(1) Been working in Public Health, esp. in the field of Tuberculosis since almost 2 decades now. I continue to be surprised, almost on a daily basis, at the level of ignorance that persists in the community regarding this killer disease. Hence the thread - prepare to be shocked..
(2) First Things first – TB is caused by a bacteria. In India, it is estimated that every year ~27 lakh people fall ill with TB and ~4.5 lakh succumb. For perspective, so far, ~1.5 lakh deaths have been attributed to Covid – meaning, TB is thrice as deadly as Covid.
(3) Lesser known fact (1) TB is probably the only disease which can affect any living tissue of our body. Think of any body part or tissue and you can get TB there. However, it most commonly (70%) affects the Lungs (Pulmonary TB).
(4) ~40% of the adult population is infected with the TB bacillus. Known as Latent TB. Significant? YES. Normally, only 5-15% of these will develop the disease in their lifetimes. However, if immunity is compromised, the risk goes up – way up. Think HIV, Diabetes, Malnourishment.
(5) Why does this ancient disease continue to be such a big problem in this day and age? To control / eliminate / eradicate any disease, 3 things are vital. An affective vaccine (to prevent), effective diagnostics and effective treatment. So, lets look at all the 3 for TB.
(6) Vaccine first: The bacillus causing TB was discovered in 1882. Thus far, we have exactly ONE vaccine for this – the BCG. The efficacy of BCG in preventing TB is one of the most debated topics.
(7) However, BCG DOES accord protection against certain severe forms like TB meningitis and disseminated disease thus preventing deaths.
(8) For context, look at the vaccine development for Covid – right from R&D to trials to roll out – in months. And multiple very efficient vaccines at that. TB has ONE – since last 140 years – and a dicey one at that.
(9) Diagnostics: There is ONE and only ONE way to diagnose TB- by actually demonstrating the presence of the bacteria in the human body. Which means, one has to actually see the bacteria (microscope) or the colonies (Culture) or the DNA of the bacteria (various tests).
(10) NOTHING else is definitive. X-Rays, Blood Tests, Mantoux / IGRA etc are either indicative or non-specific – more guesswork than proof – supportive at best.
(11) Of those 140 years since discovery of the bacillus, we had only ONLY microscopy (a low sensitivity tool) till recently. Only in the last decade or so have we see better and more sensitive diagnostics come up.
(12) Treatment: For context, imagine you have the common cold. Imagine you are prescribed 7 days of an antibiotic. How many are able to actually complete this – let’s be honest. Most stop as soon they feel better.
(13) Now for TB, the shortest treatment regimen comprises of a fistful of medicines, to be taken daily, for anything between 6 months to years. 4-6 different types of drugs, with unpleasant side effects. How many will actually be able to complete this without constant support?
(14) And the catch – if you stop midway, you develop a far more serious drug resistant TB, treating which is way more complicated.
(15) Also, despite the 140 years of its existence, we had basically ONLY 4-5 effective drugs to treat TB – all discovered between 1943-61. Zilch since then – for decades. ~50 years without any new medications! Only recently have we discovered 2 new molecules which are effective.
(16) India, in 2019, had ~1.24 lakh drug resistant TB cases. The ones which are a nightmare to diagnose and treat.
(17) Remember – both TB as well as its drug resistant sibling are easily transmitted through air – meaning, you can catch the drug resistant variety from the innocuous passenger next to you on the bus or in your office. Scary? You bet!
(18) I mean, I can go on and on… however, to cut to the chase – what all can we do to contribute towards curbing this menace? First – become aware. Know what are the symptoms and get yourself examined by a qualified practitioner at the earliest possible.
(19) Second – Ensure that you are diagnosed correctly. Ask questions – read up – do what it takes. Third – If diagnosed, make sure that you complete the whole course of treatment. Easier said than done – but remember, your first course of medications is your best bet.
(20 Never forget - All forms of TB is curable – get diagnosed early on and complete the treatment. That’s it. For more details, do visit the tbcindia.gov.in
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