Tuberculosis
TB is caused by a bacterium called Mycobacterium tuberculosis, belonging to the Mycobacteriaceae family consisting of about 200 members.
Some of Mycobacteria cause diseases like TB and Leprosy in humans and others infect a wide range of animals.
In humans, TB most commonly affects the lungs (pulmonary TB), but it can also affect other organs (extra-pulmonary TB).
TB is a very ancient disease and has been documented to have existed in Egypt as early as 3000 BC.
TB is a treatable and curable disease.
Transmission
TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air.
Symptoms
Common symptoms of active lung TB are cough with sputum and blood at times, chest pains, weakness, weight loss, fever and night sweats.
Global Impact of TB
In 2019, 87% of new TB cases occurred in the 30 high TB burden countries.
Eight countries accounted for two thirds of the new TB cases:
India, Indonesia, China, Philippines, Pakistan, Nigeria, Bangladesh and South Africa.
India reported 1.8 million TB cases between January and December 2020 as compared to 2.4 million the year before.
In 2019, MDR-TB remained a public health crisis and a health security threat.
MultiDrug Resistant Tuberculosis (MDR-TB) is a strain of TB that cannot be treated with the two most powerful first-line treatment anti-TB drugs. Extensively Drug Resistant Tuberculosis (XDR-TB) is a form of TB caused by bacteria that are resistant to several of the most effective anti-TB drugs.
BCG Vaccine
BCG was developed by two Frenchmen, Albert Calmette and Camille Guerin, by modifying a strain of Mycobacterium bovis (that causes TB in cattle). It was first used in humans in 1921.
In India, BCG was first introduced in a limited scale in 1948 and became a part of the National TB Control Programme in 1962.
In addition to its primary use as a vaccine against TB, it protects against respiratory and bacterial infections of the newborns, and other mycobacterial diseases like Leprosy and Buruli’s ulcer.
It is also used as an immunotherapy agent in cancer of the urinary bladder and malignant melanoma.
One intriguing fact about BCG is that it works well in some geographic locations and not so well in others. Generally, the farther a country is from the equator, the higher is the efficiency.
It has a high efficacy in the UK, Norway, Sweden and Denmark; and little or no efficacy in countries on or near the equator like India, Kenya and Malawi, where the burden of TB is higher.
Related Initiatives
Global Efforts
The WHO (World Health Organisation) has launched a joint initiative “Find. Treat. All. #EndTB” with the Global Fund and Stop TB Partnership.
WHO also releases the Global Tuberculosis Report.
India’s Efforts
National Strategic Plan (NSP) for Tuberculosis Elimination (2017-2025), The Nikshay Ecosystem (National TB information system), Nikshay Poshan Yojana (NPY- financial support), TB Harega Desh Jeetega Campaign.
Currently, two vaccines VPM (Vaccine Projekt Management) 1002 and MIP (Mycobacterium Indicus Pranii) have been developed and identified for TB, and are under Phase-3 clinical trial.
On World Tuberculosis (TB) Day 2023, Prime Minister Narendra Modi addressed the One World TB Summit in his parliamentary constituency Varanasi.
Each year, the World TB Day is celebrated on March 24 and the theme of this year’s World TB Day is ‘Yes! We can end TB!’.
How Many Cases of TB Are Found In India
India accounts for 28% of all TB cases in the world, according to the Global TB Report 2022.
The government’s Ni-kshay portal reported 3 lakh TB cases in 2021 as compared to 18.05 lakh cases in 2020.
The numbers are still lower than the 04 lakh cases reported before the covid pandemic in 2019.
The incidence of TB, i.e., new cases detected throughout the year, reduced by 18% in 2021 over the 2015 baseline, dropping to 210 cases per lakh population as compared to 256 cases per lakh population.
A survey conducted across 20 states pegged the incidence at a higher 312 cases per lakh population.
The incidence of drug-resistant TB also went down by 20% during the period from 1.49 lakh cases in 2015 to 1.19 lakh cases in 2021.
What Are The Reasons For High TB Incidence In India
Most Indians still do not know the symptoms of TB, and doctors rarely order enough TB tests, while a staggering one million cases remain unreported in India.
The accurate, reliable and affordable diagnostics and testing both for drug-sensitive and drug-resistant remain inaccessible to most of the India’s population.
The Nikshay Poshan Yojana, faces gaps in implementation, and its amount for support - a mere Rs 500 remains inadequate for the TB-affected patients.
It aims to support every TB Patient by providing a Direct Benefit Transfer (DBT) per month for nutritional needs.
What Are The Improvements in Treatment Protocols
Newer drugs such as Bedaquiline and Delamanid for the treatment of drug-resistant TB have been included in the government’s basket of drugs provided free of cost to the TB patients.
These oral drugs could replace the injectable kanamycin that was associated with serious side effects like kidney problems and deafness.
These new drugs have also been included in the new National List of Essential Medicines that gives the government power to regulate their market price as well.
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