World TB Day...24th March,2011 : "On the Move Against Tuberculosis : Transforming the Fight - Towards Elimination of TB"

The 24th March of every year is World Tuberculosis Day. The relevance of the statement cannot be more reinstated on the curable communicable disease in a country like India. Out of sheer ignorance, TB is still considered a fatal disease and the struggle to eradicate the disease and to open the closed mindset of the society has become an everyday battle for patients and medical practitioners alike.  
It was on 24 March 1882 that Dr. Robert Koch made a great breakthrough in the diagnosis and treatment of tuberculosis by detecting the TB bacillus—the cause of tuberculosis. A third of the world’s population is currently infected with TB and the World Health Organization (WHO) is networking with organizations and countries to reduce TB prevalence rates and mortality by half by 2015.

World TB Day 2011 enters into the second year of the two year campaign, “On the move against tuberculosis” focusing on innovation in TB research and care. Accelerating the campaign are fresh objectives and targets from the Global Plan to Stop TB 2011-2015: Transforming the Fight—Towards Elimination of TB, launched in October 2010 by the Stop TB partnership.
WHO TB Facts:
• TB kills more people than any other infectious disease in the world
• In developed countries TB is seen in elderly, while in developing countries it is commonly seen in young adults
• Every second, someone in the world is infected with TB
• One third of the world’s population has TB now
• 5-10 % of people infected with TB (without HIV infection) become sick or infectious at some point of time in life
INDIA TB Facts :
(i) * TB is everyone’s problem especially in India and China and it affects the most productive age group, 20 to 40 years.
(ii) * It is also the largest killer in India.
(iii) * There are 20 lakh new patients in India every year apart from the ones yet to be cured.
(iv) * And that makes it up to one third of world TB patients in India alone.
(v) * It is also disturbing to note that 3, 30, 000 people die every year and 8, 70, 000 are infectious making them capable of infecting others.
The TB Challenge :
(1)."If you have cough for two weeks or more, GET two Sputum examinations".
(2)."Lung TB is the most common form of TB constituting more than 85 % of the cases".
(3)."TB in children forms 5-15 % of all TB cases".
(4)."TB is the most common opportunistic infection in people having HIV/AIDS".
(5)."Improper/irregular/incomplete treatment can lead to multi drug resistant TB".
(6)."Sputum examination is the most reliable and cost effective tool to diagnose TB".
(7)."Best way of preventing the spread of TB is early diagnosis and complete treatment".
(8)."Every patient who is cured stops spreading TB, and every life saved is a child, a mother, or a father who will go on to live a longer, TB-free life".
Risk factors for developing TB include :
(a).Being around someone with active TB.
(b).Having a chronic illness such as diabetes.
(c).Being immunocompromised either from HIV, chemotherapy for patients with cancer, end-stage kidney disease, prolonged steroid use etc. 
(d).Working in the health care field.
(e).Living in a long-term care facility, such as a nursing home, mental institution, or prison.
(f ).Older people are also at an increased risk of developing TB.
(g).Social factors such as poverty, overcrowding, and homelessness are also risk factors of TB.

(h).Another social risk factor of TB is alcohol. It has long been evident that there is an association between alcohol use and risk of TB. The risk of active TB is substantially elevated in people who drink more than 40 g alcohol per day and/or have an alcohol use disorder. This may be due to both an increased risk of infection related to specific social mixing patterns associated with alcohol use and influence on the immune system of alcohol itself and of alcohol-related conditions.
Tackling the TB menace :
What makes tackling the TB menace so challenging is that the bacterium is so difficult to get at—it is slow growing, has very tough cell walls and remains hidden in body cells for a long while before it is detected. Treatment requires a drug regimen that is relatively long, requiring 4 to 6 months and breaking the intake of medicine in the middle develops drug resistant strains.
The current focus on TB elimination is aimed at developing simple, rapid TB tests, faster treatment regimens and bringing an effective TB vaccine to the market. To this end, the 2011 World TB campaign throws a worldwide searchlight for individuals who have devised new ways to stop TB and have inspired others in the fight against tuberculosis.

On the Move Against Tuberculosis :
Poster sessions, symposiums and conferences are lined up at the academic level all over the world to discuss the elimination of TB. In developing countries Road Show campaigns have been arranged to visit communities, health clinics and primary health centres spreading the message to Stop TB and to remove the social stigma attached to TB patients.

While it is important for governments to ensure availability of TB drugs to patients, it is equally important for family members of TB patients, health care providers and patients themselves to stick to the drug regimen and not break medication in the middle thereby complicating TB treatment further. Only a concerted effort from all—researchers, governments, healthcare providers, TB patients and their families, the drug industry, the media and all members of the civil society, will ensure a stiff and effective fight against tuberculosis—a disease that is both preventable and curable.
Q. Tuberculosis is curable, yet society continues to ostracize and stigmatise TB patients. Why is that ?
A. Previous experiences and movies. Movies around the 50s and 60s have romanticised TB projecting patients as coughing, bleeding and eventually dying. Before the 50s and 60s there was no concept of chemotherapy and TB patients were kept in ventilated sanatoriums. It was usually the patients with natural immunity that survived. Somehow the movie version of TB has been ingested. Hence scientific facts must be gotten right. TB is curable with correct treatment, and periodic monitoring by medical professionals trained in it.
Q. TB is complicated to handle. How has it become a primary concern?
A. TB is everyone’s problem especially in India and China and it affects the most productive age group, 20 to 40 years. It is also the largest killer in India. There are 20 lakh new patients in India apart from the ones yet to be cured. And that makes it up to one third of world TB patients in India alone. It is also disturbing to note that 3, 30, 000 people die every year and 8, 70, 000 are infectious making them capable of infecting others.
Q. Last year the DOTS Plus guidelines had been released. What's the effectiveness of DOTS ?
A. Direct Observation Treatment, Short Course (DOTS), is a procedure where medication is given under direct observation by a health worker. Since TB is a chronic disease the shortest course lasts for at least six months and depending on the severity, the duration is bound to increase to 9 months to even a year. If the treatment extends, then the motivation to continue the treatment decreases. Also, once the patient starts to get asymptomatic the motivation to continue treatment decreases.
The effectiveness of DOTS will be ensured only if patients follow the entire treatment until TB is completely eradicated. The educated dutifully follow the entire treatment; it is the poorly informed who discontinue before they are cured.
Q. The population is vast, what are the suggestions to provide uniform services ?
A. One of the challenges is the accessibility to the centres that provide DOTS. People from rural areas, hilly regions, find it difficult to reach the centres. Travelling to these centres could cost them their livelihood in case of casual labourers. In such cases, even post-men and school teachers are requested to deliver DOTS to patients living in remote areas. There should be more centres set up to provide treatment.
Q. What is the difference between the treatment provided by the government and private hospitals ?
A. DOTS are provided by the WHO and the government for free. The pills are administered thrice a week, every alternate day. Whereas in private hospitals 3 to 4 drugs are bought from pharmacies and the treatment is on an everyday basis. They are both equally effective.
 Q. What are the the current challenges in treating TB ?
A. The emergence of Multi-drug Resistant Tuberculosis (MDR-TB) is dangerous. Drug resistant TB is not curable by usual TB treatment and treatment is 20 times more expensive and needs at least 1 and half years to get cured. The time needed for identification of Resistant Tuberculosis is long(5-6 weeks) and the test is expensive and not available commonly in usual labs; hence there should be more referral sites.
In addition, newer diagnostic methods should be implemented, cost factor should be considered and quicker identification must be enforced. Most importantly, research and development needs to be in place and encouraged. That is the theme behind this World TB Day 2011’s slogan- Transforming the fight Towards Elimination. This new plan, for the first time, identifies all the research gaps that need to be filled to bring rapid TB tests, faster treatment regimens and a fully effective vaccine to market.

In general, the anti-TB medications are very safe. The prevention of MDR-TB is of utmost importance. In simpler terms, some bugs need 3 pesticides to kill it; similarly TB always needs 3 to 4 drugs to prevent it from becoming drug resistant. The wholesome regimen has to be adhered to ensure the treatment is effective.

Support TB patients, do not push them away. They can do with all the encouragement starting with eceiving a simple act of concern such as enquiring about their well-being. Health workers should exert pressure in a positive way so patients will stay on course when patients get asymptomatic.