India has the highest burden of Tuberculosis (TB), with the World Health Organisation (WHO) citing that India accounts for a quarter of the world’s annual incidence of TB. Worldwide, Tuberculosis (TB) is second only to HIV/AIDS as the greatest killer from a single infectious agent. According to estimates of WHO, 9 million people fell ill with TB and 1.5 million died from the disease in 2013. Despite being curable, Tuberculosis remains endemic and threatening. Over 95% of TB deaths occur in low and middle-income countries like India, where the treatment fails to reach a large number of people. The decline in its incidence has been slow, and the emergence of drug-resistant TB is a major concern. While a bulk of Tuberculosis infections in India are found in the economically weaker sections of the population, who live in crowded conditions and are often deprived of treatment, the disease also thrives within the urban upper class - especially in those with uncontrolled diabetes, HIV infection and low immunity (like cancer patients). A person living with HIV is about 26 to 31 times more likely to develop active TB, because HIV destroys the body’s immunity. This explains why TB is the cause for one fourth of all HIV-related deaths. Even the elderly that suffer from poor nutrition are susceptible.
TB is a contagious infection that starts usually from the lungs, but may spread to other organs of the body. The TB bacteria may lie latent or dormant in the lungs and may take years to become active. Patients with latent bacteria do not spread the infection to others. However, those with active bacteria can spread the infection to people who come in contact with them. Those with pulmonary TB are contagious for 2-3 weeks after the start of treatment. The patient is advised to wear a mask for this period. A failure to complete the treatment results in drug resistance. Anti-Tuberculosis drug resistance arises due to improper use of drugs in drug-susceptible TB patients. Once the patient takes the drug for a period of time and then skips it without completing the course, the bacteria in his or her body develop resistance to this particular drug - this drug will now have no impact on the infection when consumed again. Essentially, drug resistance arises in areas with weak TB control programs. According to WHO, India had an estimated 63,000 cases of notified Multi-Drug Resistant Tuberculosis (MDR-TB) in 2010, the highest in the South East Asia region. Globally, in 2013, an estimated 480 000 people developed MDR-TB.
On the recent World Tuberculosis Day, the doctors at Columbia Asia Hospitals, Gurgaon stressed that, while TB infection remains endemic in India, greater awareness, timely reporting of symptoms, timely treatment and completion of treatment can help prevent the spread of the disease. “In India the rates of infection are actually so high that the bacteria is prevalent in the air. This is why a large number of people here have latent bacteria. The bacteria remains passive inside the body as long as the body has strong resistance against it, and becomes active whenever (and for whatever reason) the body’s immunity levels plummet. That is why people with weakened immune systems have a much greater risk of falling ill with TB. A hurdle to its cure is that within a short time of the commencement of the treatment the patient begins to feel better and the symptoms are relieved to a great extent. The patient, feeling that he/she is cured, then tends to discontinue the treatment, often leading to a relapse with multi-drug-resistant TB, which is more virulent, difficult to treat and expensive,” said Dr Vivek Singh, Consultant Pulmonology, Columbia Asia Hospital, Gurgaon. “In urban areas many people can access only unregulated private practitioners, who have limited knowledge of the advances in the treatment of TB. The migrant population in cities needs a focused strategy for the detection and treatment of TB,” added Dr Singh.
The good news is that TB is curable. It is a bacterial infection that can be cured with a 6-9 months treatment. “According to WHO, an estimated 37 million lives were saved through TB diagnosis and treatment between 2000 and 2013. However, while the number of TB infections and well as TB deaths is declining today, it is not at the rate we would like to see. Further, even in people who are able to get treated and recover from the disease, TB affects their quality of life and productivity for several months. It is very important that we continue to boost our immunity with a healthy balanced diet and physical exercise, to prevent any latent infections from turning active,” said Dr Vivek Singh.
How to minimise the risk and prevent infection:
Eat healthy: Eat a balanced diet full of vegetables and fruits, to ensure an abundant supply of vitamins and minerals.
Live a healthy lifestyle: A growing number of our present day concerns stem from lifestyle disorders. Living a sedentary life, lack of sun exposure and absence of physical exercise weaken the body and make it prone to illness. A proper control of diabetes is essential, to prevent the lowering of the immune status.
Never ignore symptoms: Always report any symptoms that may indicate an infection. Persistent cough, recurrent fever, fatigue, weakness and loss of appetite or weight are symptoms that should never be ignored.
Be cautious against infections: If you work in high-risk zones such as hospitals, you should be all the more cautious. Maintain high levels of personal hygiene, avoid close contact with the infected and follow infection control mechanisms.