Multi drug resistant tuberculosis (MDR-TB) is spreading far and wide across the globe. The latest World Health Organisation (WHO) analysis published on Saturday said cases of MDR-TB had now been reported from 80 countries, in some instances in almost 30% of all newly diagnosed cases.
But only 34 countries have a system in place to routinely test all patients with MDR-TB for second line anti-TB drug resistance. The global overview also shows record levels of this serious public health threat, with some countries reporting MDR-TB in more than 65% of patients who have been previously treated for TB.
However, WHO rued the fact that India, which has a major burden of MDR-TB, still does not have national level data on this serious air-borne disease. It said, "Whereas China has been able to conduct a nationwide survey, India and the Russian Federation - the other two large countries that, with China, contribute to more than 50% of the estimated global burden of MDR-TB -- have only produced reliable sub-national level data to date. To understand the magnitude of the MDR-TB problem and address it, nationwide surveillance systems should be established in all countries, with greater urgency in the highest burden settings."
Dr Matteo Zignol from the Stop TB Department at WHO said, "Surveillance of resistance to drugs is the cornerstone of TB control. Following 15 years of intensive effort, we now have high quality data for two-thirds of countries in the world. At the same time, we don't know the full extent of the problem because we lack data from many countries, in particular India and most of Africa where the TB burden is high."
According to WHO, the four countries that had the largest number of estimated cases of MDR-TB in absolute numbers in 2008 were China (100,000), India (99,000), Rusia (38,000), and South Africa (13,000).
A health ministry official agreed that India only has sub-national data. He, however, added that there were no immediate plans to start a national study. According to India's official estimates, 3% of all new TB cases are MDR while 12-17% of all retreatment cases are MDR.
"At present, only 7,000 MDR-TB patients in India are on treatment. From 2015 onwards, all suspected cases will be tested for MDR-TB. Then we will have a national data. At present, all patients aren't tested for MDR-TB. We now have 36 labs to test for MDR-TB. In the next two years, we expect the number of labs to double," the official said.
India recorded nearly 2 million new cases of TB in 2009. Out of an estimated 1.3 million people who died of TB in 2008 globally, India alone accounted for 2.8 lakh lives. India's case detection was around 67%.
Mismanagement of TB treatment is the primary cause of multidrug resistance. Most cases of TB are cured by a strictly followed, six-month drug regimen that is provided to patients with support and supervision. Inappropriate or incorrect use of antimicrobial drugs, use of ineffective formulations or drugs of suboptimal quality can cause drug resistance.
In a major step, India has now decided to test the new diagnostic tool GeneXpert that can diagnose MDR-TB patients in less than two hours time. India is rolling out the test across 18 sites. The sites where the new test is being introduced includes Rohtak in Haryana, Dharavi in Mumbai, Amravati in Maharashtra, Udaipur, Jodhpur, Vilaspur in Chhattisgarh, Mankangiri in Orissa, Tehri (Uttarakhand), South 24 Parganas in West Bengal, Sangam Vihar in Delhi, Indore and two sites each in Vijayanagaram (Andhra Pradesh), Kamrup (Assam) and Ranchi (Jharkhand).
Treating MDR-TB patients is expensive. While treating a normal TB patient costs India Rs 600 over 6-8 months the cost for every MDR-TB patient is Rs 1.5 lakh over 24-28 months.
Meanwhile, India's TB control division has asked the health ministry to declare it a "notifiable disease" across the country. If approved, all private doctors, care givers and clinics will have to report every case of the air-borne disease to the government.
A ministry note said a very large number of TB patients in India are diagnosed but are not referred to or notified to the Revised National TB Control Programme ( RNTCP). Now, highly infectious diseases like plague, polio, H5N1 (bird flu) and H1N1 (swine flu) figure in the list.
By Kounteya Sinha
Times of India