One World Tuberculosis ( TB)

WORLD:

Tuberculosis  remains a worldwide public health problem  despite the fact that highly effective  drugs and vaccine are available  making tuberculosis a preventable and curable disease.

  During  the 2013, there were an estimated  9.0 million incident cases of tuberculosis globally, 1.1 million cases of HIV associated  with tuberculosis  ; and 1.5 million  deaths including  0.36 million  deaths in HIV_ positive patients. In the same year, there were an estimated  0.48 million  cases of multidrug _ resistant  tuberculosis  ( MDR_ TB) and about 0.2 million deaths associated  with MDR_ TB, and about 9 per cent cases of MDR_ TB  were  cases  of extensively drug resistant  ( XDR) tuberculosis . Drug resistant strains of tuberculosis  including   XDR_ TB, have been found in every country where they have been sought. As in previous years, 85 per cent of all tuberculosis cases occur in WHO region of South_ East Asia ( 39 per cent ), Afruca ( 27 per cent ) and Western Pacific ( 19 per cent).

  It  is  estimated that about one_ third of the current global population  is infected asymptomatically with tuberculosis , of whom 5_ 10 per cent will develop  clinical disease during their lifetime. Most new cases and deaths occur in development  countries  where infection is developing countries where infection is often acquired in childhood. The annual risk of tuberculosis  infection  in high Burden countries is estimated  to be 0.5__ 2 per  cent.


  In  many  developing  countries  particularly in Asia, acquired drug resistance  remains high, because national tuberculosis  control programmes in these countries have  not been able to achieve a high cure rate over a very long period of time, even after the introduction of short __ course chemotherapy . Poverty, economic  recession,  malnutrition,  overcrowding, indoor air pollution, tobacco,  alcohol  abuse and diabetes make populations more vulnerable to tuberculosis. Increase in human migration has rapidly mixed infected with uninfected communities.  To make global situation  worse, tuberculosis has formed a lethal combination with HIV.

  People who are infected with both HIV and tuberculosis are 25__ 30 times more likely to develop  tuberculosis  disease, than people infected  only  with TB. This is because HIV stops the immune system working effectively  and tuberculosis bacilli are able to multiply  rapidly. In developing countries  HIV associated tuberculosis is very common.


  Globally , th  DOTS strategy  has been recognized as the best cost _ effective  approach  to tuberculosis  control which is now presented  as Stop TB Strategy. 

The advantage  of DOTS  are :

(a) Accuracy of TB diagnosis  is more than double.

(b) Treatment  success rate is up to 95 per cent.
(c) Prevent th spread of the tuberculosis  infection, thus reducting the incidence and prevalence of tuberculosis. 

(d) Improves quality  of health  care and removes stigma associated  with TB.

(e) Prevents failure  of treatment  and the emergency of MDR_ TB by ensuring  patient adherence and uninterrupted drug supply.

(f) Helps alleviate  poverty  by saving lives, reducing  duration of illness and preventing  spread of infection.

(g) Lends credibility to TB control efforts.

   The target of  DOTS  programme is successful treatment  or cure rate  of 85 per cent of new smear positive cases, and detection  of  70  per  cent of  such cases.

The WHO had set International Standards for tuberculosis  care.These standards are intended to facilitate the effective engagement  of all care for patients of all ages, including those with smear_ positive, smear __ negative , extrapulmonary tuberculosis , drug _ resistant  tuberculosis, and tuberculosis  combined  with HIV infection. 


 Why in one world Tuberculosis ( TB) SUMMIT news?

The Prime Minister addressed the One World TB Summit on the occasion of World TB Day (March 24).

● Recently World Health Organization ( WHO) released new guidance to support National Strategic planning ( NSP) for the Tuberculosis  ( TB)


  More on News: 

• It was organized by the Ministry of Health and Family Welfare (MoHFW) and the Stop TB Partnership, under India’s vision of ‘One Earth, One Health’. 

• The theme of World TB Day was 'Yes! We can end TB! 

• Leading the Way India TB Report 2023 by Ministry of Health and Family Welfare was also released during the event.  

• India contributes the highest number of TB cases in the world and is infamously referred as the ‘’TB Capital of World’’

● NSP for TB is a key document that  guides national authorities  and stakeholders on how to comprehensively address the TB epidemic through goal(s), strategies, priority interventions within health and across other sectors. 

■ Each goal must be defined in line with  SMART ( Specific, measurable , attainable, realistic and  time_ bound) criteria. 

 Current document is an update to 2015 Toolkit to develop  a NSP for TB prevention ,care  and control. 


■  The guidance was developed with input from national TB progrrammes, technical partners, civil society, WHO technical staff at country and regional level, and from various departments at headquarters, and other experts in TB and in strategic plan development. 

About Tuberculosis 

●TB caused by bacteria ( Mycobacterium tuberculosis)and it most often affects the lungs.


■ It is spread through the air  when people with lung TB cough, sneeze or spit.

 Two categories of TB : Pulmonary TB( affects lungs) and  Extra Pulmonary TB( affects both lungs and other organs).

● Treatment for TB:

■ Currently, the  BCG ( Bacille Calmette__ Guerin) vaccine  is used among children at the time of birth.

■ It was developed in 1921 in France to be used against Tuberculosis. 

■ In India,BCG vaccine  was first introduced in 1948 and was then made a part of universal immunization programme and administered to millions of children at birth or soon after it.

● Drug Resistant TB : 

■ Multi__ Drug Resistant  TB ( MDR _ TB): It is TB that does not respond to at least isoniazid  and rifampicin( 2 of the most powerful first line drugs).


■ MDR _ TB remains a public health crisis and a health security threat. Only about one in three people with drug resistant TB accessed treatment in 2020.

Extensively  Drug Resistant  TB ( XDR_ TB) :It is resistant to at least four of the core anti _ TB drugs. It involves MDR_ TB, in addition to resistance to any of the fluoroquinolones ( such as levofloxacin or moxifloxacin)and to at least one of the three injectable second _ line drugs ( amikacin, capreomycin or kanamycin).

Totally drug_ resistant Tuberculosis ( TDRTB)TB which is resistant to all the first and second _ line TB drugs. 

  Reason Behind Higj Burden of TB

☆  Delay in Diagnosis  & treatment  : Self medication and less awareness  delays  the treatment. 

 ■ TB is also particularly  difficult  to diagnose  in children. 

  Lack of the latest  Equipment  : In most parts of India TB is diagnosed from  two sputum  smears taken  at different  times  of the day that a analyzed  by  a  health worker  using  a microscope. 

  ● It is a slow process, and there's  a large margin for error. 

 ● Identification: Bacterium shows no symptoms  in the latent stage. Percent of people  with latent TB is more than 40 percent.  

 • Inadequate Health Infrastructure: Government health care system is overburdened and the private system isn't transparent or highly monitored.  

■ Small budgets, lack of trained personnel etc. act as an impediment.

  • Drug Resistance: New strains of TB have developed  resistance to the first-line medicines like isoniazid and rifampicin. 

• Pollution: Studies show that long-term exposure to particulate matter may cause active TB infections.

 • Social Taboo: Considered as a social taboo, due to which people hesitate to disclose it. 

• Other Factors: Comorbidities like malnutrition, Covid, diabetes, HIV, tobacco smoking, alcohol impact etc. enhance the vulnerability.  

Key Finding of TB Report 2023 


• TB patient registration has improved by 56%. 722 (94%) districts of India have expanded TPT.  

• Highest incidence of cases was in Delhi (546 per lakh population) and the lowest in Kerala (67 per lakh population).  

• The treatment initiation rate among the notified cases for 2022 was 95.5%. 

• 2022 saw an increase in the Multidrug-resistant tuberculosis (MDR-TB)/ Rifampicin resistant (RR) TB. 

Initiatives Taken to Eliminate TB 

At National Level:


 • TB National Strategic Plan (NSP) (2017 – 2025)- It has four pillars Detect – Treat – Prevent – Build.  

● In NSP, India had fixed a target of 77 incidences and six deaths per 100,000 population due to TB by 2023. 

• Ni-kshay Poshan Yojana (NPY), 2018- Direct Benefit Transfer (DBT) of Rs 500 per month for nutritional needs.  

• National Tuberculosis Elimination Programme (NTEP), 2020- Previously known as Revised National Tuberculosis Control Programme (RNTCP)

 ■ It aims to eliminate TB in India by 2025, five years ahead of the global target of 2030. 

 • Pradhan Mantri TB Mukt Bharat Abhiyan (PMTBMBA), 2022- Also known as Ni-kshay Mitra Initiative. One can adopt TB patients and provide them with monthly nutritional support. So far Ni-kshay Mitras have adopted about 10 lakh TB patients under the programme.

 ● New Diagnostic Test: CB-NAAT (cartridge-based nucleic acid amplification test), TrueNat (rapid testing for TB) etc.  

• Ayushman Bharat Digital Health Mission-Under it, digital health IDs for TB patients have been created for better monitoring and treatment.


■ Innovative Methods adopted By States/UT 


• Chhattisgarh- Involving village health committee for TPT 

• Tamil Nadu- Local procurement of shorter 3HP TPT drugs 

• Maharashtra and Rajasthan-Introduction of TPT in prison inmates, other risk groups and integration during Active case-finding (ACF). 

                                                                                                                                              ■ other_ three month  treatment for TB prevention instead of six months course, BCG vaccine included in the Indradhanush program etc.  At Global Level:  

• End TB Strategy of World Health Organisation (WHO)- It aims for 80% reduction in the number of new cases, 90% reduction in mortality, and zero catastrophic cost by 2030. 


● In 1993 it was declared a global emergency. The directly observed treatment–short course (DOTS) was initiated by it.  

• United Nations Sustainable Development Goals (SDGs)-It includes ending the TB epidemic by 2030 under Goal 3. Way Forward 

 • Integrated approach: It should include a hygienic lifestyle, nutritional food uptake, and better health care services.  

• Human Resource Development:  Physical training at National TB Institute (NTI), Bengaluru and other institutes shall be promoted. 

• Early Diagnosis and Monitoring:  By adopting the latest technologies, creating awareness etc. 

• Research and Development (R&D): Incentives to the private player should be provided for R & D in drugs etc.  

• Community Participation: Will support government initiatives such as Ni-kshay Mitra Initiative. 

Steps taken to eliminate Tuberculosis:

■ National Strategic plan  ( NSP), 2017 __ 2025 : 
Under this, India is committed to eliminate TB by 2025, five years ahead of the target for TB set by Sustainable Development Goal ( SDG), 2030.

■ National Tuberculosis  Elimination  Program ( NTEP): To accelerate momentum towards eliminating TB in the country by 2025, NTEP has expanded both the laboratory network as well as diagnostic  facilities to cover the entire country. 

■ Earlier, it was known as Revised National  Tuberculosis Control Program ( RNTCP).

■ NIKSHAY Portal:  It is the  Natioanl TB information system which acts a one _ stop solution to manage information of patients and monitor program activity throughout the country. 

■ It provides a National Data repository  of TB information  for advanced analytics.

■ NIKSHAY Poshan Yojana ( NPY): India's NSP provides direct benefits Transfer ( DBT) for all TB patients in order to support their nutrition needs and help address the financial burden of Tuberculosis for the affected households. 


Global  TUBERCULOSIS (TB) REPORT 

  World Health Organisation released Global Tuberculosis (TB) Report, 2023. 

Key findings:  



Global o Reported global number of people newly diagnosed with TB was 7.5 million in 2022.TB remained the world’s second leading cause of death in 2022 after COVID-19. o Net reduction of TB incidence from 2015- 2022 was 8.7% far from WHO End TB Strategy milestone of 50% reduction by 2025.  Only about 2 in 5 people with drug resistant TB accessed treatment in 2022. 

• India’s findings

  India, Indonesia and Philippines collectively account for nearly 60% of reduction in number of people newly diagnosed with TB in 2020- 2021.  India has 27% of world’s TB cases. 

TB is caused by bacillus Mycobacterium tuberculosis which most often affects lungs (pulmonary TB). Most common medications to treat TB include isoniazid, rifampin, ethambutol, pyrazinamide etc.  Currently, Bacillle Calmette-Guerin is only licensed vaccine available for TB prevention.  Spreads from person to person through air.  TB Risk factors: Diabetes, HIV infection, Undernutrition, tobacco use.

 • Steps taken to prevent Tuberculosis  National Strategic Plan for Tuberculosis Elimination 2017-2025. TB Mukt Panchayat Abhiyan Initiative. Nikshay Poshan Yojana for nutritional support to TB patients. 


  Drug-Resistant TB


 Mulmultidrug Resistance TB ( MDR :Resistant to at least isoniazid and rifampicin.

 Extensively  drug _ resistant  tuberculosis  ( XDR_ TB) : Resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs. 

 Totally   drug _  resistance  tuberculosis ( TDR TB):  Resistance  to all first- and second-line TB drugs. 




































































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