World TB Day, Imagine a TB-free India - Times of India
Tuberculosis (TB) is as old as humans. It is at least nine thousand years old and is the third oldest disease known to humans. It is the deadliest infectious disease. And is the ninth deadliest disease today.
TB is treatable. United Nations has set the goal to end the TB epidemic, that is to reduce TB deaths by 90% and TB incidence by 80%, by 2030. But India has set the goal to eradicate TB from the country by 2025.
What is TB, what is its prevalence rate, what is its treatment, and what needs to be done to eradicate it.
What is TB?
TB is a serious bacterial infection which can be life-threatening if not treated. Mycobacterium tuberculosis bacterium causes it. TB usually affects the lungs. But can also affect other organs and tissues such as lymph nodes, spine, brain and nervous system, kidneys and urinary tract, bones and joints, gastrointestinal tract, and less commonly the skin, eyes, and ears.
TB usually spreads through the air when an infected person coughs, sneezes, or talks. An infected person can have latent TB, that is have TB bacteria that lie dormant in the body. A person with latent TB is not contagious. However, if the immune system is weakened, latent TB can become active. And the person develops symptoms and becomes ill and contagious. Most people with latent TB never develop active TB.
TB and Women
Because of hormonal differences that affect immunity, women are more prone than men to develop TB disease. Also, women with HIV are at a higher risk of TB disease than men with HIV.
TB can spread to women's reproductive system and can cause infertility or complications during pregnancy. Some TB medications can be harmful to fetus. So, only the medications that are safe for the fetus can be used. This restricts the treatment options.
Women and healthcare providers must be made aware of these issues.
TB Prevalence
In 2020, TB infected about ten million and killed about 1.4 million people globally. India had about 2.5 million TB cases, that is 27% of the global TB cases, and 421,000 TB-related deaths in 2020.
History of TB Treatment
Effective treatment for TB was not developed till 1900 CE. In 1800 CE, the popular treatment was nutritious diet, rest, and fresh air. TB patients were isolated in sanitoriums to prevent TB's spread in the community.
On 24 March 1882, a German physician, Dr Robert Koch, announced the discovery of Mycobacterium tuberculosis, the bacteria that causes TB. For that discovery, he was awarded the Noble Prize for Medicine in 1905. And in 1982, one hundred years after that discovery, 24 March was designated World TB Day.
In the fall of 1909, German physician, Nobel laureate Dr Paul Ehrlich, discovered the magic bullet, the drug Salvarsan that could kill specific microbe without harming the body. Salvarsan was effective against TB but was not much used because it had serious side effects. In the 1940s and 1950s, several other drugs were developed that helped to dramatically reduce TB mortality rates. However, in the 1980s and 1990s drug-resistant TB strains emerged to challenge the TB treatment.
Current TB treatments
The current treatment for TB depends on whether TB is drug-susceptible or drug-resistant.
For drug-susceptible TB, antibiotics are taken for six months.
Treatment of drug-resistant TB often requires a combination of second-line antibiotics. But these are less effective and have more side effects. Treatment can take up to two years or longer.
Full course of TB treatment must be completed even if symptoms improve or disappear earlier. Not taking full course of treatment can result in drug-resistant TB.
TB patients also need good nutrition, counselling, and social support. Bacille Calmette-Guérin (BCG) vaccine can prevent TB in some cases.
Research is ongoing to develop new drugs, especially to target drug-resistant strains of TB, and to develop shorter and more effective treatment regimens.
Eradicating TB
Tuberculosis is a disease of poverty, but it knows no social or economic boundaries. – Phil Loper
TB cannot be eradicated by health system alone. Because TB has many social determinants such as poverty, poor living and working conditions, undernourishment, marginalisation, and migration. Political commitment at the highest level is needed if TB is to be eradicated.
At the global level, the UN High-Level Meeting on TB at the General Assembly in September 2023 will bring together Heads of State to discuss how to mobilize political and social commitment to eradicate this ancient diseases.
At the country level, India's President Smt Droupadi Murmu launched the Pradhan Mantri TB Mukt Bharat Abhiyaan on 09 September 2022.
On 24 March 2023, Prime Minister Narendra Modi reiterated at the World TB Summit at Varanasi India's resolve to eradicate TB from the country by 2025. He said that additional labs have been set up for free TB screening. And free TB treatment will be given through the Ayushman Bharat Yojna.
Conclusion
TB is preventable and curable. The first step is to make people aware of the cause and treatment of the disease. The second step is to offer preventive treatment by curbing the social determinants of TB and by offering vaccination. The third step is to offer free TB screening and testing at labs with rapid molecular diagnostics and tests. Fourth is to make treatment available to the needy by giving it free or providing financial support for it. Fifth is to invest in research and innovation to develop shorter TB treatment regimens and digital tools to improve health outcomes.
Millions of lives can be saved with a firm political and social commitment to eradicate the TB scourge.
Disclaimer
Views expressed above are the author's own.
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