World Tuberculosis (TB) Day

Context

Each year, World Tuberculosis (TB) Day is commemorated on March 24 to raise public awareness about the devastating health, social and economic consequences of TB, and to step up efforts to end the global TB epidemic.

World TB Day:

• World TB Day is a day to educate the public about the impact of TB around the world.
• The date marks the day in 1882 when Dr Robert Koch announced that he had discovered the bacterium that causes TB, which opened the way towards diagnosing and curing this disease.
• Theme: The theme of World TB Day 2020 - ‘It’s time’ – puts the accent on the urgency to act on the commitments made by global leaders to:
  • scale up access to prevention and treatment
  • build accountability
  • ensure sufficient and sustainable financing including for research
  • promote an end to stigma and discrimination
  • promote an equitable, rights-based and people-centered TB response

What is Tuberculosis?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        

• Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis is curable and preventable.
• Transmission: TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air.
• A person needs to inhale only a few of these germs to become infected.
• Symptoms: Common symptoms of active lung TB are cough with sputum and blood at times, chest pains, weakness, weight loss, fever and night sweats.
• About one-quarter of the world's population has latent TB, which means people have been infected by TB bacteria but are not (yet) ill with the disease and cannot transmit the disease.

Multidrug-resistant tuberculosis (MDR-TB):

• Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not respond to isoniazid and rifampicin, the 2 most powerful first-line anti-TB drugs.
• MDR-TB is treatable and curable by using second-line drugs. However, second-line treatment options are limited and require extensive chemotherapy (up to 2 years of treatment) with medicines that are expensive and toxic.
• In some cases, more severe drug resistance can develop. Extensively drug-resistant TB (XDR-TB) is a more serious form of MDR-TB caused by bacteria that do not respond to the most effective second-line anti-TB drugs, often leaving patients without any further treatment options.

Learning from Data:

• TB remains the world’s deadliest infectious killer. Each day, over 4000 people lose their lives to TB and close to 30,000 people fall ill with this preventable and curable disease.
• Global efforts to combat TB have saved an estimated 58 million lives since the year 2000.
• To accelerate the TB response in countries to reach targets – Heads of State came together and made strong commitments to end TB at the first-ever UN High Level Meeting in September 2018.

India’s progress on the disease:

• Marking World TB Day 2020, India’s progress against the disease has seen both highs and lows. As a country possessing one of the highest global case counts, how India deals with the disease is crucial.
• India has the world’s highest incidence of TB, with almost 2.8 million cases annually, and it accounts for more than a quarter of the global TB burden.
• India also has the largest burden of multi-drug-resistant TB (MDR-TB) among all countries, with almost 1,50,000 cases every year. 
• TB kills more than 435,000 Indianseach year, making the illness among the top 10 causes of death in the country.
• Globally, of the 500,000+ people who develop drug-resistant tuberculosis (DR-TB) each year, India currently contributes to over 25 percent of cases.
• This is a critical point in India’s fight against the disease, as a failure to tackle these drug-resistant strains could allow the proliferation of TB cases that are far more difficult to address.
• On an annual basis, there are over 100,000 new cases of DR-TB in India.
• India lags far behind on targets aimed at reducing disease incidence by ninety percent and mortality by 95 percent by 2035 as compared to 2015, as the Lancet Commission on Tuberculosis noted in a report issued last year.
• India has set its goal of TB elimination by 2025 ahead of global target of 2030.
• The deadline of 2025 puts India five years in advance of the WHO goal of 2030. Such a goal is ambitious, especially considering the scope of the problem in India. 

WHO’s new guidelines:

The new consolidated guidelines recommend a range of innovative approaches to scale up access to TB preventive treatment:

• WHO recommends a scale-up of TB preventive treatment among populations at highest risk including household contacts of TB patients, people living with HIV and other people at risk with lowered” immunity or living in crowded settings.
• WHO recommends an integration of TB preventive treatment services into ongoing case finding efforts for active TB. 
  • All household contacts of TB patients and people living with HIV are recommended to be screened for active TB.
  • If active TB is ruled out, they should be initiated on TB preventive treatment.
• WHO recommends that either a tuberculin skin test  or interferon-gamma release assay (IGRA) be used to test for TB infection.
  • Both tests are helpful to find people more likely to benefit from TB preventive treatment but should not become a barrier to scale-up access.
  • Testing for TB infection is not required before starting TB preventive treatment in people living with HIV, and children under 5 years who are contacts of people with active TB.
• WHO recommends new shorter options for preventive treatment in addition to the widely used 6 months of daily isoniazid.
  • The shorter options that are now recommended range from a 1 month daily regimen of rifapentine plus isoniazid to 3 months weekly rifapentine plus isoniazid, 3 months daily rifampicin plus isoniazid, or 4 months of daily rifampicin alone.

How a day can make a change?

• This day is a valuable opportunity to educate the public about the devastation of TB disease and how we can work together to prevent it.
• The public is made aware about the negative consequences of TB with regard to health, society and economics. Moreover, leaders are called upon to step up the fight against tuberculosis

Conclusion:

As people around the globe come together to commemorate World Tuberculosis Day, the World Health Organization (WHO) is calling to unite global forces and step up the TB response - notably for TB preventive treatment - to ensure no one is left behind. The new WHO guidance shows the way forward for millions to rapidly access new tools and shorter, safer options for preventive treatment. The time for action is now. TB preventive treatment is an affordable intervention that can prevent families from sliding into poverty and preserve the health and economy of whole communities. WHO anticipates that as new and safer drugs come onto the markets, and as prices fall, it will become a highly-cost effective way to save millions of lives.