Tuberculosis (TB) an infectious disease caused by bacteria that mostly attacks the lungs and is spread through air when an infected person coughs or sneezes, is now among the top killers worldwide. According to the UN’s World Health Organization (WHO), TB rates in many countries of the world have shot up, aided by tattered health-care systems, political instability and lack of commitment to curtail it. The disease has become a bigger killer than malaria and AIDS combined, but experts complain that attention has shifted to more publicized diseases. There are 10 times as many TB cases in the world than AIDS cases, data compiled by WHO has revealed.
TB much like the common cold, is a contagious and being airborne infection, spreads easily and can be contracted by anyone upon exposure. In its initial stages, many perceive TB to be a mere cough, which without timely and proper care eventually causes a great deal of physical, psychological and economical damage, and can even lead to death.
The WHO says that Tuberculosis is uglier and more frightening than ever, as it moves with people and does not respect national boundaries. UN experts attribute the spread of the dreaded illness to poverty, malnutrition, poor living conditions, lack of medicine and low priority accorded by governments, particularly of developing countries, to their state-run health systems. The daily movement of migrants suffering from this disease has increased the number of cases even in countries that have well-functioning public health-care systems.
India is said to have 19.7 million, or a third of the world’s TB patients. Over two million new TB cases are reported every year. Two deaths occur every three minutes from the disease, making it one of the deadliest in the country. In fact, inspite of being both preventable and treatable, TB is one of the worst threat that has plagued the country for years, and shows no signs of abating.
NGOs and health experts say that TB in India cannot be tackled solely as a health problem, but must be treated as a symptom of a socio-economic malady. Overpopulation and unhygienic living conditions are the main causes for the spread of the disease to which the urban poor are particularly vulnerable, living as they do in congested and squalid tenements that lack basic civic amenities. The situation can only get worse in future with the urban population rapidly increasing – the past three decades have seen a phenomenal growth rate of over 400 per cent.
To make matters worse, there is a growing incidence of drug resistant TB. According to WHO’s global report on drug-resistant TB, which does not respond to most effective drugs, is fast sweeping across the world. What is worse, India and China are home to 50 per cent of the globe’s multi-drug resistant (MDR) TB cases.
India estimated that 5 per cent of new TB cases in the country can’t be treated with standard drug regimens. The MDR TB has several issues that have proved highly problematic for India. As against the 6-month treatment regimen for normal TB, MDR TB treatment takes up to two years or more to treat with drugs that are less potent and more toxic.
Another form of drug resistant TB – the extreme type referred to an XDR – is also raising its head much more frequently. WHO estimates that there may be around 25000 to 30000 XDR TB cases a year with most proving fatal. Since XDR TB was first defined in 2006, a total of 53 countries across the globe have reported atleast one case of this strain in the last few years.
Unfortunately, recent reports claim that a new entity – ominously called totally drug resistant (TDR) TB – has been isolated in the fluid samples of 12 TB patients at the Hinduja Hospital, Mumbai. The Hospital’s laboratory has been certified by WHO to test TB patients for drug resistance. Ten of the 12 TDR TB cases were from Mumbai itself, while the other two were patients from Ratnagiri (Maharashtra) and Uttar Pradesh.
According to information available on this latest form of TB, Iran first reported TDR TB cases in 2009, and India is said to be only the second country to report this most deadly form of the disease. TDR TB is the result of the latest mutation of the bacilli, after MDR TB and XDR TB were diagnosed earlier.
Health experts point out that from the emergence of MDR TB in 1992 to the arrival of XDR TB in 2006, the TB bacilli have now reached a totally resistant form. A hundred years ago, TB Patients were sent to the sanatorium for treatment. With the emergence of these various drug resistant strains, we have come full circle to the idea for senatoria. As the full form of TDR TB suggests, none of the known TB combination drugs work on the patients. There is little to offer the patients except for drastic surgery and medication for some temporary relief.
The WHO has pointed out that the drug resistant TB usually arises when people are poorly treated or take sub-standard medicines. Among TB patients, drug resistance develops mainly because patients fail to complete the six to nine-month first treatment phase. Patients feel better within a couple of months of taking the drugs and so they stop taking them. However, the TB germs in the body are not completely vanquished and they multiply back.
In its negative policy recommendation, the WHO has called upon governments to immediately ban blood tests to detect TB – as blood tests lead to faulty diagnosis and wrong treatment. While strongly recommending that commercial blood test not be uses for the diagnosis of pulmonary and extra-pulmonary TB, the world body said currently available commercial serodiagnostic tests (also referred to as serological tests) provide inconsistent and imprecise findings. There is no evidence that existing commercial serological assays improve patient outcome, the WHO said.
Inspite of being both preventable and curable, TB continues to be largely neglected disease. A sustained TB awareness campaign – like the Pulse Polio immunization campaign, could go a long way in prevention and control of the disease. We, therefore, as individuals need to join the efforts being made by the WHO to eradicate TB across the globe.
(The writer is a freelance journalist)
