Proposed Revision of WMA Resolution on Tuberculosis: Inputs required

Document no:	SMAC 206/Tuberculosis REV/Apr2017	Original: English
Title:	Proposed Revision of WMA Resolution on Tuberculosis
Destination:	Constituent Members	Action(s) required: For consideration
Note:	As part of the annual policy review process, the Council in Buenos Aires (April 2016) decided that the WMA Resolution on Tuberculosis should undergo a major revision. The Indian Medical Association (IMA) volunteered to undertake that work. At its 204th session in Taipei (October 2016), the Council decided to circulate the proposed revised document within WMA membership for comments. The 206th Council session in Livingstone (April 2017) considered the revised version and decided to circulate it again within WMA membership for further comments.

PREAMBLE

1.            According to the World Health Organization, tuberculosis is a significant global public health problem affecting over 8 million cases every year with 2.2 million infectious cases and over 1.5 million deaths. South East Asian and African countries are most affected.

2.            In developing countries, the incidence of tuberculosis has risen dramatically because of high prevalence of HIV/AIDS, increasing migration of populations, urbanisation and over-crowding.

3.            The emergence of strains of tuberculosis bacteria resistant to first-line drugs have become a major public health threat in the forms of multidrug-resistant (MDR) and extensively drug-resistant tuberculosis (XDR TB) due to indiscriminate or inappropriate use, lack of access, poor compliance or incomplete treatment.

4.            MDR tuberculosis is a significant threat to development and the safety of global health.

5.            Community awareness and public health education and promotion are essential elements of tuberculosis prevention.

6.            Screening of high risk groups including PLHIV (people living with HIV) and vulnerable population including migrants, prisoners and the homeless is important in tuberculosis prevention.

7.            Rapid diagnosis with molecular tests and supervised daily treatment started at the earliest should help arrest the spread of disease.

8.            BCG (Bacille Calmette-Guérin) vaccination as early as possible after birth should continue until a new more effective vaccine is available.

  

RECOMMENDATIONS

8.       The World Medical Association, in consultation with WHO and national and international health authorities and organizations, will continue its work to generate community awareness about symptoms of TB and increase capacity building of health care providers in early identification and diagnosis of TB suspects and ensuring complete treatment utilizing Directly Observed Treatment Short course.

9.       The WMA supports calls for adequate financial, material and human resources for tuberculosis and HIV/AIDS research and prevention, including adequately trained health care providers and adequate public health infrastructure, and will participate with health professionals in providing information on tuberculosis and its treatment.

Health care professionals should have access to all required medical and protective equipment to prevent against the risk of infection and spread of the disease.

10.    The WMA encourages continuing efforts to build up the capacity of health care professionals about increase in the use of rapid diagnostics methods, their availability in the public sector and in the management of all forms of TB including (MDR and XDR).

11.    The WMA calls on its Member National Medical Associations to support their National TB Programmes by generating awareness among healthcare professionals about TB management and in the community for early reporting.

12.    The WMA calls on its National Member Associations to propagate methods of TB prevention including respiratory hygiene, cough etiquettes, and safe sputum disposal.

13.    National Member Associations should encourage all its members to timely notify to relevant authorities, all patients diagnosed or put on TB treatment for initiation of contact screening and adequate follow up till the completion of treatment.

14.    National Member Associations should co-ordinate with their TB National Programme and promulgate the adopted guidelines to all members.

The WMA supports WHO's efforts and call upon all governments, communities, civil society and the private sector to act together to end tuberculosis world-wide.

All should jointly promote collaboration using new innovative approaches to achieve TB free World and achieve the Sustainable Development Goals (SDGs).

Tuberculosis still a cause for concern

Tuberculosis still a cause for concern About 45% of the multi-drug cases are from India and two other countries New Delhi, 03 May 2017: According to a report by WHO, India has 27% of the world's new tuberculosis (TB) cases. TB is one of the biggest infectious diseases in India. The country accounts for a high number of worldwide TB cases due to which the global estimates have also gone up from 9.6 million to 10.4 million. Apart from this, about 2.5% of the new TB cases are resistant to Rifampicin, or to both Rifampicin and Isoniazid, the two most commonly used anti-TB drugs. About 45% of the multi-drug resistant TB cases in the world are from India, China, and the Russian Federation. Although TB is treatable, treatment reaches only 59% of the estimated TB patients in India. This is due to the fact that many people in different regions of India still do not fall under the ambit of the government's TB programme. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said " In India, we still rely heavily on insensitive diagnostic tools such as sputum smears. For the longest time, our TB programmes have ignored the TB patients in the private sector. There is a need to carry out nationwide prevalence surveys as India has been underestimating TB prevalence majorly. We must also ensure that those who need treatment have access to it no matter what corner of the country they are in." TB is a bacterial disease and spreads when an infected person coughs or sneezes. There are no obvious symptoms in a person infected with the bacteria that cause TB. In case symptoms do appear, they include cough (sometimes blood-tinged), weight loss, night sweats, and fever. TB is completely curable and preventable. Those with active TB symptoms require a long course of treatment involving consumption of multiple antibiotics. Adding further, Dr Aggarwal, said, "Some people can develop TB within a short time frame soon after they are infected and there are others, who can get sick much later. It is imperative to get treated for latent TB infection as about 5% to 10% of the infected people who do not receive treatment tend to develop the disease at some point in their lives. Those with a weak immune system need to be particularly careful." The following steps can be taken to reduce exposure to a person with TB in households. • Ventilate the house adequately • Educate the person on cough etiquette and respiratory hygiene. Encourage them to keep their mouth covered and maintain personal hygiene. • It is better for TB patients to not spend much time outdoors or in the public.

World Tuberculosis Day: prevention, management and treatment of TB

World Tuberculosis Day: prevention, management and treatment of TB
IMA is determined to spread awareness and educate Indians about causes, prevention and management of Tuberculosis New Delhi, March 23, 2017: Every year March 24, is marked as World Tuberculosis Day, to spread awareness and educate people about the prevention and management of tuberculosis (TB). The Day also highlights the success and progress achieved till date in curbing TB. India has the highest TB burden in the world. According to WHO statistics (2014), globally 9 million people are diagnosed with TB out of which 2.2 million cases are reported from India. Around 40% of the Indian population is infected with TB bacteria, and among these TB patients cases of latent TB are significantly higher than active TB cases. Each year 12 lakh Indians are newly diagnosed with TB out of which at least 2.7 lakh Indians die. TB can affect any age, caste or race but poor people and mostly men are at increased risk of TB. Slum dwellers, tribal populations, prisoners and individuals with compromised immune systems are more likely to develop TB, compared to general population. The economic and social burden associated with TB is extremely high in India. It was observed that between 2006 and 2014, TB cost the Indian economy a massive loss of USD 340 billion. Padma Shri Awardee Dr KK Aggarwal, National President, Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon Honorary Secretary General IMA in a joint statement said that, “Because of lack of awareness, large number of TB cases either go undiagnosed, or if diagnosed, are not treated properly, or treated but not registered to Revised National Tuberculosis Control Program (RNTCP). Tuberculosis is a notifiable disease. IMA is determined to educate its 2.5 lakh members as well as the Indian population about the importance of timely diagnosis, prevention, management and rehabilitation of TB. IMA is determined to bring each and everyone together to help raise a common voice against the growing incidence of TB in our country and hope that we will fulfil the aim of Swachh, Swasth and TB Mukt Bharat.” “Tuberculosis is an extremely contagious disease that is transmitted from one person to another through droplet nuclei, which are less than 5 microns in size. These droplet nuclei can remain suspended in the air for long periods, and thus are a source of exposure to susceptible individuals from the throat and lungs of patients with active respiratory disease. The causative agent of TB is Mycobacterium tuberculosis, which most commonly affects the lungs. The common symptoms of active TB of the lung includes: cough, blood in sputum, chest pain, weakness, weight loss, fever and night sweats. Tuberculosis is a curable disease,” added Dr K K Aggarwal. Some points of importance about TB • Cough of more than 2 weeks, must not be ignored. • Diagnosis and management of TB cases should be done as per the IMA Standards for TB Care in India. • Serological tests for diagnosis of TB are banned in India. • MDR or multidrug drug resistant TB should be treated for at least 24 months. • Proper counseling of all TB patients on cough hygiene, nutrition & treatment adherence must be done.