India has the highest number of TB patients across the world

India has the highest number of TB patients across the world

Missing doses can defeat the purpose of DOTS therapy

New Delhi, 12 December 2017: According to recent reports, with 2.79 million cases, 4.23 lakh deaths, and an average of 211 new infections diagnosed per 100,000 people, India currently has the highest number of tuberculosis (TB) patients across the globe. India also has the most number of MDR-TB patients in the world as well as the largest number of ‘missing’ TB patients. There are several million who have not been identified, notified, or treated and these people remain off radar.

TB is a highly infectious disease cured by providing proper medication at the right time for the full duration of the treatment. The drug regimen is called DOTS and is provided free under the Revised National TB Control Programme (RNTCP). It is based on the principle that a regular and uninterrupted supply of high-quality anti-TB drugs must be administered to cure the disease and prevent the occurrence of the MDR-TB.

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, “TB is a major public health concern in India. Not only is it a major cause of morbidity and mortality but also poses a huge economic burden on the country. Elimination, which is defined as restricting new infections to less than one case per 100,000 people, is possible only when patients get diagnosed and cured without any break in treatment. Any interruption in treatment can exponentially raise the patient’s risk of developing MDR-TB, which is harder to treat. Missing doses defeats the very purpose of DOTS therapy, which is meant to ensure strict compliance through supervised consumption of medicines. As many as 900,000 people with TB do not have access to proper treatment, which means they risk developing drug-resistant TB and infecting others.”

Reporting is important to trace contacts of the person with infectious TB. All contacts of the patient should be screened for TB and put on treatment if required. This cascade of screening of contacts, at home and workplace, identifies individuals at risk and prevents further spread of TB, including MDR TB.

Adding further, Dr Aggarwal, said, “The approach to all notifiable diseases should be based on DTR: Diagnose, Treat, and Report. Diagnose early, using sputum Gene Xpert test; Treat: Complete and effective treatment based on national guidelines, using FDC; and Report: Mandatory reporting.”

Here are some tips that can help avoid TB infection from spreading.

Wash your hands after sneezing, coughing or holding your hands near your mouth or nose.
Cover your mouth with a tissue when you cough, sneeze or laugh. Discard used tissues in a plastic bag, then seal and throw it away.
Do not attend work or school.
Avoid close contact with others.
Sleep in a room away from other family members.
Ventilate your room regularly. TB spreads in small closed spaces. Put a fan in your window to blow out air that may contain bacteria. 

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

A World Asthma Day Initiative

A World Asthma Day Initiative Asthma attacks can be managed by an individual Asthma cases in India higher than TB and HIV combined; creating awareness is the need of the hour New Delhi, 01 May 2017: Statistics indicate that Asthma affects about 300 million people globally with about 250,000 people around the world dying prematurely due to this condition. About 80% of asthma deaths occur in low-income countries. It has been estimated that asthma will grow by more than 100 million by 2025. The picture is not too good in India either which has 20 million asthmatics with the burden higher than TB and HIV combined. With asthma cases grossly under-diagnosed and under-reported due to lack of knowledge among the general population, the condition is only likely to exacerbate. As in every year, the first Tuesday in May this year too, is being observed as the World Asthma Day. With the theme "You can control your asthma", the day this year aims at increasing awareness on asthma among people, and reiterate that this condition can be controlled with medication. Speaking about asthma and the theme this year, 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 "Every year, the World Asthma Day focuses on a certain theme. This year, it is about the patients managing asthma symptoms on their own. The patient must take initiative to stop/control their attacks, and till this happens, asthma deaths and hospitalizations cannot be reduced. On this World Asthma Day, we need to shatter all barriers, help raise awareness about the condition, and support those who are affected in any way possible." Asthma is a chronic respiratory disorder triggered by allergic reactions. It leads to breathing difficulties as a result of narrowing of the bronchial passage, which is responsible for carrying oxygen to the lungs. Asthma can have two affects: swelling in the lungs due to accumulation of mucus in the airways; and inflammation due to tightening of the muscles around the airways. Adding further, Dr Aggarwal, said, "Asthma is non-communicable. It is the duty of every individual to support asthma patients and remove the social stigma associated with it. One can support and help an asthmatic individual by creating awareness about the disease among the general population; accompanying the person to the hospital when in need; and ensuring that he/she takes proper medications on time." Every person with asthma can take small steps to keep their symptoms at bay. • Take your medications daily without fail. • Visit the doctor regularly. • Take only the prescribed medicines. • Take precautionary measures to avoid any triggers. • Always carry an inhaler with you and never feel shy to use it in public • Inform the doctor if any other health ailment is bothering you. • Lastly, don't take much stress and try to remain calm and happy.

World TB Day: Some key messages on TB

World TB Day: Some key messages on TB • India has the highest TB burden country in the world in terms of the absolute numbers of incidence cases each year. Mortality due to TB is the third leading cause of years of life lost (YLLs) lost, in the country. • TB is caused by bacilli spread through droplet nuclei (less than 5 microns) infection. Droplet nuclei can remain suspended in the air for extended periods, and thus are a source of exposure to susceptible individuals. • Split AC is not the right atmosphere for sputum-positive cases. Natural windows and fans are better alternatives. • TB does not spread through handshakes, using public toilets, sharing food and utensils, blood transfusion and casual contact. • TB can be of lungs (pulmonary), or outside the lungs (extra pulmonary). In 85% of cases, lungs are involved. • TB infection and TB disease are not the same; 90% of those infected may not develop TB in their life time. • Although TB is an infectious disease, all cases of TB are not infectious. Only sputum–positive TB patients are infectious to others. • Extra-pulmonary TB is not infectious. • All open TB patients need to immediately identified and treated till they become sputum negative and non-infective. • Most TB-positive patients do not disclose their TB status due to the fear of social stigma and so keep spreading the disease to others. • The public needs to be informed that every open case of TB will cause 15 new cases of TB, if not treated in time. • TB is a curable disease. Full and adequate treatment is important for complete recovery. • About 2-3% of TB cases have primary MDR TB. Whenever MDR TB is suspected, refer the patient to TB specialist • Do not ignore a cough of more than two weeks. • Every cough with or without sputum is not TB. • Any person with symptoms and signs suggestive of TB including cough >2 weeks, fever >2 weeks, significant weight loss, blood in sputum etc. and any abnormality in chest X-ray must be evaluated for TB. • Children with persistent fever and/or cough >2 weeks, loss of weight / no weight gain, and/or contact with pulmonary TB cases must be evaluated for TB. • If the first sputum is positive, a second sample should also be tested; if both are positive, this indicates heavy infection load. • Sputum should always be collected early in the morning as the first sample. Rinse the mouth with water and cough out the sputum. Do not use mouthwash. Move away from people, when collecting the sputum sample. • Patients with TB should dispose their sputum by burning, burying it in the soil or disinfecting them with a disinfectant. • All patient with cough should be provided with simple mask at the reception of a hospital. Doctors should wear N 95 mask for TB prevention • 10% of HIV–positive patients will develop TB every year. • If an elderly develops TB, rule out diabetes and if an elderly develops diabetes, rule out TB. • Rule out TB in every case of uncontrolled diabetes. • A minimum six months of treatment is required for a patient with TB. • In TB meningitis, treatment duration of 9 months is required • Bone TB requires treatment for 9 months. • Diagnosis and treatment for both, drug sensitive and drug resistant TB, under RNTCP, is free of cost. • The first-line drugs used for new TB cases under RNTCP are a combination of rifampicin, isoniazid, ethambutol and pyrazinamide, administered as standardized treatment regimen. Injection Streptomycin is an additional drug given to re-treatment cases. • The main second-line anti-TB drugs for treatment of MDR-TB are kanamycin, levofloxacin, ethionamide, pyrazinamide, ethambutol and cycloserine. • TB drugs are often taken as single dose. Divided doses are not recommended. • It takes up to 15 days for a sputum-positive case to make non-infectious case. The first 15 days before a person becomes non-infectious are most dangerous to the family members as the bacilli is most infectious during this period. • A sputum-positive case, if not treated, remains infective for the coming 2 to 3 years. • If untreated, two-thirds of people with full blown TB will die. • It is very important to trace or track every contact of TB. • If the patient stops treatment within one month, restart the treatment & complete it. • If the patient stops the treatment for more than one month, he/she should be treated as re-treatment case. Cases where the gap in treatment is more than one month should be referred to and treated by TB Specialists. • Treatment of sputum-negative TB is similar to that of a new sputum-positive case. • Treatment of extra pulmonary TB is similar to that of a new sputum-positive case. • Presumptive TB patients without microbiological confirmation (smear microscopy, culture and molecular diagnosis), but with strong clinical and other evidence (e.g. X-ray, Fine Needle Aspiration Cytology (FNAC, histopathology) may be diagnosed as “Probable TB” and should be treated. • In children, anti-TB drugs are to be given as per weight for each child. • Vide letter number Z-28015/2/2012-TB, the Government of India, Ministry of Health and Family Welfare on 7th May 2012 declared TB as a notifiable disease. • Not notifying TB is a violation of MCI Act (5.2, 7.14), Municipal Corporation Act and Sections 269 & 270 of the Indian Penal Code. • In adults starting ATT only on the basis of X-day or tuberculin test may amount to deficiency in service under CPA. • Compliance of treatment should be counseled. Not counseling a patient about compliance may amount to violation of Indian Penal Code under Clauses 269 and 270. • Maintenance of written records in TB care is very important. • Government of India has released Standards for TB Care in India (STCI), an initiative to introduce uniform standards for TB care in all sectors. • Serological tests for TB are banned in the country. • In 2016, Bedaquiline, a new anti-TB drug for treatment of MDR TB was launched as part of the RNTCP. It is being introduced at six identified tertiary care centres across India. • Cartridge Based Nucleic Acid Amplification Test (CBNAAT) was also introduced in the program in 2016. CBNAAT is a rapid molecular test which detects Mycobacterium tuberculosis and rifampicin drug resistance, simultaneously. • IMA plans to open IMA Surveillance Cell, IMA Single Window Disease Surveillance and Adverse Events Reporting Cell under one roof for Notifiable diseases such as TB and other communicable diseases. • IMA is committed to the SDG target (3.3) of ending the epidemic of TB by 2030. Dr KK Aggarwal National President IMA & HCFI

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.

New IDSA guidelines on diagnosis of TB in adults and children

New IDSA guidelines on diagnosis of TB in adults and children A task force supported by the American Thoracic Society (ATS), Centers for Disease Control and Prevention (CDC) and Infectious Diseases Society of America (IDSA) has published new guidelines on the diagnosis of tuberculosis (TB) and latent tuberculosis infection (LTBI) in adults and children. The guidelines published in the January 2017 issue of the Clinical Infectious Diseases journal include 23 evidence-based recommendations about diagnostic testing for latent tuberculosis infection, pulmonary TB and extrapulmonary TB. The six strong recommendations include: • An interferon-γ release assay (IGRA) rather than a tuberculin skin test (TST) should be done in individuals 5 years or older who are likely to be infected with Mtb, who have a low or intermediate risk of disease progression, and in whom it has been decided that testing for LTBI is warranted. • Acid-fast bacilli (AFB) smear microscopy is recommended in all patients suspected of having pulmonary TB. • Rapid molecular drug susceptibility testing for rifampin with or without isoniazid is recommended using the respiratory specimens of persons who are either AFB smear positive or Hologic Amplified MTD positive and who meet one of the following criteria: (1) have been treated for tuberculosis in the past (2) were born in or have lived for at least 1 year in a foreign country with at least a moderate tuberculosis incidence (≥20 per 100 000) or a high primary multidrug-resistant tuberculosis prevalence (≥2%) (3) are contacts of patients with multidrug-resistant tuberculosis, or (4) are HIV infected. • Mycobacterial cultures should be done on specimens collected from sites of suspected extrapulmonary TB. • Genotyping should be done on one culture isolate from each mycobacterial culture-positive patient.

First of its kind e-meet on Tuberculosis held between 1000 IMA doctors from across 28 of its State branches and the Association leadership

First of its kind e-meet on Tuberculosis held between 1000 IMA doctors from across 28 of its State branches and the Association leadership

The interactive webcast was an initiative under IMA Digital, a program in line with the Prime Minister’s Digital India initaitve

New Delhi, July 23 2015: Bridging the vast geographical gap that exists in our country, the Indian Medical Association has launched several digital initiatives aimed at more efficient implementation of its programs. As a part of this, a first of its kind e-meet was held between 2-3pm today which connected over 100 doctor members of IMA from across States with the leadership on the subject, “Why notifying tuberculosis cases was important”.  The overall aim of the Indian Medical Association is to use the digital medium to amplify important healthcare messages to both its 2.5-lakh doctor members and to the public at large.

Interacting with over 1000 IMA doctors from across the country, Padma Shri Awardee, Dr A Marthanda Pilliai, National President, IMA and Padma Shri Awardee, Dr KK Aggarwal, Honorary Secretary General, IMA in a joint statement said, “In May, 2012 the Ministry of Health & Family Welfare declared Tuberculosis as a notifiable disease. Most Municipal Corporation Acts also include Tuberculosis under the section of dangerous diseases, which mandate reporting. The Medical Council of India in its ethics for doctors clearly states under regulations 5.2 and 7.14 that it is mandatory for all practicing doctors of modern medicine to notify communicable diseases, which includes Tuberculosis. It further states that once Tuberculosis is notifiable disease as per the IMA guidelines, there is no question of confidentiality or privacy.”

There are provisions of Negligent Act likely to spread infection under Indian Penal Code Section 269-270. Section 270 specially applicable to MDR Tuberculosis. If spread of Tuberculosis is allow to continue  in the society by not taking treatment or not advising treatment may amount to negligence under Indian Penal Code.

The IMA further said that each person who gets exposed to a patient suffering from Tuberculosis must traced and treated. One undetected Tuberculosis patient can spread the disease to 20 additional people on an average and can continue to do so for up to 2-3 years. 10-14% of the total cases where the patient receives only half the treatment can take more serious forms and develop into MDR TB. MDR Tuberculosis is highly contagious and can cause the infection to spread to healthy people at a rapid speed.

In addition to the e-meet, IMA has already created a digital group called Team IMA, which will make daily communication between over over 2000 Central Council Members possible. Since the beginning of this year, over 2 lakh doctor members of the IMA are being sent daily updates on the organization and key health matters through the medium of text messages and emails.  

IMA will also be launching a first of its kind Tele Medicine Rural Health Consultation service on 16th August, 2015 where the IMA Dhule Branch will connect with the IMA headquarters through video conferencing.