Tuberculosis (TB) is a serious infectious disease that mainly affects the lungs but can also spread to other organs. Caused by bacteria – Mycobacterium tuberculosis – it is aerially transmitted when an infected person coughs or sneezes.
World Tuberculosis Day is celebrated on 24 March every year, to commemorate the date when Dr Robert Koch announced his discovery of the causal bacterium in 1882. This day is observed to increase awareness about Tuberculosis, and its impact on the world.
A total of 1.4 million people died from TB in 2019. Worldwide, it is one of the top 10 causes of death, and the leading cause from a single infectious agent, ranking above HIV. India accounts for a quarter of the global burden of TB.
In 2019, India ranked highest and alone accounted for more than 450,000 deaths caused by TB.
Despite being preventable and curable, why is TB not easily controlled? We bring you a quick insight into what the disease is, the challenges it poses, and the global effort against it.
TB Types and Symptoms
There are two types of TB infections – latent and active. The symptoms, along with being very similar to the common cold or flu, are only observable in the case of active TB. Latent TB infections can be identified only if the appropriate test is conducted.
TB Risk Factors
TB is caused by aerial transmission of the bacteria, just like the cold or the flu. You can only get TB when you come into contact with a person who has it.
When someone with TB sneezes, coughs or talks, they release tiny droplets into the air that contain the germs. If one breathes in these droplets, infection can occur. But the TB bacteria do not thrive on surfaces – shaking hands with an infected person will not infect you.
A healthy immune system normally fights the TB bacteria. However, one may not be able to effectively fend it off in the presence of other ailments, such as:
HIV or AIDS
Diabetes
Severe kidney diseases
Cancer treatments such as chemotherapy
Low body weight and poor nutrition
Medications for organ transplants
Babies and young children also have higher risk of getting it as their immune systems aren’t fully developed.
TB Tests and Diagnosis
There are two common tests for TB – skin test and blood test.
As part of the global effort to end the TB epidemic, the Government of India has facilitated almost all government hospitals with free TB diagnosis and treatment.
Treatment
TB can be cured, but the treatment depends on the infection.
Depending on the TB history of the patient, appropriate drugs need to be prescribed and monitoring of the same is required. Also, the drug dosage is given according to the body weight of the patient.
Latent TB is treated with medication to kill the bacteria and prevent the infection from becoming active. The drugs are prescribed for up to nine months, with fewer side effects. But one must remain vigilant throughout the treatment and look out for symptoms of active TB.
Active TB is also treated with a combination of medicines, and the dosing is for six to 12 months.
The treatment for MDR-TB in India is a six-drug regimen, with an intensive nine-month phase followed by a continuation phase of 18 months; making the total duration of treatment about 24-27 months, causing more side effects.
World Health Organization (WHO) remarks that since the year 2000, an estimated 63 million lives have been saved through TB diagnosis and treatment.
Multidrug-resistant TB (MDR-TB)
MDR-TB is a form of TB caused by bacteria that do not respond to TB medications. The occurrence of MDR-TB has been documented in most of the developing countries. And its emergence is due to inappropriate administration – incorrect prescription, poor quality drugs, lack of punctuality in patients – of anti-TB medicines.
Despite its increased complication, MDR-TB can be treated using second-line anti-TB drugs. However, along with the drugs being highly toxic and expensive, this could also lead to the emergence of a more resistant TB infection.
Due to its nature, MDR-TB remains a public health crisis and health security threat. India ranks the highest in the burden of MDR-TB as well.
TB and HIV co-infection
As reported by WHO, people with HIV (human immunodeficiency virus) are about 16-27 times more likely to develop the latent or active TB disease.
HIV damages the individual’s immune system, making the individual more susceptible to develop TB within weeks or months, rather than the normal years to decades.
HIV and TB form a lethal combination, mutually speeding up the infection – called coinfection. About 80 per cent of the TB cases in 2019 in India had a known HIV status, but many others remain undetected. The risk of death in co-infected patients is also twice that of HIV infected individuals without TB.
There is a lack of effective diagnostic techniques to identify TB among HIV patients. Now, with the combined effort of the global community, progress is being made to detect and treat active TB cases among HIV positive individuals.
Global commitments against TB
On 26 September 2018, the United Nations (UN) held its first high-level meeting on TB.
The UN has now incorporated it into their Sustainable Development Goals (SDGs – 3.3) to end the TB Epidemic by the year 2030. Also, The End TB Strategy by WHO defines specific milestones and targets for the reduction of TB cases and deaths.
The targets for 2030 are a 90 per cent reduction in the number of TB deaths and an 80 per cent reduction in the incidence rate, compared to 2015.
India’s fight against TB
In March 2017, the Government of India announced a new aim – elimination of TB by 2025. The National Strategic Plan 2017-2025 (NSP) set out the government’s plan of eliminating TB.
(As defined by WHO, elimination means that there should be less than one person with TB among a million people.)
Moreover, in 2018, the government launched the Nikshay Poshan Yojana (NPY), a direct benefit transfer scheme to provide nutritional support for TB patients.
The BCG (bacille Calmette-Guérin), one of the most widely used vaccine, is made a part of India’s national childhood immunization program. It has a documented protective effect against TB in children.
Covid-19: the added challenge
The start of year 2020 brought the Covid-19 pandemic. Restrictions in its response – lockdowns and reassigning of healthcare personnel – have had an impact on the global TB detection and care programs.
A global TB case detection decreased by an average 25 per cent over three months – causing a serious setback to WHO’s End TB Strategy.
The theme of World TB Day 2021 is ‘The Clock is Ticking.’ It conveys the sense that the world is running out of time to act on the commitments made by global leaders to end TB.
In light of today, Dr Tereza Kasaeva, Director of WHO’s Global TB Program has said:
“We are running out of time to fulfill global commitments to end TB. Even as we battle Covid-19, we must not ease up the fight against TB, but redouble efforts to save more lives and end suffering.” She continues to say, “We need political will and accountability, financial resources, engagement from all sectors, and community ownership, and we need this now. The clock is ticking!”
There is now a new National Strategic Plan 2020-2025 put in place with ambitious ideas endorsed by the Government of India. The financial resources for TB control are to be doubled, the new diagnostic tool (CB-NAAT) is to be distributed along with two new drugs (bedaquiline and delamanid) scheduled for broader rollout. Also, all patients with HIV are to be tested for TB.
“We as a nation, need to come together to fight tuberculosis and the stigma surrounding it so that every TB patient can seek care with dignity and without discrimination. The community must act as a wellspring of support and comfort for a patient,” says Dr Harsh Vardhan, Union Minister for Health and Family, released in the Annual TB Report of 2020.
This Report also highlighted that India is still on-track to achieve their target of eliminating TB by the year 2025, five years prior to the global target set by the UN.
Do your bit, be aware of this silent killer and advocate its importance. Let’s come together to put an end to TB.
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