is important to get tested for TB because once you know your result; you can make more fully informed health decisions.  The TB test will tell you if there are TB germs in your body and are therefore at risk for TB disease. You can take medication to kill the TB germs before you get sick and prevent yourself and your friends and family from getting sick.   It is important to get tested because TB is contagious and getting tested and treated will keep you, your family, friends and community healthy.
 
It does sound important; Kate Rose, how can someone get tested for TB? There are two tests for TB.  You can get a skin test or a blood test.  If either is positive, you will get a chest x-ray.  If the x-ray is normal you will be diagnosed with TB infection.  If you are diagnosed with TB infection you can take medicine to protect yourself from developing active TB disease.  

I have heard that the BCG vaccine will make the skin test positive.  Dr. Doshi, is that true?  
That is a great question.  Many countries around the world give the BCG vaccine to babies because it protects them from the most fatal kinds of TB, such as TB meningitis or TB of the brain.  However, the protection provided by the BCG vaccine decreases over time and has not been shown to protect adults from active TB disease.  The BCG vaccine can sometimes cause a very small reaction to the TB skin test, but this reaction gets smaller over time.  If you had a BCG vaccination many years ago and your skin test is now positive, that means that you have TB infection.

It is important to know that not everyone who got the BCG vaccine has a positive skin test. A positive test means that you are infected with TB germs. It does not mean that the BCG vaccine is working in your body.  Also, there is now a blood test for TB; BCG will not make the blood test positive.

There is a blood test now?  Dr. Doshi, will the BCG vaccine effect the results of that test?
Yes, there is a blood test for TB.  BCG will not affect the results of the blood test. If the blood test is positive you have TB germs in your body and will need a chest x-ray.

Why concentrate on the Indian community?  Mr. Mehta? I now know that certain populations are at higher risk for TB infection and disease, including immigrants and refugees who come to Massachusetts from countries where TB is common.  Many people can have TB germs in their body and remain healthy, but when your immune system is weakened by things such as diabetes, cancer, arthritis, other infections, biomedical treatments or stress you become more likely to move from TB infection to active TB disease.  The Indian community, by virtue of exposure, is at a greater risk for being diagnosed with TB infection and becoming sick with TB disease.  But, it is important to remember two things:

1.    We can prevent people from becoming sick with TB disease.  People can take medicine to prevent TB infection from progressing to TB disease.
2.    Any one who breathes can get TB; there is no shame in being diagnosed with TB because it can happen to anyone regardless of socioeconomic status, culture, or ethnicity.

Dr. Doshi, can you tell me about active TB?  Why would someone want to take medicine to prevent TB disease?  There are several reasons that people should consider taking preventive treatment.  For example, TB can make you very sick; in 2011 alone 1.4 million people around the world died from TB disease.  People often have symptoms such as cough, night sweats, fatigue, weight loss, loss of appetite and fever.  Also, although TB is more often found in the lungs it can also travel elsewhere in your body and can be very difficult to treat.  Another good reason is that TB is contagious.  If you get sick, chances are someone close to you will be infected with TB as well.  Preventing TB in individuals also prevents TB in communities.

Dr. Doshi, please tell me how we can all prevent TB? People who have TB germs in their body are not sick and considered to have TB infection.  If you are infected with TB you will not have any symptoms and will not be contagious.  However, you can develop active TB disease if your immune system is weakened from something like cancer, diabetes or and another illness. You can help protect yourself from ever getting TB by talking to your doctor about getting a TB test and taking preventive treatment for TB.

So, what happens next?  Mr. Mehta?  We recently had a Leadership Council Meeting with leaders of 20 organizations at which we discussed next steps for CITE and the Indian community. Kate Rose, Dr. Doshi and I will be working with community groups to provide education at their meetings, outreach and educational materials at community celebrations around Massachusetts.  We hope to expand the education initiatives in the future.  We will also use various other approaches to increase awareness in our community.

Dr. Doshi: In addition, to provide education to medical providers the MDPH is putting together a tool kit to encourage them to screen, test and treat their patients for TB.

Kate Rose:  Together, ICC, IMANE and MDPH are going to get a lot done.

Mr. Mehta, do you have any final thoughts to share: Yes, I think that the most important first step that we can take is to start talking about TB.  TB is a highly stigmatized disease in our community.  But it shouldn’t be.  TB forces you to remember that we are all connected by the air we breathe.  Therefore, there is no shame in having TB.  No blame.  Anyone can get TB.  If you know anyone who may have active symptoms, please encourage them to talk to their doctor.  They should also talk to their doctor about getting a TB test and if infected, they should take preventive treatment.   Please visit the ICC website for more information about TB and some of the steps you can take to keep our community healthy.  Please also feel free to contact ICC, we will be happy to guide you.

Also, we plan to have ICC booth at a number of other community events during the rest of the year.   We encourage our community members to stop by visit us and learn more about this important health issue.  We look forward to answering your questions!  We also will provide information about this topic on ICC website.

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