India has a high prevalence of TB with an annual incidence of 28 lakhs or 27% of the total global TB incidences.
Hence, India is currently the TB capital of India and to outsmart the disease, India must intercept - infection, progression and transmission.
What is TB?
Tuberculosis (TB) is a disease caused when one gets infection with TB bacilli.
It has the unique character of mimicking other diseases and hence confuses doctors, which delays diagnosis and further treatment.
Notably, the common symptom associated with Cough and blood in sputum occurs only in lung TB and there are others like Brain TB, Pelvic TB etc...
TB can affect the lungs, brain, bones, joints, the liver, intestines or for that matter any organ and can progress slowly or kill in weeks.
There are 3 distinct stages in TB -infection, progression, transmission.
Infection - Infection occurs when TB bacilli are inhaled and the Bacilli may stay in the lungs or travel to other organs.
Once infected, the bacillus persists lifelong inside an organism’s body, but lies dormant - This phase is “latent TB”.
This can be diagnosed by a ‘Tuberculin Skin Test’ (TST) and cumulatively, 40% to 70% of us are estimated to be living with latent TB.
Progression - From this dormant bacterium pool, a few germs slowly lead to the progression of disease in a time span of anywhere between 5 – 30 years.
Hence, the TB disease sets in only when bacilli become active and starts multiplying, and this phase is called “active TB”.
Transmission - Only when active TB affects the lungs do bacilli find an exit route to the atmosphere, which is the only mode of transmission.
What is the current status of TB in India?
The incidence rate of tuberculosis (TB) in India is estimated at 200-300 cases per lakh population per year, whereas it is only 5 per lakh in Europe.
Revised National TB Control Programme (RNTCP) provides for free diagnosis and treatment, but it doesn’t track incidences and there are no targets.
Estimates are that every day 1,200 Indians die of TB, a calamity rate unrivalled by any other disease and a clear indication that control efforts are failing.
Hence, this calls for a more robust and specific health interventions to foster a deliberate reduction of incidence to as low as practicable.
What are the challenges?
While curative treatment is the patient’s urgent need, it will not control the spread of TB as germs already gets spewed due to delayed diagnosis.
As cough is a very common symptom, TB isn’t suspected until other treatments have failed, which delays targeted treatment.
Inclination to self-medication thought pharmacies, where patients don’t see a doctor until thing get complicated is another worry in India.
Additionally, according to RNTCP guidelines, testing is done only after two weeks of consistent cough, which results in the loss of precious lead time.
Also, 70% of people seek treatment in the private sector and as the mandatory reporting system for TB isn’t rigourous – incidences might be underestimated.
Hence, strengthening public-private sector health partnership and establishing efficient primary health care services is essential for early diagnosis of TB.
What is the way forward?
Dealing with TB requires mass initiatives - health professionals, policy planners and administrators and the public must come together to solve it.
Prevention - Public education on TB and its prevention must replace ignorance and misconceptions that are presently prevalent.
While dealing with the disease after onset is difficult, it is easier prevent transmission and infection by healthy public etiquettes.
TB cases can be greatly reduced if basic health sensitiveness of not spitting in public and “mouth covered cough and sneeze practices” are adopted.
Notably, a person with “Lung TB” disseminates TB bacilli over several weeks and by the time dissemination stops, it would’ve already affected many others.
To block transmission, treatment should begin as soon as symptoms show up, which will effectively bring down incidences.
Treating latent TB - Drug treatment of “latent TB” is an option and it has been recommend for all children in the 5-10 age group to be screened for TST.
Treatment of latent TB will prevernt its progression to active TB and consequently bring down the “Annual Risk of Tuberculous Infection” (ARTI).
While these will take as much as 2 to 3 decades, this is the only way to acheieve sustained reduction of TB incidences and a start has to be made now.
Any further delay can be catastrophic as the TB microbes are increasingly becoming multi drug resistant.
