The long fight against TB

The long fight against TB

Context

Fight against TB

What is the rate of incidence of TB in India?

The incidence rate of tuberculosis (TB) in India is estimated at 200-300 cases per 100,000 population per year. As a comparison, in Western Europe it is five per 100,000 per year

Situation in India

• India’s estimated annual TB burden is 28 lakh, 27% of the global total; our population is only 18%
• Every day 1,200 Indians die of TB — 10 every three minutes

What are the processes that need to be kept in mind while designing programmes for TB control?

In designing TB control three processes must be understood:

• Infection
• Progression
• Transmission

When does an infection occur?

Infection occurs when TB bacilli are inhaled

• Latent TB: Bacilli may stay in the lungs or travel to other organs. Infection is lifelong, with bacilli lying dormant. This phase is “latent TB”, diagnosed by a tuberculin skin test (TST). Cumulatively, 40% to 70% of us are living with latent TB
• Progression to TB disease: From this reservoir pool, a few progress to TB disease, one by one, 5-30 years, average 20 years, later

When does progression happen?

Progression occurs when bacilli become active, multiply and cause pathology; now we have “active TB”. Only when active TB affects the lungs do bacilli find an exit route to the atmosphere, necessary for transmission

How can progression be stopped?

The biomedical method is drug treatment of latent TB

• Experts recommend an age window of 5-10 years when all children must be screened with TST; those with latent TB must be treated to prevent progression
• We should get annual data on ARTI (annual rate of TB infection) to track the decline. A yearly 5% reduction of ARTI is achievable. In 20 years we can be on a par with Western Europe in terms of infection incidence. Active TB will also decline, but more slowly

What should be done in India?

• Public etiquettes: If no one spits in public places and if everyone practises cough and sneeze etiquette (covering one’s mouth and nose when coughing or sneezing), the TB affected will also do the same
• Begin treatment early: As per RNTCP (Revised National TB Control Programme)  guidelines of testing only after two weeks of cough result in the loss of precious lead time and aids the spread of infection too. To block transmission, treatment should begin as soon as a symptom shows up
• Partnership with the private sector is essential for early diagnosis of TB. Delay in diagnosis, is a result of the lack of efficient primary health care
• Universal primary health care, a basic human right, and a diagnostic algorithm for early diagnosis are essential for TB control. Every country that has reduced TB incidence practises universal health care

Conclusion

Author concludes by stating that our only chance of stopping TB lies in a concerted use of all interventions ie both biomedical and socio-behavioral