9 lakh new TB cases reported in China every year

As another World Tuberculosis Day passes by, India continues to struggle with a staggering burden of TB. Shortages affect even the basic first-line TB drugs that are sold in Canada, a serious concern given the importance of reliable, uninterrupted access for a successful cure.

According to the report, approximately 20% of TB cases globally are estimated to be resistant to at least one of the first- or second-line anti-TB drugs, and 5% are resistant to both isoniazid and rifampicin, the most powerful and commonly used antibiotics in first-line treatment.

Five years back, TB reemerged as one of the biggest public health challenges in India when Hinduja Hospital's Dr Zarir Udwadia found that some of his patients had totally drug resistant TB. The vision of NSP is a TB-Free India.

The mortality rate is extremely high at around 40% for patients with MDR-TB and 60% for patients with XDR-TB.

As many as 81,482 cases of TB among children were detected in 2012, accounting for seven per cent of all TB cases in the country, as per a national report titled "TB in India".

Until recently, it was thought that drug-resistant strains of TB were less transmissible, and that drug-resistant strains were mainly acquired as a result of poor treatment compliance.

Beyond this, we need new investments in research on a range of pathogenic mycobacteria-not just M. tuberculosis-as well as new investments toward the development of field-ready and affordable diagnostic and drug-resistance tests.

Multi-drug resistant tuberculosis reflects the meeting of an ancient and under-addressed disease - tuberculosis - with an emerging modern threat - antimicrobial resistance.

People with active TB can infect 10 to 15 other people through close contact over the course of a year. "What we are now doing is house to house campaign and screening of people for TB and we are now working in 187 slums in Nigeria", he said. Strict adherence to the regimen, especially in low-income settings, can be hard.

But without improved efforts to control the spread of the disease the drugs could be worthless. This is known as secondary transmission. "A high proportion, nearly 92% of TB patients with HIV has been put on antiretroviral therapy, Shri Nadda added".

Take a recent study on drug-resistant TB in South Africa in the New England Journal of Medicine. Even in patients who are identified, TB or MDR-TB is often diagnosed and treated late. It is imperative to engage with private sector and community based care providers to improve early notification, treatment adherence and outcome for TB patients.

"Despite some progress in the pipeline for new diagnostics, drugs and regimens, and vaccines, TB research and development remains severely underfunded". Globally, TB in 2015 surpassed HIV as the leading killer.

@ Introduce newer rapid diagnostics and point-of-care tests for TB.

In addition to M. bovis, several other species of zoonotic mycobacteria can cause TB in livestock and wildlife, but we do not know much about the risk these pathogens pose to humans. People nearby may breathe in these germs and become infected, and subsequently develop active disease. Thus, reliable and uninterrupted access to TB treatment is crucial for curing the sick, but it is also of utmost importance for protecting the community from infection and preventing the emergence of further drug resistance. Particularly, students living in hostels sharing space with others, travelling daily in crowded public transport, living in houses with inadequate ventilation and congested cities are all highly prone to catch the TB infection.

Screening involves either a blood or skin test, to determine if latent TB is present. Only one in 10 Indians infected will develop TB disease in their lifetime.

Socio-economic factors such as the stigma against tuberculosis also cause a small number of patients to fail to complete their treatment, increasing the likelihood of drug resistance. "But it's also possible that we could start to use the tools we have...to really reverse the epidemic".

The fourth multidrug-resistant tuberculosis (MDR TB) conference will be held at the University of Cape Town (UCT) this weekend. A tremendous influx of resources to meet that epidemic, Dowdy explained, led to better treatment, infection control, and case findings, all of which generated a 67% drop in incidence over 5 years.

Past year alone approximately 30,000 Zimbabweans were diagnosed with TB. This is important not only to ensure appropriate patient care, but also to safeguard the continued effectiveness of existing medicines against the development of further drug resistance.

  • Joanne Flowers