Doctor , how long I have to take these medicines ? Should I continue it even if I am completely all right?
I hear this question very frequently, mostly from patients diagnosed with tuberculosis. TB medicines usually make most patients all right in 4-6 weeks. But science has estimated that at least 6 months of treatment is needed for complete eradication of the pathogen from the body. The sad fact is most people stop therapy early and there by help in development and propagation of drug resistant TB
Fortunately I do not see much drug resistant TB in my clinical practice. But in last 10 years, I have not seen a visible reduction in incidence of TB. It’s true that we do not see the TB meningitis and spinal TB as much as before, but the pleural effusions, lymph node TBs and the most dangerous variety to the community, the sputum positive TBs are not declining much. In my experience TB is not confined to poor people. The middle and high income population are also very much affected.
Today, March 24, is the World Tuberculosis Day. It was on this day in 1882 that Robert Koch, the German bacteriologist, announced to the Berlin Physiological Society that he had discovered the cause of tuberculosis.
Tuberculosis is an ancient disease. It is said that modern strains of mycobacterium tuberculosis originated around 15-20 thousand years ago. But still it kills around 4400 people every day. In 2014, TB killed 890 000 men, 480 000 women and 140 000 children. Every year 9 million people get sick with TB. Of this 3 million or 1/3rd do not get the correct and complete treatment. If correctly treated with first line combination of 3-4 drugs most of the tuberculosis patients are cured. 3 million do not get treatment because of lack of facilities, poverty , lack of awareness etc.
Huge shortage of funds is also a cause for this missing 3 million. It is said that there is an annual short fall of 1.4 billion US $ in treatment programs and 1.3 billion US$ in research.
Due to lack of timely, correct and complete treatment multi drug resistant TB has emerged as a big threat to the health of humankind. It is estimated that globally in 2014, 480 000 people got infected with multi drug resistant TB ( MDR TB).
India has the dubious position of number one country in the world, both in incidence of TB and mortality due to it. It is estimated that in 2014, 2 million Indians got sick with TB and around 222 000 died due to the disease. But there is some reassuring news. India has met the World Health Organisation targets set for 2015. The targets were a falling number of new cases of TB and 50% reduction in prevalence and deaths due to TB compared to 1990.
This World TB day came with some good news for India. A new drug, Bedaquiline has been introduced into the national tuberculosis (TB) programme.. Bedaquiline, which is a drug for Multi-Drug Resistant TB, is being introduced at six identified tertiary care centres across India.
The government has also inducted more than 500 Cartridge Based Nucleic Acid Amplification Test (CBNAAT) machines into the Revised National TB Control Programme. This is a fully automated rapid molecular test which detects mycobacterium tuberculosis and rifampicin drug resistance simultaneously.
Tuberculosis is only a surrogate marker of poor living conditions in the society. Containing and eradicating of tuberculosis from the world is closely linked to eradicating poverty and hunger. It is also very much related to availability of affordable good quality health care for all human beings. A humanist world view and great political will are a must for eliminating this captain of death.