In a huge step towards tuberculosis management, new TB patients in Mumbai are all set to get individualised treatment soon in public sector. The Union government has decided that all new TB patients will have their drug sensitive tests – for all 13 available medicines – done before commencing of their treatment.
The plan will be implemented as a pilot project in Mumbai, where currently this is done only certain categories like children, HIV patients, and close-contact people of drug resistant TB patients testing positive for TB undergo. The Centre has also lined up a nationwide TB survey to get a real picture of TB prevalence in the country.
According to doctors, the 'Universal drug susceptibility testing' for all TB patients in the city will enable quicker treatment for drug-resistant TB and also control spread of new infections. Experts say that one TB patient can infect 10 contacts in a year and if s/he is an Extensive Drug Resistant TB (XDR-TB) patient, the person is 2x as infectious as MDR contacts.
"There is a good evidence about the rising number of multi-drug resistant and extensive drug resistance TB cases from Mumbai. The universal drug susceptibility testing will start from Mumbai in a phased manner," said Dr Sunil Khaparde, deputy director general, ministry of health and family welfare, on Saturday, during a workshop on TB research, organised by PD Hinduja Hospital, Mahim.
"It is one of the most important directives of the End TB Strategy according to the guidelines by the World Health Organisation (WHO). It is a diagnostic test that checks for the TB causing bacterium's drug resistance pattern for all 13 anti-drugs available," he added.
Dr Dakshah Shah, TB officer-BMC, who was also one of the speakers at the two-day long workshop, said that individualised treatment is recommended in the guidelines layed out by WHO. "Universal DST is recommended by the National TB control program for all MDR cases as it is the only way to move towards individualised treatment," she said.
Shah added that in Mumbai, 'universal DST' is extended only for select cases like paediatric, HIV positive and contact tracing. The Brihanmumbai Municipal Corporation is also set to have a house to house survey in 12 chosen wards to detect TB and start treatment.
The National TB Institute under the guidance of Central TB Division is also kick-starting a pan India survey for prevalence of TB which the results are expected by the end of 2016.
"The prevalence survey is important as it will be give us clearer picture on where we stand in terms of TB. We will be holding a three day long meeting starting on May 10 for the designing and sampling for the survey. Screening by symptoms, radiology examination, gene expert and other confirmatory tests will be part of the survey," said Khaparde.
He further said that the department is also doing drug resistance survey for which 5,400 samples from 120 TB units across the country has already been collected and will be checked for the resistance pattern for all 13 anti-TB drugs drug.
"The results will provide reliable estimate of drug-resistant TB and community level resistance pattern of first and second line drugs," he added.
According to Global TB Report 2015, WHO, Geneva
Global annual incidence of Tb is 9.6 million
India's is 2.2 million
Estimated incidence of all forms of TB in India in 2014- 22 lakh
Estimated incidence of HIV associated TB in 2014- 1.1 lakh
Estimated number of deaths 2014 for all forms of TB -2.2 lakh
Estimated number of deaths 2014 HIV associated TB -31,000
Economic loss due to Tuberculosis: $23.7 billion in a year
There are 63,000 new MDR-TB cases in India
It is estimated that about 40% of the Indian population is infected with TB bacteria, the vast majority of whom have latent rather than active TB.
70% of the TB patients opt for treatment in private sector.
1 Indian will die every two minute
The probability of transmission from one person to another depends upon the number of infectious droplets expelled by a carrier, the effectiveness of ventilation, the duration of exposure, and the virulence of the M. tuberculosis strain.
There is 63% in XDR TB cases and 3% MDR Tb cases in Mumbai in last 1 year.
% increase from 2014 to 2015: 20%
In 2014, around 30,000 TB cases were reported whereas in 2015 the figures went up to 45,333.
The plan will be implemented as a pilot project in Mumbai, where currently this is done only certain categories like children, HIV patients, and close-contact people of drug resistant TB patients testing positive for TB undergo. The Centre has also lined up a nationwide TB survey to get a real picture of TB prevalence in the country.
According to doctors, the 'Universal drug susceptibility testing' for all TB patients in the city will enable quicker treatment for drug-resistant TB and also control spread of new infections. Experts say that one TB patient can infect 10 contacts in a year and if s/he is an Extensive Drug Resistant TB (XDR-TB) patient, the person is 2x as infectious as MDR contacts.
"There is a good evidence about the rising number of multi-drug resistant and extensive drug resistance TB cases from Mumbai. The universal drug susceptibility testing will start from Mumbai in a phased manner," said Dr Sunil Khaparde, deputy director general, ministry of health and family welfare, on Saturday, during a workshop on TB research, organised by PD Hinduja Hospital, Mahim.
"It is one of the most important directives of the End TB Strategy according to the guidelines by the World Health Organisation (WHO). It is a diagnostic test that checks for the TB causing bacterium's drug resistance pattern for all 13 anti-drugs available," he added.
Dr Dakshah Shah, TB officer-BMC, who was also one of the speakers at the two-day long workshop, said that individualised treatment is recommended in the guidelines layed out by WHO. "Universal DST is recommended by the National TB control program for all MDR cases as it is the only way to move towards individualised treatment," she said.
Shah added that in Mumbai, 'universal DST' is extended only for select cases like paediatric, HIV positive and contact tracing. The Brihanmumbai Municipal Corporation is also set to have a house to house survey in 12 chosen wards to detect TB and start treatment.
The National TB Institute under the guidance of Central TB Division is also kick-starting a pan India survey for prevalence of TB which the results are expected by the end of 2016.
"The prevalence survey is important as it will be give us clearer picture on where we stand in terms of TB. We will be holding a three day long meeting starting on May 10 for the designing and sampling for the survey. Screening by symptoms, radiology examination, gene expert and other confirmatory tests will be part of the survey," said Khaparde.
He further said that the department is also doing drug resistance survey for which 5,400 samples from 120 TB units across the country has already been collected and will be checked for the resistance pattern for all 13 anti-TB drugs drug.
"The results will provide reliable estimate of drug-resistant TB and community level resistance pattern of first and second line drugs," he added.
According to Global TB Report 2015, WHO, Geneva
Global annual incidence of Tb is 9.6 million
India's is 2.2 million
Estimated incidence of all forms of TB in India in 2014- 22 lakh
Estimated incidence of HIV associated TB in 2014- 1.1 lakh
Estimated number of deaths 2014 for all forms of TB -2.2 lakh
Estimated number of deaths 2014 HIV associated TB -31,000
Economic loss due to Tuberculosis: $23.7 billion in a year
There are 63,000 new MDR-TB cases in India
It is estimated that about 40% of the Indian population is infected with TB bacteria, the vast majority of whom have latent rather than active TB.
70% of the TB patients opt for treatment in private sector.
1 Indian will die every two minute
The probability of transmission from one person to another depends upon the number of infectious droplets expelled by a carrier, the effectiveness of ventilation, the duration of exposure, and the virulence of the M. tuberculosis strain.
There is 63% in XDR TB cases and 3% MDR Tb cases in Mumbai in last 1 year.
% increase from 2014 to 2015: 20%
In 2014, around 30,000 TB cases were reported whereas in 2015 the figures went up to 45,333.
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