In the Philippines, TB is the number six leading cause of death
Tuberculosis (TB) is an infection caused by bacteria that usually affect the lungs. These bacteria, called Mycobacterium tuberculosis, can be passed on to another person through tiny droplets spread by coughing and sneezing. Even the accidental spread of saliva through laughing, singing, and spitting can pass on the TB bacteria.
In the Philippines, TB is the number six leading cause of death, with 73 Filipinos dying every day of TB. Let us look at 10 facts about TB:
1. An estimated 200,000 to 600,000 Filipinos have active TB. This condition makes the person sick and contagious to others. Active TB can occur in the first few weeks after infection with the bacteria, or it can occur a few years later. Signs and symptoms of active TB include cough, phlegm (sometimes with blood), unexplained weight loss, fatigue, afternoon fever, night sweats, chills, and loss of appetite. See your doctor if you have these symptoms.
2. The danger of TB is real. Out of 196 countries, the Philippines has the distinction of being included in the top 22 high-burden tuberculosis countries in the world. This report is according to the World Health Organizations (WHO), which ranks the Philippines at number nine worldwide. Together, these 22 countries (including the Philippines) contribute 80 percent of the global TB burden. TB is a disease of poverty and the high TB burden is a reflection of our economic status. On the other hand, some people consider being number nine as “good news” since we came from number seven worldwide! In fact, after China, the Philippines had the second highest number of TB cases in the WHO Western Pacific Region in 2007.
3. Each person with active TB can spread the disease to 10 other Filipinos each year! This is alarming since there are between 200,000 and 600,000 Filipinos with active TB. Multiply this by 10, and just imagine how much TB is being spread yearly. Hence, if someone in the household has been diagnosed with TB, all the other members of the household should get tested (like a chest x-ray) for TB, too. The usual treatment course for TB is between six and nine months of continuous medicines. The good news, however, is that once active TB is treated with the appropriate drugs, the person is no longer contagious after three weeks. That is why those who are being treated for TB are advised to rest during the first month.
4. Another alarming fact: An estimated 80 percent of Filipinos have latent TB. Because of the huge TB burden in the country, most of us already have the so-called “latent TB.” Yes, that in all likelihood means you and me. In this condition, we already have the TB infection in our bodies, but the TB is still in the inactive state. Hence, we feel no symptoms and we are not contagious to other people. Some countries, like the US, will treat those with latent TB with medicines. But we can’t help it because we are born in the Philippines. We just need to observe a healthy lifestyle, or else the TB infection might get reactivated.
5. Tuberculosis can affect other organs of the body, such as the kidneys, spine or brain. Symptoms depend on the organ affected. TB of the spine causes severe back pain, while TB of the kidneys can cause bloody urine. Hence, TB should be checked and treated as early as possible.
6. Treatment of TB may not change your chest x-ray results back to normal. Thus, many Filipinos cannot pass job tests for abroad because of past or present TB infection. Studies show that once treatment for TB is completed, a repeat chest x-ray may show the following results: 30 percent of chest x-rays will revert to normal (good news), 30 percent of chest x-rays will improve but will still show a scar (still can’t pass job test), 30 percent of chest x-rays will remain the same. This just goes to show that the TB burden in the country is also affecting the employment of our people.
7. The BCG vaccine against TB is not 100-percent effective. Although the WHO recommends that BCG be given to all infants and young children in countries with high TB burden, the vaccine does not always protect people from TB. In addition, the protection given by the BCG does not seem to be effective as the person becomes an adult. Still, the BCG appears to protect the person from a more serious TB disease and should be a part of the immunization program.
8. Beware of multiple drug-resistant tuberculosis (MDR-TB). Another challenge is the emergence of a new drug-resistant strain of TB called MDR-TB. This new “superbug” probably arose because TB patients did not adhere to their drug regimen, which means that they didn’t take their medicines religiously for the usual six months. Because of this, the TB bacteria developed a resistance to the first-line drugs like Isoniazid and Rifampicin. MDR-TB is difficult and expensive to treat. Worldwide, in 2008, there were an estimated 440,000 new cases of MDR-TB and 150,000 deaths from MDR-TB. Estimates show that 3.3 percent of new TB cases are really MDR-TB.
9. Have you heard of XDR-TB? If having the multi-drug-resistant TB is bad enough, scientists have discovered a third more terrible strain of TB. These nasty bacteria are called “extensively drug-resistant TB” or XDR-TB. This means that XDR-TB is resistant even to the special drugs developed for MDR-TB. Be forewarned: The WHO has reported that XDR-TB cases have been confirmed in 58 countries, including the Philippines.
10. Finally, some good news. Despite the high TB incidence, significant developments have been made in increasing case detection and treatment in the country. In 2007, the Philippines achieved a TB case detection rate of 75 percent, exceeding the WHO target of 70 percent. The Directly Observed Therapy Short Course or DOTS is the internationally recommended strategy for TB control. DOTS simply means asking a relative or a health worker to directly observe the patient taking the anti-TB medicines daily. The Philippines’ DOTS treatment success is at around 88 percent, which is higher than the WHO target of 85 percent. Fortunately, international agencies, like the Global Fund and USAID, are helping the country combat TB.
Despite these accomplishments, many factors still need to be addressed such as reducing the stigma of TB patients, and increasing the public’s awareness of the disease, especially the need for treatment. Some infected TB patients still refuse treatment and continue to pose a danger to people around them.
I appeal to our policy makers, health workers, and media to further strengthen our campaign against this terrible scourge.
By Willie T. Ong, MD