Is Tuberculosis Eradication An Attainable Dream

By Dr Nivetha S

TUBERCULOSIS – AN INTRODUCTION:

Housefull in the theatres of Science among scientists for 100 long years and we still doubt if the Immortal king of Disease can be put to death to save lives of lakhs of people. He roars that he can never be underestimated for his size. Never an exaggeration but the threat he had given worldwide is immense and his widespread impact over almost all organ of humans and his cruelty on all spheres of life , still leaves us unanswerable to the dreams of Tuberculosis Eradication .

Dr. Koch might have never thought that you would survive this long , Sir. ”Mycobacterium Tuberculosis”.

THE GLOBAL BURDEN-THE PLOT:

One third of every one of us are infected asymptomatically by Tuberculosis and 5-10% of us come up with clinical disease in our lifetime which accounts 0.5-2% in high burden countries like India , Nigeria, Indonesia, Pakistan and Philippines . Duh! The developing countries. Globally 7.1 million new cases are notified in 2019 and 2.9 million still underreported.

The burden of the disease isn’t in mere numbers but in other spheres also. The number of Rifampicin or multi drug resistant cases are at stake. Almost 10% of total TB load is found in children. The acquired drug resistance in spite of short course chemotherapy is high. Poverty , Economic recession, Malnutrition, Overcrowding, Indoor air pollution, Tobacco, Alcohol abuse and diabetes makes population more vulnerable to TB. Moreover, Human migration didn’t leave behind the uninfected communities also.

Come on , Lets walk through the Warfield of Tuberculosis to know its reign of terror in detail .

DRUG RESISTANCE-THE ANTAGONIST:

The contribution of drug resistance to the global burden of Tuberculosis is huge. Either the individual is affected by drug resistant bacilli or the sensitive drug becomes resistant during the course of treatment.

The inadequate regimens, inadequate supply and quality of drugs, irregular and incomplete drug intake from patient side are the lead contributes for the development of Multi Drug Resistant Tuberculosis (MDR-TB). Either the reliable drug resistance surveillance system or the labs for conducting quality assured second line drug susceptibility test is available in India. The cost of second line drugs as like 30 times as much as in non-resistant Tuberculosis. The isolation and hospitalisation adds to the cost of treatment.

To limit the spread of MDR-TB, the countries can develop National Emergency response plans for MDR and XDR TB, conduct rapid surveys, expand lab capacity, implement infection control precautions , promote universal access to ART , establish capacity for Clinical and Public health managers and increase the funding for research .

HIV - THE PARTNER IN CRIME:

HIV downgrades body’s natural defences , accelerates the speed at which TB progresses from a harmless infection to a life threatening situation . It is perfect partner in crime as it increases the risk of being newly infected , recurrence and reactivates the latent Infection. The diagnosis is challenging because HIV positive people have higher frequency of sputum negative smears , tuberculin skin test fails to work , chest radiography shows less cavitation and cases of Extra Pulmonary TB is more common . Measures like HIV screening at Microscopy centre , expanded clinical algorithm and early case detection and care had to be carried out.

“The biggest today isn’t leprosy or TB but rather the feeling of being unwanted “-said Mother Teresa. Yes , The people suffer additional discrimination and its high time to make them understand that TB is curable and not infectious after few weeks of treatment .

DIABETES- THE VILLIAN FROM DOWN SOUTH :

Diabetes is an independent risk factor for TB from South India. There is 2-3 times higher risk of progressing from Latent to active TB and subsequently possess higher risk of relapse and death. Collaborative acts to improve diagnosis via screening , joint monitoring and evaluation are to be carried out to better the outcome .

TOBACCO- THE THRILL THAT KILLS :

“The biggest lie of smoking is believing it gives us an intrinsic pleasure”. Is it not ? But , the tobacco causes disturbances in the bronchial surface of the lung and weakens immune system, thus increasing the risk of TB infection ,relapse , outcome ,drug resistance and mortality rates by 3-4 times . “Every breath counts“, is what I would like to remind here.

COVID 19 - THE CAMEO VILLIAN :

The COVID 19 threatened to reverse the progress made towards global TB targets.In the absence of mitigation strategies such as social protection and health insurance , severe economic contractions and loss of income worsened the Tuberculosis . The TB notifications fell, out patient and in patient care was compromised due to fewer health facilities and hospitals .The NTP staff , gene expert machines and funding was reallocated .To revive back the pace, continued access of treatmentcan be facilitated by home delivery of Anti TB drugs , nominate a household member to collect Anti TB drugs , expand remote advise and support using digital technologies.

ECONOMIC AND SOCIAL BURDEN:

"Tuberculosis is the disease of the poor". Poverty and Tuberculosis is a viscious cycle . “I saw Poverty loading its pistol with Tuberculosis to shoot humanity on the forehead”-said Assa’ady. The main victims of Tuberculosis include migrant workers, slum dwellers, residents of backward areas and tribal pockets.

Tuberculosis targets the most productive years of human lives. In females, the reproductive age group is affected and it's the main cause for female infertility. Assessing the safety, tolerability, and long-term treatment outcomes of pregnant and postpartum women with tuberculosis are lacking, particularly for HIV-positive women on ART. The benefits of treatment during pregnancy, however, outweigh the risks.

" I was a sickly child, contracting Tuberculosis at the age of five " Said Dinah Steridon. Around 3 lakh children leave school and take employment to help and support their families.

The variety of patients possessed challenge to set standard tuberculosis case and WHO has come up with the same that applies to all- Smear positive, smear negative, extra pulmonary, drug resistant and HIV associated Tuberculosis.

DOTS-STOP-END TB:

For the past two decades, national and international efforts in TB prevention, diagnosis and treatment have been guided by DOTS strategy (mid-1990 until 2005) and subequently by the Stop TB Strategy (2006-2015).

End TB Strategy ( introduced in May 2014 by World Health Assembly ) were reaffirmed and new ones added.Its actively driving down TB deaths, incidence and eliminating catastrophic costs . Global targets for funding to be mobilized for TB prevention, care and research, and for the number of people to be treated for TB infection and disease, were set for the first time.

CONCLUSION:

"What makes TB a compelling issue to me is it's universality and that it remains persuasive despite so many years of efforts. " Said Dr James Allen and true that! Despite all the measures taken, it's remaining as a grave challenge for us to eradicate from our community.In a nutshell, Eradicating Tuberculosis is an achievable dream tomorrow , but a grave challenging dream for today.

By Dr Nivetha S