MDR TB should be declared a public health emergency

MDR TB should be declared a public health emergency Not adhering to prescribed medications can lead to MDR TB in existing TB patients New Delhi, 13 August 2017: As per available statistics, India accounts for one-fourth of the global TB burden of both TB and MDR TB. About 1.3 lakh incident multi-drug resistant (MDR) TB cases occur in India every year, including 79,000 MDR-TB cases among the notified pulmonary cases. As per the IMA, to prevent the epidemic of MDR TB, it should be declared a public health emergency. Multidrug resistant (MDR) TB is TB resistant to both isoniazid and rifampicin with or without resistance to other first-line anti-TB drugs. Extensive drug resistant (XDR) TB is TB resistant also to a fluoroquinolone (ofloxacin, levofloxacin or moxifloxacin) and a second-line injectable anti TB drug (kanamycin, amikacin or capreomycin). 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, “Tuberculosis (TB) is a major public health concern in the country. Despite advances in TB care, the disease continues to be a major cause of morbidity and mortality. And, it takes a heavy toll on the economy too. Emergence and spread of drug-resistant TB has become a major public health concern now. A person can acquire MDR TB in two ways. First is when a person does not take drugs as instructed by the health care provider or does not take the correct drugs. This situation is likely when the bacteria are resistant to more drugs than the health care provider has prescribed. One can also get MDRTB if they become infected with TB bacteria from another person who already has MDRTB. This is known as primary TB.” The symptoms of MDR TB are similar toregular TB: severe cough lasting for three weeks or more, bloody or discolored sputum, night sweats, fever, fatigue and weakness, pain in the chest, loss of appetite, pain in breathing or coughing, and weight loss. Adding further, Dr Aggarwal, said, “A person can develop XDR-TB if the treatment for MDR TB fails. The treatment for this acquired disease is lengthier, more complex, and expensive. At time, XDR TB can even be impossible to treat and be a death sentence. It is difficult to estimate the incidence of XDR-TB is as many laboratories are ill-equipped to detect and diagnose it. As a result, many of the cases go undocumented.” Here are some tips prevent TB. • Vaccination Newborns must be given the BCG vaccine to protect them against TB. • Keep your immunity high Vaccines may not be able to provide life-long protection. Thus, it is important to maintain a healthy lifestyle and consume a healthy diet rich in fresh fruits and vegetables. Quit smoking and drinking alcohol, exercise regularly, and stay fit. • Maintain good hygiene Certain simple hygienic practices such as covering the mouth while coughing, not spitting in public places, etc. are good ways to avoid infections from spreading. Wash your hands before eating and drink clean water. If you are around someone you know is suffering from TB, avoid direct contact with them. • Take medications on time This is one of the major reasons for acquiring MDR TB. People who have the infection are carriers of the disease. If they don’t adhere to the prescription, the TB bacteria can develop resistance to the drugs.

MDR-TB is a public health emergency

MDR-TB is a public health emergency Over the years, there has been an alarming increase in cases of drug-resistant TB in India. The prevalence of MDR TB is more than 2% in primary TB cases. India has the highest burden of TB patients, including drug resistant patients in the world. MDR-TB is a public health emergency, not only for patients but also for doctors, who are at risk of acquiring the infection from their patients. Control of TB should therefore be of immediate priority for all stakeholders including health care providers and policy makers. Inaccurate diagnosis and/or delayed diagnosis, especially detection of infected but asymptomatic patients (latent TB) as well as incomplete treatment are fueling this epidemic of MDR TB. The entire country is in a state of “angina” with an impending “TB attack”. GTN (glyceryl trinitrate) is used to relieve angina and prevent an anticipated heart attack such as before exercise. A similar “GTN” is needed to prevent “TB attack”. It’s time to adopt and implement an intensive strategy to control this preventable and curable disease. Yesterday, I had spoken about the IMA TB Initiative “DTR-C” “Diagnose, Treat, Report to track Contacts”. We received suggestions and inputs on this, following which, we have altered the message of our campaign to “IMA TB Initiative: GTN”. G: GeneXpert test (diagnose) T: Treat (patients) & Trace (contacts) N: Notify (mandatory) Dr KK Aggarwal

IMA-FOMA emergency meeting discusses generic drugs

IMA-FOMA emergency meeting discusses generic drugs Urges government to strengthen quality control mechanisms New Delhi, April 30, 2017: With the on-going confusion and deliberations on the prescription of generic and branded drugs in the country, an emergency meeting was conducted by the Indian Medical Association–Federation of Medical Associations of India (IMA– FOMA) at the IMA Headquarters in Delhi. The meeting was held to discuss t/he emergent situation on generic drugs as well as the prescription of generic name of drugs by medical professionals. The IMA-FOMA lauded the Hon'ble Prime Minister's concern about the availability, accessibility, and affordability of quality economical drugs to the society. The body also recommended that the government should ban differential pricing of a drug under different brand names and advocated for "one chemical drug, one company, one price". 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, "The medical fraternity collectively wants the government to strengthen quality control mechanisms to ensure adherence to good manufacturing practices for the safety of patients. While we are all for the move on conducting bioequivalence tests for drugs, it is also a fact that the judgment to choose a rational drug and its format vests only with the registered medical practitioners. This right of the medical profession is sacrosanct." Amidst directions by the MCI, which state that doctors should prescribe generic drugs to patients, IMA-FOMA members felt that for a rational prescription, doctors should choose drugs (generic– generic or generic–brand based) depending upon their quality, efficacy, and economy. This prescription should also be written legibly and preferably in capital letters. Adding further, Dr Aggarwal said, "As per a study based on clinical trials, there is no evidence that brand name drugs worked any better than generic drugs. And therefore, we suggest that differential pricing be done away with and a uniform policy be adopted." The meeting was attended by the following associations: Indian Medical Association, All India Ophthalmological Society, Urological Society of India, Geriatric Society of India, Indian Radiology and Imaging Association, Indian Academy of Echocardiography, Heart Care Foundation of India, Cardiological Society of India, Association of Surgeons of India, Indian Psychiatric Society, Delhi Psychiatrist Society, Indian Orthopaedic Association, The Federation of Obstetric and Gynaecological Societies of India, Indian Association of Dermatologists, Venereologists and Leprologists, Association of Physicians of India, Indian Academy of Echocardiography, and FFPAIA. IMA–FOMA will be meeting the President of MCI, Union Health Minister and Prime Minister of India about the views of the medical fraternity on this issue. All the constituent members of IMA–FOMA shall communicate these Delhi Resolutions to its members.