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The Health Thread

Tuberculosis: Causes, Prevention and Management

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Written By THT Editorial Team

Sujata Shakya

Reviewed by Sujata Shakya, Public Health Practitioner, Assistant Professor, Public health (IOM)

Tuberculosis (TB) is a contagious infectious disease caused by the bacterium Mycobacterium tuberculosis. It primarily affects the lungs but can also impact other parts of the body. Understanding the causes, prevention, and management of TB is essential for controlling its spread and reducing its impact on public health.

Causes of Tuberculosis:

Tuberculosis is caused by the transmission of Mycobacterium tuberculosis from an infected individual to a susceptible person. The bacteria can be spread through the air when an infected individual coughs, sneezes, or speaks, releasing respiratory droplets containing the bacteria (1). Factors such as overcrowded living conditions, poor ventilation, and compromised immune systems increase the risk of TB transmission (2).

Prevention of Tuberculosis:

Preventative measures play a crucial role in reducing the incidence of TB. Some examples of preventative measures include:

Vaccination: Bacille Calmette-Guérin (BCG) vaccine is used to prevent severe forms of TB in children. It provides partial protection against TB and reduces the risk of disseminated TB in infants and young children (3). However, the BCG vaccine’s effectiveness in preventing pulmonary TB, the most common form of the disease, varies and is generally less effective in adults.

Infection Control: Implementing effective infection control measures is crucial to prevent the spread of TB. This includes identifying and promptly isolating individuals with active TB, ensuring proper ventilation in healthcare facilities, and promoting cough etiquette (4).

Screening and Testing: Active case finding and early detection of TB cases are essential for preventing further transmission. Regular screening of high-risk populations, such as close contacts of TB patients, healthcare workers, and individuals living with HIV, is recommended. Diagnostic tests such as sputum smear microscopy, molecular tests, and chest X-rays are used to detect TB infection (5).

Treatment of Latent TB Infection: Individuals with latent TB infection, who have the TB bacteria in their bodies but do not have active disease, can progress to active TB if not treated. Treating latent TB infection with antibiotics, such as isoniazid or rifampin, can prevent the development of active TB disease (6).

Management of Tuberculosis:

TB management focuses on early diagnosis, appropriate treatment, and adherence to medication. Some key aspects of TB management include:

Directly Observed Therapy (DOT): DOT is a strategy in which healthcare providers or trained community health workers directly observe patients taking their TB medications. This approach ensures treatment adherence and helps prevent the development of drug-resistant TB (7).

Drug Therapy: TB is treated with a combination of antibiotics for a specific duration. The standard treatment regimen for drug-susceptible TB includes a combination of isoniazid, rifampin, ethambutol, and pyrazinamide. Drug-resistant TB requires more complex treatment regimens using second-line drugs (8).

Contact Investigation: Identifying and testing individuals who have had close contact with TB patients is crucial for early detection of TB cases and preventing further transmission. Contact investigation involves screening and testing close contacts to identify latent TB infection or active TB disease (9).

Adherence Support: Ensuring treatment adherence is vital for successful TB management and prevention of drug resistance. Providing patient education, counseling, and support services can improve medication adherence and treatment outcomes (10).


Preventing and managing tuberculosis requires a comprehensive approach involving vaccination, infection control measures, screening and testing, treatment of latent infection, and effective management of active TB cases. By implementing evidence-based preventative measures and ensuring early diagnosis and appropriate treatment, communities can work towards reducing the burden of tuberculosis and protecting public health.


Influenza: Causes, Prevention and Management

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Written By THT Editorial Team

Sujata Shakya

Reviewed by Sujata Shakya, Public Health Practitioner, Assistant Professor, Public health (IOM)

Influenza, also known as the flu, is a contagious respiratory illness caused by influenza viruses. Influenza viruses are of different types (A, B, C) and are further classified into subtypes based on their surface antigens. Influenza is a significant public health concern, causing morbidity and mortality worldwide. This research-based article provides an overview of the causes, prevention, and management of influenza.

Causes of Influenza:

Influenza is caused by influenza viruses, which primarily target the respiratory system. The viruses spread mainly through respiratory droplets generated when an infected person talks, coughs, or sneezes. Influenza viruses can also spread by touching contaminated surfaces and then touching the mouth, nose, or eyes.

Prevention of Influenza:

Preventing influenza infections is critical to reducing the burden of illness. Several strategies can help prevent influenza, including:

Vaccination: Influenza vaccination is the most effective way to prevent influenza infections. The influenza vaccine is designed to match the circulating influenza viruses and provides immunity against the viruses. Annual vaccination is recommended for all individuals aged six months and older (1).

Non-pharmaceutical Interventions: Non-pharmaceutical interventions such as frequent hand washing, covering the nose and mouth with a tissue or sleeve while coughing or sneezing, and staying home when sick can reduce the spread of influenza viruses (2).

Antiviral Medications: Antiviral medications can be used to prevent influenza infections, especially in high-risk population, such as immunocompromised individuals, older adults, and those with underlying medical conditions. Antivirals can also be used for post-exposure prophylaxis in individuals who have been in close contact with an infected person (3).

Management of Influenza:

Influenza infections can range from mild to severe, and management approaches depend on the severity of the illness. The following management approaches are commonly used:

Symptomatic Treatment: Symptomatic treatment, such as antipyretics and analgesics, can alleviate symptoms such as fever, body aches, and headaches. Over-the-counter medications such as acetaminophen and ibuprofen can be used for the relief of symptoms (4).

Antiviral Medications: Antiviral medications can be used to treat influenza infections, especially in individuals at high risk for complications, such as older adults, young children, pregnant women, and those with underlying medical conditions. Treatment with antivirals should be started within 48 hours of onset of symptoms (3).

Hospitalization: Severe influenza infections can require hospitalization, especially in individuals at high risk for complications. Supportive care, including oxygen therapy, mechanical ventilation, and antiviral medications, may be needed (5).

Examples of Preventative Measures:

In addition to vaccination and non-pharmaceutical interventions, several examples of preventative measures can be implemented to reduce the spread of influenza, such as:

Environmental Cleaning: Regular cleaning and disinfection of frequently touched surfaces, such as doorknobs, keyboards, and countertops, can reduce the spread of influenza viruses (2).

School Closures: Closing schools during influenza outbreaks can reduce the spread of influenza viruses. School closures should be implemented early and for an extended period to be effective (6).

Social Distancing: Social distancing measures such as avoiding large gatherings, working from home, and staying home when sick can reduce the spread of influenza viruses (7).


Influenza is a significant public health concern, leading to morbidity and mortality worldwide. Preventing influenza infections through vaccination, non-pharmaceutical interventions, and antiviral medications is critical to reducing the burden of illness. Environmental cleaning, school closures, and social distancing are examples of additional preventative measures that can be implemented. By adopting these preventive measures and following evidence-based management approaches, the impact of influenza can be minimized, protecting individuals and communities.


  1. Centers for Disease Control and Prevention. (2022). Key facts about seasonal flu vaccine. Retrieved from https://www.cdc.gov/flu/prevent/keyfacts.htm
  2. Centers for Disease Control and Prevention. (2022). Preventing the flu: Good health habits can help stop germs. Retrieved from https://www.cdc.gov/flu/prevent/actions-prevent-flu.htm
  3. Uyeki, T. M., Bernstein, H. H., & Bradley, J. S. (2019). Clinical practice guidelines by the Infectious Diseases Society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza. Clinical Infectious Diseases, 68(6), e1-e47.
  4. National Institute for Health and Care Excellence. (2017). Acute respiratory tract infections: Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care. Retrieved from https://www.nice.org.uk/guidance/ng109
  5. Fry, A. M., Goswami, D., Nahar, K., Sharmin, A. T., Rahman, M., Gubareva, L., … & Azim, T. (2019). Efficacy of oseltamivir treatment started within 5 days of symptom onset to reduce influenza illness duration and virus shedding in an urban setting in Bangladesh: a randomised placebo-controlled trial. The Lancet Infectious Diseases, 19(2), 209-218.
  6. Jackson, C., Vynnycky, E., Hawker, J., Olowokure, B., Mangtani, P., & The UK Influenza Pandemic Preparedness Strategy Expert Group. (2013). School closures and influenza: systematic review of epidemiological studies. BMJ Open, 3(2), e002149.
  7. Glass, R. J., Glass, L. M., Beyeler, W. E., & Min, H. J. (2006). Targeted social distancing design for pandemic influenza. Emerging Infectious Diseases, 12(11), 1671-1681.

Zika virus: Causes, Prevention and Management

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Written By THT Editorial Team

Dr. Kishor Adhikari

Reviewed by Prof Dr. Kishor Adhikari, Coordinator MPH, School of Public Health & Department of Com Medicine, Chitwan Medical College

Zika virus is an emerging mosquito-borne viral infection that has caused serious public health concerns worldwide. The virus was first identified in 1947 in Uganda, but gained global attention during the outbreaks in 2015-2016, especially in Latin America and the Caribbean, where it was linked to severe birth defects and neurological complications (10). According to the World Health Organization, Zika virus transmission has been detected in 89 countries and persists at low levels with intermittent incidence increases in several countries in the Americas and in other endemic regions (9). Zika virus is primarily transmitted by Aedes mosquitoes and can also be transmitted through sexual contact and from mother to fetus during pregnancy. Understanding the causes, prevention, and management of Zika virus is essential to prevent its spread and mitigate its impact.

Causes of Zika Virus:

Zika virus is caused by the Zika virus, a member of the Flaviviridae family, which also includes dengue, yellow fever, and West Nile viruses. It is primarily transmitted to humans through the bite of infected Aedes mosquitoes, particularly Aedes aegypti and Aedes albopictus, which are active during the day and breed in urban and semi-urban areas (1). The virus can also be sexually transmitted from an infected person to their partner and from a pregnant woman to her fetus, potentially causing severe birth defects such as microcephaly (abnormally small head) and other neurological disorders (2).

Impact of Zika Virus:

Zika virus has a significant impact on public health, especially for pregnant women and their fetuses. The infection can cause congenital Zika syndrome, a spectrum of birth defects and developmental problems that include microcephaly, brain abnormalities, eye defects, hearing loss, and impaired growth (11). Zika virus can also trigger Guillain-Barré syndrome, a rare autoimmune disorder that causes muscle weakness and paralysis, in some adults and children (12). Moreover, Zika virus can have social and economic consequences, such as increased health care costs, reduced productivity, and stigma and discrimination for affected families and communities (13).

Prevention of Zika Virus:

Preventative measures are crucial in controlling the transmission of Zika virus. Some examples of preventative measures include:

Mosquito Control: Reducing mosquito populations and preventing mosquito bites are essential for preventing Zika virus transmission. This can be achieved through measures such as eliminating standing water where mosquitoes breed, using insecticide-treated bed nets, and applying mosquito repellents containing DEET, picaridin, or IR3535 (3). Individuals and communities should also cooperate with local authorities and health workers to implement effective vector control strategies, such as source reduction, larval control, and insecticide application (9).

Safe Sexual Practices: Zika virus can be sexually transmitted. Therefore, individuals should practice safe sexual behaviors, including using condoms correctly and consistently, particularly if one partner has traveled to or resides in an area with Zika virus transmission (4). Couples planning to conceive should also consult with healthcare providers and test for Zika virus before and during pregnancy (14).

Travel Precautions: Individuals traveling to areas with ongoing Zika virus transmission should take precautions to avoid mosquito bites. Pregnant women and couples planning to conceive should consult with healthcare providers and consider postponing travel to areas with active Zika virus transmission (5). Travelers should also follow the travel advisories and recommendations issued by the relevant authorities and agencies, such as the World Health Organization and the Centers for Disease Control and Prevention (15).

Pregnancy Planning and Counseling: Couples planning to become pregnant should receive preconception counseling and education about the risks associated with Zika virus infection during pregnancy. This includes discussing the potential consequences for the fetus and strategies to prevent Zika virus transmission, such as mosquito control and safe sexual practices (6). Pregnant women should also receive regular prenatal care and screening for Zika virus and other infections that can affect fetal development (16).

Management of Zika Virus:

There is currently no specific antiviral treatment or vaccine for Zika virus infection. Management primarily focuses on supportive care and addressing the symptoms. Some key aspects of Zika virus management include:

Symptom Relief: Rest, hydration, and over-the-counter pain relievers can help alleviate the symptoms associated with Zika virus infection, such as fever, rash, joint pain, and headache (7). However, aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided until dengue infection is ruled out, as they can increase the risk of bleeding complications (17).

Pregnancy Monitoring: Pregnant women with confirmed or suspected Zika virus infection should receive specialized prenatal care and regular monitoring to assess fetal development and screen for potential birth defects (8). Ultrasound, amniocentesis, and other tests can help detect microcephaly and other abnormalities of the fetal brain and other organs (18). Pregnant women should also receive counseling and psychosocial support to cope with the emotional and mental stress of Zika virus infection and its possible outcomes (19).

Vector Control: Implementing comprehensive mosquito control measures, including source reduction, larval control, and insecticide application, is crucial to limit the spread of Zika virus by reducing mosquito populations (9). Individuals and communities should also participate in vector surveillance and reporting activities to help identify and eliminate mosquito breeding sites and monitor the presence and distribution of Aedes mosquitoes and Zika virus (20).


Zika virus is an emerging mosquito-borne viral infection that has caused serious public health concerns worldwide. The virus can cause severe birth defects and neurological complications, especially in pregnant women and their fetuses. Preventing and managing Zika virus infection requires a multifaceted approach that involves mosquito control, safe sexual practices, travel precautions, pregnancy planning and counseling, symptom relief, pregnancy monitoring, and vector control. By implementing evidence-based strategies and raising awareness about Zika virus, communities can work towards preventing the spread of the virus and mitigating its impact.



Ebola: Causes, Prevention and Management

Ebola virus disease (EVD) is a severe, often fatal illness caused by the Ebola virus. The disease was first identified in 1976 in Sudan and the Democratic Republic of Congo (DRC) and is primarily spread through contact with bodily fluids of infected animals or humans. Outbreaks of EVD have occurred intermittently in several countries in Africa, with the largest outbreak in West Africa from 2014-2016 (1). Understanding the causes, prevention, and management of EVD is essential to effectively control its spread.

Causes of EVD:

EVD is caused by the Ebola virus, a member of the Filoviridae family. The virus is primarily transmitted through contact with bodily fluids, such as blood, vomit, or feces, of infected humans or animals. The virus can also be transmitted through direct contact with contaminated surfaces or objects (2).

Prevention of EVD:

Preventative measures play a crucial role in controlling the spread of EVD. Some examples of preventative measures include:

Avoiding contact with wild animals: Direct contact with bats, monkeys, or other wild animals should be avoided as they may be carriers of the Ebola virus (3).

Proper infection control measures: Healthcare workers should use appropriate personal protective equipment (PPE) when caring for EVD patients and follow strict infection control measures, including proper handling of contaminated materials and disposal of medical waste (4).

Safe burial practices: Proper handling and burial of infected bodies can help prevent the spread of EVD. Bodies of deceased patients should be handled by trained professionals and buried in a safe and dignified manner (5).

Vaccination: An effective vaccine for EVD has been developed, and vaccination has been shown to be effective in preventing the disease (6).

Management of EVD:

Early identification and management of EVD cases are critical to prevent further transmission. Some examples of management approaches include:

Isolation and supportive care: Patients with suspected or confirmed EVD should be isolated and provided with supportive care, including fluid and electrolyte replacement, management of complications, and treatment of any underlying medical conditions (7).

Contact tracing: Identifying and monitoring individuals who have come into contact with confirmed or suspected EVD cases is essential for preventing further transmission (8).

Use of experimental therapies: Several experimental therapies have been developed for the treatment of EVD, including monoclonal antibodies and antiviral drugs. These therapies are still under investigation, and their efficacy and safety need further evaluation (9).


EVD is a severe disease with a high mortality rate, and preventative measures play a crucial role in controlling its spread. Avoiding contact with wild animals, practicing proper infection control measures, safe burial practices, and vaccination are some of the key preventative measures. Early identification and management of EVD cases, including isolation, supportive care, contact tracing, and use of experimental therapies, are essential for effective management of the disease. By following evidence-based practices and guidelines, communities can work towards reducing the impact of EVD outbreaks.