India contributes to 27% of global TB burden. It is estimated that over 35-50cr population in India have TB infection and over 26 Lakh people develop tuberculosis annually. Globally, 3.5% of new TB cases and 18% of previously treated cases had multidrug resistant / rifampicin resistant TB (MDR/RR-TB).
Worldwide, TB is the 13th leading cause of death and the second leading infectious disease killer. In 2020, an estimated 10 million people developed TB worldwide and 1.5 million people died from TB. It not only impacts the health of infected individuals but also their social and economic condition. Globally, around one out of two TB-affected households face costs that exceed 20% of the annual household income.
TB spreads from person to person through air. When a person infected with lung TB coughs, sneezes, or spits; the TB bacteria are dispersed in air. When another person inhales these bacteria containing air, they are likely to become infected. However not all individuals that are infected develop active TB disease. The common symptoms of active TB disease are low grade fever, chronic cough (lung TB), night sweats and weight loss.
Gold standard for detection of TB including drug resistant TB remains culture test. However, it may take several weeks for the result to arrive. Nucleic acid amplification tests (e.g., CB-NAAT, LPA) shorter this time to detection from several weeks to a few hours or days. The current NAATs can detect drug resistant mutations in limited number of known target regions of the TB bacterium. Whole genome sequencing, an advanced technology can identify drug resistant targets in the entire genome of the TB bacterium. This technology will be included in the management algorithm under Programmatic Management of Drug Resistant Tuberculosis (PMDT) guidelines in India.
TB is a notifiable disease. If any individual is diagnosed with TB, it must be notified to national surveillance system through “Nikshay” who is given a unique Nikshay identification number under NTEP. NTEP is National Tuberculosis elimination programme. The programme provides free diagnosis and treatment to notified patients in public sector. But not many are aware that these free services can be accessed by patients in private sector also through attractive linkages.
World Health Organisation's (WHO) has set the target for TB elimination globally by 2035. But in 2017 Government of India has set its own target for TB elimination a decade earlier that is by 2025. Let us help our government achieve this goal by:
- Not spitting on road and not allowing others to spit on road
- Seek medical advice and test for TB if cough persists for more than 2 weeks
- Cover mouth and nose when coughing or sneezing
- People taking TB treatment should complete the full course
If full course of treatment is not completed it may lead to drug resistant TB. When TB causing bacteria replicate some of them mutate and can become resistant to anti-TB drugs. India has the highest incidence of drug resistant TB followed by China and Russia. Individuals with drug resistant TB need to be put on second line drugs. These are expensive, have more side effects and take longer to treat. Remember TB maybe a killer but it is curable and preventable.
Recently Agilus also launched the Whole Genome Sequencing test for Tuberculosis. The test enables a clinician to decide the most appropriate drug regimen by providing an accurate and clinically relevant diagnosis within few days. In addition to its use in accurate detection of drug resistance, the test has the potential to revolutionize epidemiology studies and disease surveillance. The pandemic has reversed years of progress made in Tuberculosis control not just in India but across the globe. Relevant use of advanced and rapid diagnostics technology can help create a major breakthrough in tuberculosis diagnosis and control. This genomic test is particularly useful for antibiotics such as Ethambutol, Pyrazinamide, Ethionamide and Linezolid due to challenges associated in traditional culture methods. Additionally, the test also covers all drug resistance markers as the test targets complete genome (4.4 Mb) of M. tuberculosis thereby enabling drug resistance detection for 18 different drugs. It is also designed to detect mixed infections and co-infections including Nontuberculous Mycobacteria infections (NTM) and Mycobacterium other than tuberculosis (MOTT) infection (MOTT).
References:
- https://www.who.int/news-room/fact-sheets/detail/tuberculosis
- https://tbfacts.org/tb-statistics-india/
- World Health Organization Global tuberculosis report 2020 Available from: https://apps.who.int/iris/bitstream/handle/10665/336069/9789240013131-eng.pdf
- Guidelines for Programmatic Management of Drug Resistant Tuberculosis (PMDT) guidelines in India
Agilus Diagnostics, a subsidiary of Fortis Healthcare Limited
