March 24 was World TB Day and on this occasion here's an interview with Ms. Karishma Sadan, Program Assistant of Global Health Strategies, New Delhi, on the subject. Of late, drug resistant TB (DRT) has been in the news giving cause for concern for all since we live in over-crowded metros. People living in over-crowded cities like Bombay are worst affected because people spit without looking. You never know when the man sitting in a bus or a man standing on the road would turn around and spill deadly Tuberculosis virus at you.
Why is India leading in the spread of TB, is it because we spit so often, indiscriminately?
We seem to lack what is known as 'cough etiquette'. In the case of TB it is essential for one to cover his/her mouth when coughing to prevent the spread of infectious germs and of course spitting does not help.
What is drug resistant TB? How far is it prevalent in India?
These forms of TB include Multi-Drug Resistant (MDR), Extensively Drug Resistant (XDR), Extremely Drug Resistant (XXDR) and Totally Drug Resistant (TDR) TB. The latter two terms have not been recognized by the WHO yet.
MDR-TB is caused by TB bacilli resistant to at least isoniazid and rifampicin, the two most powerful anti-TB drugs. This means that two or more first line drugs are ineffective in treating MDR-TB.
XDR-TB is defined as resistance to at least isoniazid and rifampicin, and to any fluoroquinolone, and to any of the three second-line injectables (amikacin, capreomycin, and kanamycin).
The recent reporting (January 2012) of 12 cases of TDR TB at Mumbai's Hinduja Hospital has created quite a panic as researchers suggest that the patients are resistant to all known TB drugs. The National Programme has suggested that these are not cases of TDR-TB rather they are cases of XXDR-TB which stands for extremely drug-resistant TB as against XDR and MDR versions. The term TDR-TB has been used by local investigators.
The annual incidence of MDR-TB is estimated at 99,000 cases according to the WHO Global TB Report.
Why is there such social stigma attached to TB?
There is ignorance, a lack of awareness and at one point in time this disease was associated with the lower socio –economic classes. It was considered to be a disease which spread in unhygienic conditions. Although now we see that TB affects people from all sections of society.
Free TB drugs made available by government are not available in hospitals. Why?
Free TB drugs are supposed to be available at all government hospitals. Free TB drugs are for all, although sometimes patients turn to the private sector where they might be charged for the drugs. In some cases there is a lack of monitoring which is why the drugs are not available.
What's India's expenditure in TB control?
The direct and indirect costs of TB stand at $23.7 billion annually. (RNTCP Status Report 2011)
How many children die due to TB?
TB kills close to 280,000 men women and children each year in India.
What is the ratio of adult to children when TB deaths are concerned?
Exact figures are not known.
What new research has been initiated into finding a definite cure for the disease?
New research is being carried out to develop a vaccine for this disease. For more info: http://articles.economictimes.indiatimes.com/2012-03-15/news/31197181_1_effective-vaccines-tuberculosis-tb