Tuberculosis and Contact Tracing in Australia

This article discusses tuberculosis and contact tracing in Australia. It covers the transmission, screening, and prevention of TB. It also highlights the differences in contact tracing guidelines between Northern Territory and Victoria. The article is relevant for healthcare professionals and students studying nursing and public health.

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Nursing
Name of the Student
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Answer: 1
According to the Australian Government Department of Health (2018), the
communicable diseases are required to be notified nationally and hence are regarded as
notifiable diseases. These notification of this communicable diseases are required to be
provided to the Commonwealth’s National Notifiable Diseases Surveillance System in order
to prevent the outbreak of these diseases. The Communicable Diseases Network Australia
(CDNA) (2018) has published a detailed list of the common notifiable diseases prevalent in
Australia which is highlighted in the figure below.

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Figure: Notifiable Disease in Australia
Source: Communicable Diseases Network Australia (CDNA) (2018)
According to the Australia Government Department of Health (2018), tuberculosis
(TB) is one of the significant health-problems to the population worldwide. The yearly report
of tuberculosis in Australia and bacteriology have confirmed cases along with drug resistance
as generated by the report of Australian Mycobacterium Laboratory Reference Network and
published in Communicable Diseases Intelligence. According to Fogel (2015), tuberculosis
(TB) is an infectious airborne respiratory disease is caused by bacterial invasion,
Mycobacterium tuberculosis. The intubation period is 3 to 9 weeks. The reports published by
the World Health Organisation (2012) highlighted that there were 8.7 million of cases of
tuberculosis reported globally and 1.4 million of people have died from TB. The morbidity
and mortality cases are higher in the low or middle income countries (95%) like South-East
Asia and western Pacific regions (60%). The high incident rate of TB is attributable to a
combination of several factors like increased rate of HIV infection, poor living standards,
over-crowding, warning allocation to healthcare resources to TB program and subsequent
generation of the multi-drug resistant bacterial strains (World Health Organisation, 2012).
The reported cases of TB in Victoria experienced a steep decreases during the tenure
of 1954 (1000 cases) to 2000 (294). However, this was followed by gradual increase from
2003 to 2012, with reaching the peak in 2010 (435 cases). The average notification rate is 7%
per 100,000 cases per 10 years (2003 to 2012). In Victoria, the incidence rates and higher
among African, Indians, Vietnamese and Fillipino population. Almost 50% of the overseas
population is detected with TB within 5 years of their arrival in Victoria, Australia (Victoria
State Government, 2018).

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According to the Government of Australia (2018), leprosy and tuberculosis are significant
health concerns in Northern Territory and is mainly prevalent among the refugees, illegal
foreign fisherman and international students. The Australian Tuberculosis Review (2017)
highlighted that rate of incidence of Tuberculosis is high in the Northern Territory due to
presence of multi-drug resistant bacteria.
Answer: 2
According to the World Health Organisation (WHO) (2017), people who come in
close contact with someone who is suffering from communicable diseases caused by
pathogens like virus or bacteria, are at a higher risk of developing the same infection along
with increased potential of infecting others. Closely monitoring these contacts after disease
exposure helps the contacts to avail proper care and treatment and thereby helping to prevent
disease transmission. This monitoring process is known as contact tracing and can be sub-
divided into three steps. The first step is contact identification, second step of contact listing
and third step of contact follow-up. Contact identification means when some is infected with
a communicable disease, the contacts are spotted by enquiring the person’s roles and
activities of the other persons around them since the onset of illness. Contacts can be
anymore who has been in close contact with an infected person. Contact listing deals with
consideration and listening of all persons who have contact with the infected persons. WHO
(2017) are of the opinion that efforts should be given in order to identify every listed contact
and simultaneously inform them about their contact status. WHO also stressed over
conducting follow-ups and importance of receiving early care during the development of
initial symptoms. The contacts must be provided with proper information about disease
prevention. The high risk contacts are recommended to keep under isolation at hospital.

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Contact follow-up deals with regular follow-up of the contacts for proper monitoring of the
symptoms and testing for the signs and symptoms.
Answer 3
According to Centre for Disease Control (2016), majority of the cases of TB is
Northern Territory in Australia arise out of contact. The risk of the disease is highest during
the first 2 years of infection and disease development can occur within 2 to 3 months of the
initial contact. The identification of contacts early, followed by new cases infected by new
(index) care is the main priority of TB control programs. The aim of contact tracing is to
identify new cases of active TB followed by initiation of treatment and identification of the
TV-infected contacts by the process of Mantoux testing for offering effective management
for latent tuberculosis infection (LTBI). The aim of contact tracing of Northern Territory
Australia also focus on identification of a source case for the index cases who TB is likely to
have been acquired recently; identification of the source case with extra-pulmonary disease;
cases where community screening is important and providing education for TB health
awareness.
The contact tracing of the contact investigation for the Victorian Government of
Health (2018) deals with detailed encryption of the history of the contact followed by
tuberculin testing and radiographic examination. The level of investigation is mainly
governed by the attributes of the source case. The overall scope of the investigation is
extended when the below mentioned factors in the source case are present like acid-fast
bacilli in sputum, captivation through chest x-ray.
One of the difference of the between the contact tracing guidelines of the Northern
Territory and Victoria is, in the National Territory (NT), Centres for Disease Control (CDC)
units are responsible for the regional TB control programs. These units are situated in

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Katherine, Darwin, Tennant Creek and Nhulunbuy. Each of this unit is responsible like
screening, management of the diseased case, effective contact tracing and notification of the
diseases. A patient diagnosed in state/territory (like New South Whales) but is being treated n
NT will have same national notification. However, the patient’s will be administered in
special domain as a “transfer in” to state/territory. However, the contact tracing as
highlighted by the Victorian government department of Health does not have separate cabin
or their types of contact tracing principle between state-to- state. Having a separate regional
contact tracing principle will be helpful in eradicating TB from the grass root level.
Another difference highlighted between the contract tracing guidelines for the
Northern Territory (NT) and Victoria is, NT has different screening programs for high risk
contacts, medium and low risk contacts along with protocol for the first and the second visits.
This differentiation of the screening process is absent in Victoria. According to Fox, Barry,
Britton and Marks (2013) having different levels of contact screening for the communicable
diseases is important in order to differentiate the population in the domain of severity of the
disease transmission. However, in the Victorian Government (2018), notification of TB must
be made within first five days of diagnosis as entitled under the Public Health and Well-being
Regulations (2009). In Vitoria, asymptomatic contacts are not included in the screening
process as opposed to NT. Kranzer et al. (2013) stated that screening of the asymptomatic
contacts is also important as probability of the transmission of TB also remains high even
when the preliminary symptoms subsides.
Answer: 4 (i)
According to National Notifiable Diseases Surveillance System’s report (2014), 1339
number of reported cases of TB in Australia, which represents 5.7 per 100,000 population.
Australia was successful in achieving and maintaining proper tuberculosis control during mid

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1980s with annual TB incidence rate is 5 to 6 cases (approx) per 100,000 population. The
main victims are the overseas-born population and constitute 86% of the diseased percentage.
Moreover the vulnerability of developing TB is 6-time higher in indigenous population in
comparison to the non-indigenous population. While Australia is successful in achieving,
excellent and sustained control of TB due to lower percentage of the multi-drug resistant
bacteria (1 to 2%), sustained efforts are still required in order to reduce the rates further to
achieve the WHOs goal of eradicating TB epidemic by the end of 2023 (Australian
Government Department of Health, 2017).
Notification of Tuberculosis form 2009 to 2014
State/Territory 2009 2010 2011 2012 2013 2014 Mean
for 5
years
Lower
range
Upper
range
Northern
Territory
21 37 35 28 43 28 33 21 43
Victoria 410 436 360 369 380 448 391 107 172
(Source: Australian Government Department of Health, 2017)
From the case study, the race and the ethnicity of the student of the secondary school who
was affected with TB. However, it can be said that since he/she is a child, his/her
susceptibility of developing TB is higher in comparison to other members of the society.
Answer 4 (ii)
Transmission of TB is mainly medication through air. Mycobacterium tuberculosis is
a airborne bacteria and is mainly transmitted through inhalation of the infectious droplets
produced by people who are suffering from TB and is associated with pulmonary and

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laryngeal coughing, sneezing, laughing and shouting. Invasion might also occur through
mucous membrane or membrane of the damaged skin. TB also spreads due to lack as proper
hygiene as the bacterial pathogen of TB is also excreted through the urine of the infected
persons. Ingestion of unpasteurized milk also leads to disease transmission. Aerosol
transmission has been reported among abattoir employees. The extra-pulmonary TB apart
from laryngeal infections is not highly communicable (Victoria State Government Health,
2018). The transmission of TB for child in relation to the case study might have occur from
any of the members in his/her school.
Infectious of tuberculosis can be acute or chronic. Other causative agents of TB apart
from M. tuberculosis are M. bovis or M. africanum. Active disease occurs immediately after
initial infection (progressive disease) and might of followed by a latent stage and then sudden
aggravation of the disease severity (Victoria State Government Health, 2018)
Answer 4 (iii)
The infections are mainly transmitted in air from the patients who have chronic
pulmonary diseases. The vulnerability of transmission is higher if index case is “sputum
smear positive” and is proportional to the bacillary density of the respiratory secretions. Thus
the proximity and persistence of direct contact can be regarded as the major determinants of
the risk of disease transmission and those who are residing within the same family or
household are at a higher risk of getting infected with the disease in comparison to the casual
contacts. Among the household contacts, those who are young or have immune-suppression
are at an increased risk of developing the disease from the contacts. It is due to this reason
that children of the TB infected parents are more susceptible in getting infected with the
disease and thus screening of contact is important for early detection and prevention of the
disease transmission. Apart from young, infants are also vulnerable in getting affected with

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the disease. Although infected children or the infants show sputum negative and thus do not
directly contribute to immediate disease transmission. People who have previous medical
history of pulmonary congestion or make tobacco addiction are also prone to get affected
with the disease (Singh, Mynak, Kumar, Mathew & Jindal, 2005).
The distant contacts or the other members of the family are not susceptible for the
disease transmission unless and until they come to direct contact with the infected
individuals. The distant contacts if immune-compromised are more susceptible in developing
the disease once come in direct contact. However, spreading of infection is high among the
visitors of the clinic who have come for testing of TB (Singh, Mynak, Kumar, Mathew &
Jindal, 2005).
Answer 4 (iv)
According to the World Health Organisation (WHO) framework for the “End TB
Strategy”, post 2015, proper screening of the people who have migrated and other cross-
border migration is highlighted as priority action for the prevention of the tuberculosis in
Australia (Kaushik, Lowbridge, Scandurra & Dobler, 2018). The Australian National
Notificable Diseases Surveillance System (NNDDS) is a passive surveillance system. This
system collects information on the communicable diseases. Australian Government,
Department of Health, manages NNDDS and the entire work-process is monitored under the
auspices of the Communicable Diseases Network Australia (CDNA). After identification of
the contact, there occurs screening of the infectivity index under grade of high, medium, low
and negligible based on the test of the smear. The identified children in the case study has
smear positive and hence can be classified under the high index infectivity. This is followed
by the degree of risk in contact classification like high risk group, medium risk group and the
low risk group (Mille, Deeble, Roche & Spencer, 2004). In relation to the case study it can be

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that that the student of the secondary school has developed TB from the medium risk groups
that is less intense contact but frequent contact. In this case, it might be his/her school friends,
teachers of school staffs. His high risk group, with whom he/she spends majority of his time
(parents and siblings) are not his/her source of infection. Thus screening of the medium and
the low risk contacts are also important. Data collected from each of the state or territory is
analysed and then disseminated by the Australian Government Department of Health (Mille,
Deeble, Roche & Spencer, 2004).
Answer 4 (v)
The index case student will return to class when he/she will be completely cured from
TB. The improvement in the prognosis of TB along with showing the path of the complete
recovery from TB can be detected through the sputum test. However, negative sputum test is
not always a direct indicator for the TB infection. Thus in order to eradicate false positive
results, the physicians at times suggest for chest X-ray for the TB student. If the chest X-ray
is found clean without any spots inside the lungs then possible signs TB recovery is indicated.
However, there might also be chances of the extra pulmonary TB, in that case the level of
spesis in blood (presence of C-reactive protein) along with urine test must be undertaken
(Wallis et al., 2013).
The community members must be educated about the process of the disease
prognosis, the medication management of TB, the effectively of the infection of the bacillus
calmette guerin and confirmatory test done for the detection of TB. Educating the community
members will help in increase in the level of knowledge about the prognosis of TB and
thereby helping the community members to accept a TB infected individual who have
recently undergone a recovery. However, recovery phase might follow with disease
recurrence as at this time a person might be immune-compromised (Wallis et al., 2013). In

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relation to the case study, it can be said that the children must be kept in isolation even after
he is cured and must be given nutritional diet in order to eradicate disease recurrence.
Nutritional diet will help to increase the level of immunity (Wallis et al., 2013). The
community members must also be educated that person who is cured from TB completely is
no longer a carrier and is unable to spread disease through contact transmission or through
sneezing and coughing (Wallis et al., 2013).

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