You probably don’t think about tuberculosis in New Zealand much at all. You may know a little about it, like that it’s a disease that affects the lungs, and you may even know that it killed author George Orwell and composer Frederic Chopin! That’s because fortunately these days tuberculosis (TB) is generally preventable and more curable due to better treatment options, but it hasn’t disappeared yet. And while you don’t hear much about it, particularly in Australia and New Zealand, it still exists and still kills. In fact, according to the WHO TB is one of the top 10 causes of death worldwide.
What is Tuberculosis?
Tuberculosis (TB) is a disease caused by infection with the bacteria Mycobacterium tuberculosis. TB most commonly affects a person’s lungs, however, it can also affect other parts of the body and cause serious illness. TB is spread through the air when a person with TB disease of the lungs or throat coughs, sending the bacteria into the air, which is then inhaled by others who the person has been in close and probably frequent contact with. Only about 10 percent of people with TB infection will ever get TB disease.
Tuberculosis in Aged Care
While tuberculosis cases in aged care facilities in Australia and New Zealand are rare, they can happen. In New Zealand tuberculosis is reportable to public health authorities under the Health Act 1956, which means that once tuberculosis has been suspected or confirmed it must be reported to the local medical officer of health. TB specialists from the local public health service will ensure that the appropriate investigation and treatment are undertaken.
Please consult your public health service if you suspect or have confirmed cases of TB in your aged care facility.
Tuberculosis in Australia and New Zealand
The Ministry of Health Guidelines for Tuberculosis Control in New Zealand, 2019 states: “New Zealand has committed to the World Health Organization (WHO) goal to end tuberculosis (TB) by 2035.”
Together with a relatively small number of other countries, incidence of TB in New Zealand is <10 per 100,000 people. New Zealand is classified as a low incidence country (<100 cases per million population) however the Ministry of Health identifies room for improvement to achieve pre-elimination targets (<1 case per one million people). It must be noted that there is an ongoing risk of imported cases from countries with high TB incidence. During 2011–15, 78% of new TB cases notified were in the non–NZ born population.
Worldwide indigenous communities are significantly overrepresented in TB cases. During the 2011–15 period, over 50% of New Zealand–born cases were Māori. The Ministry of Health requires providers of TB services to have a specific focus for Māori with a culturally competent whānau-centred model (timely diagnosis, treatment and transmission prevention) to reduce this historic health inequality.
The international and public health communities have sought to shift focus from control of the TB epidemic towards elimination, following successes in pursuing elimination for other infectious diseases globally.
Although New Zealand has maintained a low and stable incidence rate of TB, indicating effective TB control, there has been little progress in recent decades for incidence reduction, with the absolute number of cases increasing from previous periods. Migration, and to a lesser extent short-term residency, often from countries of high TB burden, ensures there is an ongoing potential source of new TB cases, including drug-resistant ones.
Where do we go from here?
It will be interesting to see how the elimination of TB in New Zealand is realised.
A paper released in 2020 suggests NZ could be the first of the low incidence countries to see total elimination of TB, based on WHO frameworks. However, New Zealand currently has no overarching authority of TB services with cases and clusters handled by individual public health units. To achieve elimination, a coordinated national response from the Ministry of Health is suggested.
The paper calls for screening of latent TB both within New Zealand and for those coming into the country from high-prevalence areas. The Ministry of Health has identified this will require increased funding and resources. Currently those arriving into NZ from high-prevalence countries are screened using chest radiograph; however, this method is only useful for active TB.
In the interim, however, some positive results have been achieved in the wider medical community towards TB treatment, specifically drug-resistant TB treatment.
Will a combination of coordinated services with improved governance and an increased financial commitment from the government be enough to decrease tuberculosis rates in New Zealand? Only time will tell.