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FIGHTING THE TB THREAT

P A Francis
Thursday, March 30, 2017, 08:00 Hrs  [IST]

World Tuberculosis Day is observed every year on March 24 across the world to raise awareness among the public and mobilize efforts to totally eradicate this disease. Around 1.7 million people are dying of this disease every year throughout the world. Of late, TB has turned out to be multi drug-resistant with the spread of HIV and in the absence of any new drug to cure the deadly disease. At no time in the recent history TB has been a great concern as it is today. TB cases are on the increase world over and the most serious aspect of the problem is the outbreak of multi drug-resistant TB, which pose an urgent public health problem and require rapid intervention. Although most of the deaths occur due to TB among the low and middle income groups including poor communities, it is now spreading fast among all classes of people because of HIV infection. For HIV-infected persons who have latent tuberculous infection, the risk of developing active TB is 7 to 10 per cent per year. Even more dramatic is the effect seen when persons who are already infected with HIV become newly infected with MDR TB.

The main task in controlling TB is timely detection and effective treatment with advanced anti TB drugs. Effective treatment keeps the patients from dying of TB and stops the transmission of infection to other persons in the household, at the work site, or in the community settings. Treatment of active TB involves taking multiple anti TB drugs daily for at least 6 months. If the patient does not take the medications for the full treatment period, the disease may not be cured and may recur. If medications are not prescribed properly or taken regularly, the TB organisms can become resistant to the drugs, and drug-resistant TB may then be transmitted to other persons. Drug resistant disease is difficult and expensive to treat. Thus, the most important step to prevent drug-resistant disease is to ensure that patients take all their medications regularly. Directly observed therapy is the best way of ensuring patient compliance. In India, the major challenge in controlling TB is detection of all TB cases. With a large number of TB cases not recorded in private hospitals across the country, fighting TB continues to be is an extremely serious task. According to a recent WHO report more than 40 per cent of TB cases are going unnoticed in the country. The report further noted that as India does not have a mechanism to register and record the TB cases and intimate the same to the district TB center. As per WHO statistics, India reported just 56 and 59 per cent of TB cases in the years 2014 and 2015 respectively. This calls for developing a reliable mechanism to detect all TB cases from village and district levels from all the states. The state health departments should be directed to build such a data base without any further delay. Without detection of all TB cases, eradication of this highly contagious disease is just impossible in a vast country like India. Effective treatment of patients with all available advanced drugs is another challenge. In a recent medical survey it has been found that in several cases, organisms are resistant to both isoniazid and rifampicin, the two standard drugs available for treating TB. Bedaqualine and Delmanid are the two new anti-TB drugs now available for treatment of TB after nearly 50 years. And current medical research indicates that a complete cure is possible through a combination treatment of standard anti TB drug regimen with Bedaqualine and Delaminid. Bedaqualine is approved for use in India since 2013 but Delaminid is not yet approved for treatment in India. It can be accessed on recommendation for personal use through an individual’s treating doctor. The office of the DCGI needs to look into this issue with utmost urgency and make these drugs easily available in the country to fight the growing threat of MDR TB.

 

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