Stepping up efforts towards building a TB free India

24^thMarch 2018: World Tuberculosis Day

Theme: ‘Wanted: Leaders for a TB-free World’

New Delhi, March 23, 2018: Despite progress over the last decades, TB continues to be the top infectious killer worldwide, claiming over 4 500 lives a day. The emergence of multidrug-resistant TB (MDR-TB) poses a major health security threat and could risk gains made in the fight against TB.Every year, on 24^th March 2018, World Tuberculosis Day is observed with the objective of spreading awareness about the disease. This year the theme, ‘Wanted: Leaders for a TB – free world’ which places emphasis on enabling all stakeholders to build strategies and programmes which are committed to ending tuberculosis.

According to the WHO, tuberculosis accounts for 95% of the deaths that occur in low and middle income countries. Seven countries account for 64% of the total, with India in the lead (Global TB Report 2017), followed by Indonesia, China, Philippines, Pakistan, Nigeria, and South Africa. In India, an estimated 27.9 lakh patients were suffering from TB and up to 4.23 lakh patients were estimated to have died during the year (2016).

Dr Amitabh Parti, Additional Director, Internal Medicine, Fortis Memorial Research Institute, gives below important steps on how to recognize, manage and treat TB effectively:

Early Stage Symptoms:

A persistent cough for over 3 weeks with or without streaks of blood
Persistent low grade fever with night sweats
Unexplained weight loss and weakness

Later Stage Symptoms:

Progressive drowsiness
Shortness of breath
Falling urine output
Deteriorating hemoglobin
Excessive and frequent bleeding

Tests to detect TB:

Simple tests such as a chest X-Ray
Sputum test for AFB (acid fast bacilli)
Histopathological tissue diagnosis from biopsy samples of the tissues affected
A molecular test – the CB-NAAT has been introduced, for which the Government of India has established 600 laboratories around the country
In high suspicion casesn an ESR and a montoux skin test can be used

Treatment Options:

Continuous therapy of six months – Four drugs for the first two months and then three drugs for the rest of the four months. However when TB is multi drug resistant or it affects the brain or bones, the duration can be extended up to 12 to 18 months.
The DOTS (Directly Observed Treatment Short Course) programme of tuberculosis which is a supervised intermittent therapy – recommended by the WHO in which a healthcare worker ensures medicine supplies and compliance of the patient in consuming the medicine and completing the full schedule of therapy.

Preventing TB:

Ensuring mandatoryadministration of the BCG vaccine at birth.
Maintenance of adequate immunity especially in the elderly, diabetics, HIV positive or immunocompromised patients by adequate control of underlying disease, exercise and nutrition.
Barrier Nursing should be practiced and a face mask should be worn by all patients who are sputum AFB positive.
For couples intending to start a family, it is advisable to complete the schedule of 6 months therapy in order to conceive a healthy baby.

Understanding Multi – Drug Resistant TB:

Failure to respond to conventional therapy despite more than 6 weeks of treatment with resistance to 2 or more drugs is indicative of MRD TB
Incidence of MRD TB is rising due to patients defaulting schedule of treatment.
AFB culture and Gen – expert tests are performed to detect resistance.
An inadequately managed MDR TB leads to extensively drug resistant TB – XDR TB.

The Government of India has also taken some proactive steps to“End-TB by 2025”under the ‘Revised National Tuberculosis Control Programme’.In order to reduce the pill burden, a daily treatment regimen consisting of a fixed dose combination has been established. Universal drug susceptibility testing for drug resistance in all TB diagnosed patients will also be done to determine a more appropriate course of treatment. Newer drugs will be introduced in hospitals and other centres of care. There will be an allocation of additional funds for TB patients – Rs. 500 per month as nutritional support during the course of treatment. Several digital initiatives would also be created for the seamless integration of TB related services.