Tuberculosis (TB) is a major public health concern in the country. Despite advances in TB care, the disease continues to be a major cause of morbidity and mortality. And, it takes a heavy toll on the economy too. Emergence and spread of drug-resistant TB has become a major public health concern now.
India accounts for one fourth of the global TB burden, both TB and MDR TB, as reported in Global TB Report 2016. Every year, about 1.3 lakh incident multi-drug resistant (MDR) TB cases occur in India, including 79000 MDR-TB cases among the notified pulmonary cases (TB India 2017 Report). The incidence of primary MDR TB may be higher in selected states like Maharashtra. To prevent the epidemic of MDR TB, it should be declared a public health emergency.
Multidrug resistant (MDR) TB is TB resistant to both isoniazid and rifampicin with or without resistance to other first-line anti-TB drugs. Extensive drug resistant (XDR) TB is TB resistant also to a fluoroquinolone (ofloxacin, levofloxacin or moxifloxacin) and a second-line injectable anti TB drug (kanamycin, amikacin or capreomycin).
Early and complete treatment is important to prevent emergence of drug-resistant cases. This year, there has been a shift in policy under the government’s Revised National TB Control Programme (RNTCP) from the “intermittent thrice weekly” regimen to a “daily fixed-dose combination (FDC) drugs” regimen for drug-sensitive TB to improve patient compliance to treatment, prevent relapse and minimize chances of developing drug resistance.
All cases of TB, whether in the public and private health care sector, should uniformly adopt and follow these standards.
Bedaquiline, a new anti-TB drug to be used in the treatment of MDR-TB and XDR-TB was added to the RNTCP, at six identified tertiary care centres across India.
Reporting is important to trace contacts of the person with infectious TB. All contacts of the patient should be screened for TB and put on treatment if required. This cascade of screening of contacts, at home and workplace, identifies individuals at risk and prevents further spread of TB, including MDR TB.
All GPs should focus on tracing the contacts of their TB patients and screen them for latent TB infection. Accurate diagnosis is important in this endeavor. The rapid diagnostic molecular sputum GeneXpert test should be used to diagnosing TB including drug-resistant TB.
Contact tracing increases community awareness about the disease. Contact tracing interrupts the chain of transmission of the disease by early diagnosis of cases as well as timely and complete treatment.
Early diagnosis and complete treatment is important to prevent and control TB. To address the problem of rising drug resistance, TB is a notifiable disease. It was declared a notifiable disease in 2012. Every case of TB has to be notified to the local authorities.
The approach to all notifiable diseases should therefore be based on DTR “Diagnose, Treat & Report”.
• Diagnose early, using sputum GeneXpert test
• Treat: Complete and effective treatment based on national guidelines, using FDC
• Report: Mandatory reporting
The Indian Medical Association (IMA) is launching a new campaign “IMA-TB Initiative: DTR-C” i.e. Diagnose, Treat, Report to track Contacts.
IMA requests all its members to actively participate and support this initiative. It is only through a united and concerted effort that this public health menace can be controlled.