TB is no longer the disease of the poor; steps to manage and contain it

Worse, it is antibiotic resistant; get yourself tested if you think you have the disease; start treatment immediately, self-quarantine for 2-3 weeks

On World TB day, the world bank and the ministry of Health and Family cautions that Tuberculosis can no longer be confined to spaces which are segmented into poor, unsanitary slums. India leads the world with the largest number of patients at 480,000 of the estimated 600,000 world wide cases in 2016. Almost 1,400 deaths are attributed to TB daily in India. Amongst the notifiable disease, TB is the biggest threat to our population as the airborne disease with a bacteria which is able to survive upto 24 hours can be transmitted as easily in confined public places.

“One reason is that society is no longer compartmentalised and an airborne bacteria makes everyone equally vulnerable” says Dr Sandeep Buddhiraja, senior director, Internal medicine and Clinical Director, Max Health Care, New Delhi. Add to that the hardiness of the bacteria which stays alive in the air for over 24 hours unlike the influenza bacterias who die with a few hours, the TB bacteria strain is an epidemic which cannot be ignored. 

The other major reasons for the rapid spread of the disease is drug resistance to the antibiotics. “The TB bacteria, even when it infects the body is slow to grow, it is also a bacteria which is extremely slow to kill.” says Buddhiraja. It needs aggressive treatment and given that people fall off the protocol of taking drugs, the bacteria, over time has become drug resistant to Rifampicin, the first line of treatment for TB. Of the 600,000 new cases identified world wide, 490,000 suffered from MDR – TB. Half the cases were in India. 

Internationally, it came into the limelight once again in the nineties with the rising cases of HIV. TB affected those with AIDs and was one of the primary reason for death.

Although TB of the lungs is most common, the strain which is the same could affect the spinal cord – nerves, bones and in very rare cases the heart.

What needs to be done

If you have fever with sweat for over two weeks loss of an appetite and persistent cough, get yourself tested for TB. The conventional TB test takes six weeks, the newer one takes about 48 – 72 hours. Yet newer molecular diagnostics screening test which use sputum and X rays can identify TB within a few hours. An Indian specialist pathology lab, Core Diagnostic now offers a molecular diagnostic test which gives the result in three days including offering sensitivity to drugs so that immediate and targetted treatment can be given to patients with MDR TB. 

Doctors advice getting on to the drug treatment immediately and self-quarantine for 2-3 weeks to stop the spread of TB.

What is the treatment protocol?

The basic treatment of TB, whether it is TB of the lungs or any body part is the same.

Its a six-month course wherein a cocktail of four drugs is given. Rifampicin and INH being the most important. Resistance to drugs is classified as mono ( single drug resistance), duo or multidrug resistance (MDR)or three drug resistance is a global problem. For the first two months all four drugs are given and after X-rays and tests, if the bacteria is responding, the medicines are reduced to two for the next four months. 

In cases of TB of the brain or spine, treatment could go on for a year and a half or more. The treatment is toxic so patient need to get liver function tests(LFT) periodically and treatment may be tweaked accordingly.

The biggest problem that TB eradication has faced is people falling of treatment. Internationally and in India the medicine protocol of Directly Observed Therapy (DOT) where patients have to go every day or three times a week, to take their medication from a centre has been followed. For immigration to countries like US, UK, Australia, Canada – open cases of TB are the biggest fears and if a potential immigrant is a patient, he has  to undergo compulsory DOT, three times a week with accredited hospitals.

TB has been on the list of notifiable diseases and to respond to TB elimination strategy by 2020 so as to be completely  TB free by 2025, five years before the WHO target of 2030, Government of India has started taking aggressive measures including making not reporting cases a cognizable offence. 

Private hospitals, clinics, diagnostic laboratories have been collecting  data in the hospital record departments and giving it to the state governments. TB drugs which are expensive are also given free of cost to all patients in government hospitals. In private hospitals like Max, EWS patients may be treated free.

In a case of public-private partnership in Haryana, Medanta Hospital has partnered with the local government to begin TB screening at the primary health centres level with X rays along with testing two years ago. It has assigned van which works with the local TB officer and goes to each PHC to screen at-risk patients the district. In 16 districts, over 10,000 presumptive cases have been screened. Identified Patients are referred to the medicine regime and after six months screenings are conducted as follow up.

TB Fact Sheet

Tuberculosis (TB) is one of the top 10 causes of death worldwide. In 2016, 10.4 million people fell ill with TB, and 1.7 million died from the disease (including 0.4 million among people with HIV). Over 95% of TB deaths occur in low- and middle-income countries. India leads the world count among seven countries ( Indonesia, China, Philippines, Pakistan, Nigeria, and South Africa.) and accounts for 1400 deaths every day with almost 480,000 killed every year. India accounts for the highest number of cases for multidrug resistance (MDR) related TB, nearly half of the affected.

Taking 2015 year as the baseline, the government has a structured approach to reduce the mortality from 32 per 100,000 to 3 per 100,000 by 2025 with 100 percent identification of TB cases under the revised national Tuberculosis elimination programme (RNTEP)