Tuesday, 24 March 2009


“The greatest wealth is health.” - Virgil

March 24th is World Tuberculosis Day and it is observed each year so as to continue spurring on the global fight against tuberculosis (TB). TB is a “forgotten” disease by many people living in Western countries as it has a relatively low incidence there and most people with it are treated early and effectively. However, in developing countries, TB is getting deadlier by the day due to its growing drug resistance and the fatal connection between TB and AIDS.

In many third world countries TB is a common and dangerous infectious disease and is caused by the bacterium Mycobacterium tuberculosis. Although TB affects the lungs in most of the cases, the disease can also affect almost any other body system. Symptoms of TB include a chronic cough productive of sputum and blood, weakness, fever, night sweats and weight loss. Two hundred years ago, tuberculosis was one of the most feared killer diseases. One hundred years ago, people with tuberculosis were placed in sanatoria in order to prevent TB from spreading from one person to another and to help cure the sufferers through good diet, and rest.

A vaccine against tuberculosis, the BCG vaccine, which was developed in the early decades of the twentieth century was widely used for several decades in many countries around the world. This was never a very effective vaccine and provided limited protection to the infection. However, the vaccine together with improved public health measures, better diet and antibiotic treatment the disease was controlled in Western countries.

With the discovery of better, specific antibiotics, TB was controlled and for a time was all but eliminated. But with the emergence of HIV over the last 25 years, TB has returned and must be dealt with. In some parts of the world, HIV and tuberculosis are at epidemic proportions. The most current tuberculosis statistics are quite frightening:

• Over 400,000 cases of Multi Drug Resistant TB (MDR-TB) are reported across the world every year with more than 100,000 estimated deaths
• 80,000 MDR-TB cases from India each year
• 64% of the TB patients are women
• Up to 80% of TB patients test positive for HIV/AIDS in countries with high AIDS incidence

MDR-TB is posing a challenge to modern medicine because of its resistance to two of the first line drugs which in the past were used effectively to cure TB (rifampicin and isoniazid). This drug0resistant form of the disease is caused by the spontaneous mutation of the bacteria on treatment. More serious is the XDR-TB (eXtensively Drug Resistant TB that is also resistant to fluoroquinolones and to the injectibles, Kanamycin, Capreomycin and Amikacin).

MDR-TB and XDR-TB are the biggest health hazards for people living with HIV/AIDS. With the social stigma attached to AIDS, detecting TB becomes doubly difficult. In developing countries like India patients stop medication for the following reasons: migration, alcohol, drug addiction, and sometimes due to violent side effects like vomiting that discourage the patient from further medication. Sometimes treatment is stopped after a couple of months, when the symptoms subside. Directly Observed Treatment, Short Course (DOTS) providers regularly track TB patients and encourage them to continue with the treatment till they are completely cured.

The World Health Organization (WHO) encourages governments and health departments to develop programs where the coordinated efforts by Health Care Providers, families and patients can help to completely eradicate TB. Health departments can organise effective campaigns to inform people about TB control and DOTS with a view to increase self-referral and facilitate detection of TB cases. They can enable patients (more so the vulnerable and marginalized ones such as women and transgender people) to access DOTS and other TB services. Also, it is vital to assure the quality of TB services provided in public or private enterprises.

There is crying need to stop the spread of TB and cure existing cases. The spread of drug resistant strains must be checked and a it is vital that a worldwide effort is renewed to seek new approaches, strategies and tools such as new TB vaccines for people of all ages, to protect against all forms of TB. With a number of global initiatives for new drugs and diagnostic tools along with broad community participation to eradicate TB, a world free of TB is a dream that can be realised.

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