Every minute someone dies of TB in India. More than a 1000 die everyday. More than 500,000 die every year. If there is no effective action, five million may die of TB in the next few years. Dr L S Chauhan, Director General(TB) at the Ministry of Health and Family Welfare says that there are around 1.8 million new cases every year. India has the highest burden of the disease in the world.
As TB is widespread and contagious, everyone is at risk. Tomorrow, it could be me. Or you. TB today kills more people than any other infectious disease in India. One out of every two adults is infected with the tuberculosis bacilli. According to the World Health Organization, 28 people out of every lakh are dying due to TB. India has over thirty per cent of the worlds tuberculosis patients. It is not just the death figures that are startling. TB can whip up a huge economic loss. The annual economic cost of tuberculosis to the Indian economy is at least US$ 3 billion (more than Rs.13,000 crore).
Starting January 2007, India is conducting its second large-scale countrywide study called the Annual Risk of TB Infection aiming to cover over three lakh children to check for early transmission of the disease. It will take atleast two years and will be conducted by the Tuberculosis Research Centre, Chennai and the National Tuberculosis Institute, Bangalore.
It is a frightening scenario. Bangladesh, India, Indonesia, Myanmar and Thailand contribute more than 95 per cent of the cases in South East Asia. India has the highest number of cases followed by China. Indonesia and Bangladesh.
More than 100,000 Indian women suffering from TB are rejected by their families.
The HIV epidemic and the spread of drug-resistant strains of tuberculosis threaten to make the tuberculosis epidemic even more lethal. It will become very expensive to control.
The HIV epidemic will increase tuberculosis cases by at least 200,000 each year in India. If HIV spreads more rapidly, tuberculosis may become uncontrollable for at least a generation.
Continuous proper treatment for six months can virtually cure all TB patients.
Countries implementing effective TB control have cut TB deaths by 80 per cent in three years and cases by 50 per cent in eight years.
TB in India has not got the attention it deserves in part because it has mainly affected the poor. The usual victims are migrant labourers, slum dwellers, residents of backward areas and tribal pockets. In that sense, it is not yet a fashionable disease like AIDS that has hit the rich too. Second, TB is such a silent killer. No wants to admit it. Many doctors if quizzed will tell you that AIDS is the biggest killer. Indians still are not aware that TB is a grave threat. TB has few champions or advocates unlike say AIDS or cancer. Unless there are icons like Shabana Azmi or Rahul Dravid talking about it, it is likely not going to catch public imagination.
Adding to the problem is the fact that reporting of the disease is poor and many patients are not immediately treated when they are identified because of poor health services. So, they are potential dangers to others as they spread the disease wherever they go. A diseased person just has to cough in a bus for numerous passengers to soon contract the disease.
Multidrug Resistant TB - a death warrant
On the face of it, we do not need to fear TB, as it is curable. But one of the biggest challenges for TB control has been its cure. Presently, it is too cumbersome, long winding and expensive. Hope of new research breakthroughs is nowhere seen on the horizon.
But what we must be virtually paranoid about is the multi-drug resistant tuberculosis that is resistant to the powerful anti-TB drugs- isoniazid and rifampicin. Treatment of MDRTB is extremely expensive, toxic, arduous, and often unsuccessful. This strain of TB is slowly tightening its deadly grip on India. It is almost impossible to cure. It is gathering root, because TB patients often do not take the full course of treatment, as it is cumbersome. Consequently, this helps the bacteria rejuvenate, learn how to neutralize the drug and survive. The result: The bacterium thrives and when the drug is administered again, it is ineffective.
Multidrug-resistant TB has the potential of returning humanity back to a point in time where TB infection was akin to a death sentence. Multidrug-resistant tuberculosis is a direct sign of poor programme performance.
The cost of treating a multidrug resistant TB patient is almost 100 times more than a normal TB patient. In developing countries most of these patients die. Though reliable figures are unavailable on the spread of the multidrug resistant strain, estimates put it at 50 million patients. As multidrug resistant TB is bound to be a big threat, the only way out is a vaccine which seems remote as it may take many years of research.
DOTS can arrest TB
Is there a way out? With the World Health Organization coming out with a powerful and effective multi drug formulation, there is hope. It is called DOTS which means Directly Observed Treatment-Shortcourse. DOTS if done properly can prevent the multidrug-resistant tuberculosis.
DOTS simply means that the doctor or health worker will supervise the patient consuming the pills all through the treatment course. The idea is to ensure that the patient consumes the medicine the way it should be taken, completes the course and consequently gets completely cured.
The key to controlling TB is rapid detection by an effective framework and then implementation of DOTS by dedicated doctors and health workers.
According to the Global TB Report 2003, two-thirds of the additional sputum positive cases reported under DOTS in 2001 was found in India. In 2002, over 620,000 cases were placed on treatment of which nearly 250,000 were new smear positive cases. In the year 2003, it was 900,000 cases. In 2004, it was 1100,000 cases. In 2005, it was 290,000 cases that were more than any other country. By June 2006, more than 5.8 million patients were initiated on treatment, saving more than a million additional lives. The success of DOTS in India will determine the success of TB control in the world.
Prevention is the key. TB does not affect everyone it infects. But if your immune system is weak, you are an easy victim.
In India, TB can be arrested with better nutrition building up weak immune systems, better indoor air quality, cleaner kitchens replacing fossil fuels with gas and so on. Many houses are ill ventilated especially in rural India where smoke from the kitchen adds to the poor indoor air quality all through the day. If you have unclean indoor air, the immunity of your lung is much lower allowing TB to get the better of you. If your immune system is weak, you are an easy victim. If windows are open for cross ventilation and the air is cleaner, there are greater chances that your lung will not be pressured as much and you will have better immunity.
TB can also be controlled by early detection, ensuring that each patient takes the full dose and does not get re-infected. Identify the affected person and keep the person out of range so he or she does not spread the disease. (Concluded in part II.)