It’s Time to End TB

WHO

Tuberculosis (TB) has been a constant companion of mankind for more than 4,000 years. Now celebrated once a year to raise awareness on March 24, the day commemorates the discovery of the bacteria which causes the disease by Dr. Robert Koch. The World TB Day aims to educate people about the impact the disease collectively has on human race, and to share success stories and raise awareness about the disease with the world.

This year the World Health Organization and Centers for Disease Control and Prevention (CDC) picked “It’s time” as the theme for the day. The aim was to highlight key agendas which should be adopted to eradicate TB disease.

The TB, caused by a bacteria known as Mycobacterium tuberculosis, can spread from one person to another through air. It usually affects human lungs, but it can also infect brain, kidneys, eyes, intestines and even spine. The symptoms of the disease vary according to the site of infection in the body. In case of infection of lungs, symptoms like pain in the chest, chronic cough, haemoptysis, fatigue, weakness, fever, weight loss and night sweats can occur.

Eliminating TB

Over the years, WHO has used different strategies to deal with global burden of tuberculosis. These include the Dots Strategy (1994-2005), the Stop TB Strategy (2006-2015), and the current End TB Strategy (2016-2035).

Source: European Respiratory Review

Now, the health organization has launched a new initiative with the help of Global Fund and Stop TB Partnership. The joint initiative is called “Find. Treat. All. #EndTB”. The aim of the initiative is to accelerate TB response and ensure access to care. This folds into the WHO’s bigger plan, universal health coverage.  This multiple pronged strategy encompasses several key actions being taken by the health organizations, such as WHO and CDC, including:

Raising Awareness and Educating People About TB

Awareness is key when fighting any infectious disease. The more the people know about a disease and the importance of stopping it, the more focus can be put on it along with funds to stop the disease in its tracks. To eliminate TB and to stop its spread, keeping awareness about the disease and educating people on the subject is key. And the higher the awareness, the higher will be the funds directed towards the problem. World TB Day is a part of this awareness and education campaign.

Sharing Stories to End the Stigma Attached To TB

Sharing TB Battle stories can be the difference between people knowing the disease or not. When people share their stories, others can put a face to the problem and make a human connection. This also helps negate stigmas attached to the tuberculosis disease.

Testing and Treating Latent TB Infections

There are 13 million people in United States alone with latent infections of tuberculosis. CDC is now suggesting active testing of people who are at high risk of TB, for latent infections. This can help curb the burden of infections of TB.

Investing in Research, Innovation and Health care

As new stronger and resistant strains of the bacterium that causes tuberculosis emerge, there is an increased need to accelerate treatment options for people suffering due to them. Other areas in which research can be vital include better diagnostic capabilities to diagnose children who are difficult to diagnose, equipping doctors with strategies to prevent latent infections from turning into active infections, and vaccinations for resistant strains.

New WHO Recommendations for TB Prevention

WHO now recommends a wide range of approaches to scale up access to preventative TB Treatment. The new guidelines highlight and summarize these approaches as following:

  • Scaling up of preventative TB treatment in populations that are at high risk such as people living with someone who has TB, people with HIV, people living in crowded areas, or people with lowered immunity.
Source: WHO
  • Integration of TB preventative treatment services into ongoing case finding efforts for active TB.
  • Using interferon-gamma release assay (IGRA) or tuberculin skin test to check for TB infection.
  • Using shorter option for preventative treatment such as 1-month daily regimen of rifapentine plus isoniazid, 4 months of daily rifampicin alone, 3 months daily rifampicin plus isoniazid, or 3 months weekly rifapentine plus isoniazid.

Anyone Can Get Infected by TB

You can easily get infected with TB if you come in contact with this bacterium or a person infected with the TB disease. TB is highly contagious and can spread quickly from one person to another. This bacillus bacteria has an airborne transmission and can be caught if you breathe in the infected air of a person who has the disease. An infected person can transmit the bacterium through breathing, talking, coughing, sneezing and even singing. These activities can force the TB germs into the air. Once a person breathes them in, he or she can get infected too.

It does not matter where you are or who you are. You can get TB as easily as common flu. One third of people who get exposed to these germs get infected with tuberculosis. Furthermore, one in 10 adults with normal functioning immune system get the TB disease after exposure. Half of these people develop the disease within two years.

People who have a high risk of developing tuberculosis include the ones with medical history of rheumatoid arthritis, severe kidney disease, HIV, diabetes, lymphoma, leukemia, silicosis, head and neck cancer.

You can Have Latent or Active TB

Source: AIDS Info, NIH

A person after exposure can either have latent TB infection or TB disease (active TB). This particular bacterium can live in human body without causing disease. This state is called latent TB infection. In conditions where the body fights bacteria from growing, a person can have bacterium in their body but not feel sick, have any symptoms, or be able to spread TB bacteria to others. According to estimates, 13 million people in United States alone have latent TB infection.

On the other hand, people who have underworking immune systems can develop TB disease. When defenses of immune system fail, TB bacteria multiplies in the body. This results in development of active tuberculosis. People with active form of TB are infectious and can spread the bacterium. If a person is suspected of having the TB disease, he or she should receive complete medical evaluation. If not treated timely, the disease can be fatal.

Diagnosis and Treatment

The most commonly used method to diagnose TB is sputum smear microscopy. In this method a laboratory technician takes sputum samples and studies them under a microscope. If bacteria are present, the patient is declared TB positive. This method is only effective in diagnosing half of the cases and cannot be used to diagnose the drug resistant TB.

A comparatively newer technique in common use since 2010 is the rapid test Xpert MTB/RIF®. The test can detect the TB disease and resistance to the drug rifampicin simultaneously. The test can provide a diagnosis in two hours. WHO recommends this test as the initial diagnostic step for all the people who show symptoms of TB. Diagnosing drug resistant TB (especially multi-drug resistant) can be especially expensive and complex. WHO since 2016 has recommended the use of four diagnostic tests, including a rapid molecular test to detect TB where the rapid test Xpert MTB/RIF® cannot be used and three other tests that detect resistance to first- and second-line TB medications.

Source: CDC

This disease is both treatable and curable. The standard treatment includes a six-month course with four antimicrobial drugs. According to estimates, between 2000 and 2018, 58 million lives were saved with help of treatment of TB.

TB Risk Factors

Some people have a higher risk of developing tuberculosis. These risks include:

  • People who spend time with someone with TB
  • People in countries where this disease is high incidence
  • People who work in high risk settings like nursing homes, prisons, homeless shelters
  • Healthcare workers who work with patients with high risk of TB disease
  • Children and adolescents who spend time with adults having latent TB infections

Drug Resistant TB

Drug resistance can occur when anti-TB drugs are used incorrectly, such as incorrect prescriptions by health care professionals, patients stopping treatment prematurely, or poor quality of the drugs themselves.

In cases of multi-drug resistant TB (MDR-TB), the TB is caused by bacterium resistant to isoniazid and rifampicin. These two are powerful first line drugs. In such a case, second line drugs are used. However, with these types of drugs options are limited and there is a requirement of extensive chemotherapy of up to two years. In cases of extensively drug resistant TB (XDR-TB), the bacterium is resistant to even second line drugs. This leaves patients without any treatment options in many cases.

MDR-TB is an increasingly worsening problem in the world. Only 56% of such cases are successfully treated. Of all of such cases, 6.2% are of extensively drug resistant TB.

Source: Doctors without Borders

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