Tuberculosis: 70% of cases occur in age group of 15-54 years

World Tuberculosis Day, which is marked every year on March 24, commemorates Dr Robert Koch’s discovery of Mycobacterium tuberculosis, the bacillus that causes tuberculosis (TB). It was on this day that the German scientist and physician announced his discovery in 1882 in Berlin. The event, which aims to raise awareness about the lethal and infectious disease amongst the public, also marks 131st anniversary of Dr Koch’s historic finding. The theme for this year is “Stop TB in My Lifetime”, which is the second year to run the same theme. On the occasion of World Tuberculosis Day, Dr Gangadhara Goud, MBBS, MD, Community Medicine (Public Health /PSM), Professor and Head, Dept of Community Medicine, Vijayanagara Institute of Medical Sciences, Cantonment, Bellary, Karnataka, in an exclusive interview with Salome Phelamei of Zeenews.com, spoke on how to prevent the contagious lung disease in view of the situation being further worsened by the threat of drug-resistant TB, thereby complicating the treatment. Dr Gangadhara is working as External Monitor for IPPI (Intensive Pulse Polio Immunization Programme) (WHO) since 1995, and as Coordinator for immunization coverage (UNICEF). He was selected for WHO International Fellowship for the year 2010-11 in Public Health Informatics at CDC, Atlanta, USA. Apart from various field experiences, he has also worked as MCI inspector for recognition of PG degree in Community Medicine. He has been awarded “Rashtriya Gaurav Award” for the year 2010-11 by the India International Friendship Society in recognition of his services in the field of Public Health, “Glory of India 2011, Gold medal” by International Institute of Success Awareness, and “Best citizen award 2011” by International Publishing House. Tuberculosis and its types: TB is an infectious disease caused by bacteria Mycobacterium tuberculosis. Types are: i) Pulmonary, in which affected parts are lungs.

ii) Extrapulmonary, in which other parts of the body are affected for ex: abdominal organs, lymph nodes and meninges etc Which age group is most vulnerable to TB? What can be done about it? In India about 70% of the cases occur among the age group of 15-54 years (most productive age group), whereas in the developed countries, elderly people are affected more. Nearly 60-65% of newly diagnosed cases are males. To prevent the spread of disease- Early diagnosis and prompt treatment of cases is the best option. Sputum should be disposed hygienically. Indiscriminate spitting of sputum should be avoided. TB is a transmittable disease that spreads through the air. Tell us some measures on how to prevent getting it. The source of getting TB is - a person suffering from disease whose sputum is positive for bacteria and who has not taken treatment or who has not been treated fully. The patient is infective as he/she remains untreated. Treatment with correct regimen and dosage reduces infectivity by 90% within 48 hours of starting treatment. Measures to prevent it are: -Early diagnosis and complete treatment of cases -Measures taken by patient to cough with covered mouth, stopping indiscriminate spitting of sputum and proper disposal of sputum -BCG vaccination which prevents severe forms of TB What is the current scenario of Tuberculosis in India? Out of 9.4 million cases occurring worldwide per year, nearly 2 million cases occur in India, i.e. 1/5th of the global burden, and 2/3rd of South East Asian Region. Out of 2 million cases, around 55% of cases are sputum positive, i.e. the cases are infectious and can carry the risk of transmitting disease. How do MDR or XDR-TB or “TDR-TB” spread? How is it treated? MDR/XDR TB spread in same way as any other TB. MDR-TB is defined as resistance to isoniazid and rifampicin, (first line anti TB drugs) with or without resistance to other anti-TB drugs. The prevalence of MDR-TB is low, i.e. less than 3% amongst new cases and 12-17% in re-treatment cases. The Government has started the treatment for MDR-TB as Category-IV (DOTS-PLUS) and duration of treatment is for about 2 and a half years. -Intensive Phase: 6 to 9 months (K O E C Z) -Continuation Phase: 18 months (O E C E) XDR-TB is defined as resistance to at least Isoniazid and Rifampicin (i.e. MDR-TB) plus resistance to any of the fluoroquinolones and any one of the second-line injectable drugs (amikacin, kanamycin, orcapreomycin). India is struggling with new cases of TB, which are resistant to all treatments/drugs. What measures should be taken by the government to deal with drug-resistant TB, specifically TDR TB? The government has started the facilities for the diagnosis of suspected drug resistant cases and treatment of proved cases in the year 2012 with the drug sensitivity checking labs all over India. -Decentralized diagnostic and treatment services -Diagnosis: Clinical indication to offer DST -Drug susceptibility testing In order to plan for proper TB diagnosis and case management and reduce transmission and to address the problems of emergence of resistant strains, the government of India passed TB Notification Order on 7th May, 2012, by which the doctors would report any proved TB case to the district authority in a prescribed format every month. This notable step will facilitate early diagnosis and rational treatment, prevention of complications and drug resistance, and reduce deaths due to TB. It will help the healthcare providers offer better linkages for quality diagnostic and treatment services to the TB patients. It would also enable the National TB Control Programme to realistically estimate TB disease burden, plan resources and control measures commensurate with the actual burden of disease. How is TB linked to HIV? The lethal combination may be due to the effect of HIV on the immune system, i.e. the body’s natural defense system. The newly acquired tuberculosis infection can rapidly progress to active disease or there may be reactivation of the latent infection. TB is the most common opportunistic infection among people infected with HIV. Diagnosis of TB in HIV-infected patients is often difficult due to several reasons such as (i) frequently negative sputum smears, (ii) atypical radiographic findings, (iii) higher prevalence of Extra Pulmonary TB, especially at inaccessible sites, and (iv) resemblance to other opportunistic pulmonary infections. HIV and TB are also intricately linked to malnutrition, unemployment, alcoholism, drug abuse, poverty and homelessness. TB can be cured if diagnosed in time and treated properly with the same available drugs.