Dear Editor:
World Tuberculosis Day is observed on 24th March every year. This annual event commemorates the date in 1882 when Dr. Robert Koch announced his discovery of Mycobacterium tuberculosis, the bacteria that causes Tuberculosis (TB). Koch's discovery opened the way towards diagnosing and curing tuberculosis. This year the slogan for world TB day was, "I am stopping TB". This slogan started last year on world TB day 2008 as a two-year campaign that belongs to people everywhere who are doing their job to control TB. This year’s World TB Day is about celebrating the lives and stories of people affected by TB: women, men and children who have taken TB treatment; nurses; doctors; researchers; community workers and anyone who has contributed towards the global fight against TB.
This day also provided us an opportunity to create awareness regarding tuberculosis, to communicate tuberculosis-related problems and solutions, and support TB control program.
TB is one of the most ancient diseases and is mentioned in the Vedas and Samhitas. Those days no effective medicines were available. It was only by the middle of the 20th century that some drugs were tried out, but as no single drug was found sufficient to cure TB. A combination of four drugs viz. Isoniazid, Rifampicin, Ethambutol and Pyrazinamide were introduced which ultimately proved to be sufficient to cure TB. Of these four, Rifampicin is the most important drug and its discovery in the year 1967 was the turning point in the effective treatment of TB.
In 2006, 1,621 cases in Canada (5.0 per 100,000 population) of new active and relapsed TB were reported to the CTBRS. The highest rate of 155.9 per 100,000 population was reported in Nunavut. There were no TB cases reported from Prince Edward Island for 2006. The three most populous provinces (British Columbia, Ontario and Quebec), which collectively made up 76% of Canada’s population in 2006 accounted for 73% of the total number of reported cases.
Individuals between the ages of 35 and 44 made up the largest number of reported cases, accounting for 17% of the total. TB among foreign-born individuals accounted for 64% of all reported cases in Canada. Canadian-born non-Aboriginal and Canadian-born Aboriginal cases made up 12% and 20%, respectively.
Pulmonary TB, defined as tuberculosis of the lungs and conducting airways, was the most frequently reported main diagnostic site, representing 62% of all reported cases in 2006. TB of the peripheral lymph nodes accounted for 15% of all cases and was the second most commonly reported diagnostic site.
The best overall source for statistics on respiratory diseases in Canada is the report called Life and Breath: Respiratory Disease in Canada released in November 2007. This report is a collaborative effort of the Public Health Agency of Canada's Centre for Chronic Prevention and Control, the Canadian Lung Association, Statistics Canada, and the Canadian Institute for Health Information.
In India TB is a killer disease. Statistics given by the Ministry of Health and Family Welfare are horrific. TB causes three hundred and seventy thousand (370,000) deaths each year in India. This means that nearly one thousand (1000) people die each day due to TB or in other words two deaths in every three minutes! Every year eighteen hundred thousand new cases of TB are reported in India out of which eight hundred thousand are potentially infectious cases that can spread to others. India’s share of the global burden of Tuberculosis is very high – as high as 1/3rd.
Usually TB affects the lungs; but it can affect almost all the organs of the body excluding hair and nails. It’s a contagious disease that spreads through the air like the common cold. Only people who are sick with TB in their lungs are infectious. When infectious people cough, sneeze, talk or spit, they propel TB bacilli into the air. A person needs only to inhale a small number of these to be infected. If not treated, each person with active TB can infect on average 10 to 15 people a year. However infection with TB does not necessarily mean that the infected person would develop TB disease. An infected person develops disease when his/her immunity declines.
Diagnosis can be made through quality sputum examination of patients who are having the chest symptoms like cough more than three weeks.
TB is a curable disease. Treatment period is of six to eight months. Some types of TB may require longer treatment. Patients should not discontinue treatment midway on their own volition. If such persons get TB again, it will be difficult to treat them, as some may develop drug resistance. Directly Observed Treatment, Short-course is known as DOTS and is the only proven strategy for effective control of TB on a mass basis. DOTS was introduced in India in 1993 with excellent results as Revised National Tuberculosis Control Program (RNTCP) and by March 2006 RNTCP covered the entire population in India. In DOTS, patients swallow the medicine in the presence of a DOTS provider so that there can be no chance of TB patients not adhering to treatment.
The Human Immunodeficiency Virus (HIV, the virus that causes AIDS) is the strongest risk factor for tuberculosis among adults. Tuberculosis is one of the earliest opportunistic diseases to develop amongst persons infected with HIV. HIV debilitates the immune system increasing the vulnerability to TB and increasing the risk of progression from TB infection to TB disease. An HIV positive person is six times (50-60% life time risk) more likely of developing TB disease once infected with TB bacilli, as compared to an HIV negative person. Until 50 years ago, there were no medicines to cure TB but now, though there are effective medicines, there are also TB bacteria on which the medicines have no effect. Such Drug-resistant TB is caused by inconsistent or partial treatment because patients do not take all their medicines regularly for the required period.
If TB is to be brought under control, there needs to be more political motivation and community involvement. Poverty, ignorance and illiteracy are a big hindrance. TB control is possible only if people from all walks of society come forward, like patients who have been cured of TB after taking anti TB medicines, volunteers from community, NGO’s, corporate sector etc and make TB control program a success in world.
Kanayalal Raina, Brampton
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