Tag: Tuberculosis

  • Tuberculosis on the rise for first time in decades: Expert

    Millions of people around the world still suffer from this disease, not because of a lack of medical knowledge, but because of persistent social inequities. Before SARS-CoV-2, the virus that causes COVID-19, spread across the world in 2020, tuberculosis was responsible for more deaths globally than any other infectious disease.

    But thanks to targeted public health efforts in the US and globally, tuberculosis cases had been steadily falling for decades.

    Carlos Franco-ParedesAssociate Faculty Mycobacteria Research Laboratories, Colorado State University Fort Collins (US) is an infectious disease clinician and public health practitioner who has been caring for underserved communities in the US for more than two decades. He writes:

    During the pandemic, it at first appeared that, as with many other common illnesses like the flu, COVID-19 prevention efforts reduced tuberculosis cases, too.

    But tuberculosis numbers have quickly climbed back up to pre-pandemic levels, marking the first time in decades that cases and deaths have risen globally.

    The pandemic not only interrupted important health interventions for tuberculosis, it also caused a decrease in social and economic opportunities for marginalised people around the globe.

    Together, these effects appear to have put a serious dent in the fight against tuberculosis.

    Tuberculosis before and during COVID-19 Tuberculosis is a contagious bacterial infection of the lungs that is normally spread through the air.

    Most tuberculosis infections are asymptomatic and not contagious.

    About 5 per cent to 10 per cent of infected individuals develop active tuberculosis, which is characterised by cough, fever, decreased appetite and weight loss.

    If left untreated, tuberculosis is a very contagious and dangerous disease that can result in death.

    Total estimated tuberculosis infections globally have been falling for years.

    The lowest number, 10.1 million cases, occurred in 2020, according to the World Health Organisation.

    2021 saw a significant increase in infections, to 10.5 million, the first rise in more than a decade.

    Global tuberculosis deaths followed a similar pattern, reaching a low point of an estimated 1.4 millions deaths in 2019, then rising to 1.5 million in 2020 and 1.6 million in 2021.

    The number of confirmed cases of tuberculosis — infections detected through direct testing — tells a different part of the story.

    As testing efforts have improved, confirmed cases have been rising globally to a peak in 2019.

    As the coronavirus disrupted lives in 2020, confirmed cases of tuberculosis fell significantly before quickly rising again in 2021.

    A similar pattern played out in the US. There was a sharp drop in confirmed cases in 2020 — mostly driven by lack of testing — followed by a sharp rise back to pre-pandemic levels.

    Tuberculosis is a social disease Tuberculosis is a preventable disease, thanks to effective vaccines, testing and treatments.

    But millions of people around the world still suffer from this disease, not because of a lack of medical knowledge, but because of persistent social inequities.

    Unequal access to economic opportunities, limited health care, poor sanitation, crowded living conditions, malnutrition and illnesses such as diabetes or HIV are all associated with increased risk of tuberculosis.

    In the US in 2021, racial and ethnic minority groups accounted for more than 85 per cent of tuberculosis cases, with 71 per cent of cases occurring in persons born outside the US.

    Increased inequality causing more tuberculosis Even as the world witnessed a rapid decline in confirmed cases in 2020, experts were worried that interruption of prevention and treatment efforts might result in a rise in tuberculosis.

    These fears were warranted.

    Many health experts, along with the US Centres for Disease Control and Prevention, have confirmed the pandemic disrupted access to tuberculosis testing and diagnosis.

    It is likely that many cases were missed because of the interruption of tuberculosis control activities, since funding, resources and staff were reassigned to assist in COVID-19 control efforts.

    Additionally, during health encounters, similarities in symptoms between COVID-19 and tuberculosis may have led to missed diagnoses.

    The drop in confirmed cases seems to be, in large part, driven by a lack of testing.

    The rapid increase since the pandemic, and especially the rise in deaths, confirms that progress made in tuberculosis control over the past 20 years has stalled, slowed or reversed.

    These two troubling trends are also almost certainly connected to the increase in inequality brought about by the pandemic.

    The existence of multigenerational households, overcrowding in low-income neighborhoods, lack of paid sick leave, inability to shield from the pandemic, use of public transportation and lack of health insurance all converged to heighten the risk of both COVID-19 and tuberculosis among the most vulnerable people.

    Of course, the pandemic is not the only factor that has increased human hardship– and therefore, tuberculosis — in recent years.

    For example, Ukraine now has one of the world’s highest tuberculosis disease burdens as a result of Russia’s invasion and the resulting harm to Ukraine’s medical, social and economic systems.

    Ongoing conflicts in other parts of the world, energy shortages and the effects of climate change and associated impacts on food security are expected to worsen the broader social and political determinants of tuberculosis.

    There are many neglected diseases of poverty, and tuberculosis is a great example of how social forces produce human disease.

    With an estimated one-third of the world’s population at risk for tuberculosis today, fostering social justice interventions to reduce health inequities is a critically important step to relieving the global medical burden of this relentless disease.

    (The Conversation) 

  • After Covid, India faces an uphill battle to meet PM Modi’s goal of ending TB by 2025

    By AFP

    MUMBAI: When Covid-19 ripped through India in 2020-21, several million people are thought to have died. Desperate efforts to stem the pandemic hurt the battle against another huge killer: tuberculosis.

    India is the home to a quarter of the world’s TB infections and an estimated half a million people died of the curable lung disease in 2020 in the South Asian nation — a third of the global toll.

    Because of the pandemic, global deaths from the “silent killer” rose in 2020 for the first time in more than a decade, reversing years of progress, the World Health Organization says.

    In India, the number of new cases detected in 2020 actually fell by a quarter to around 1.8 million due to Covid restrictions and as the pandemic diverted resources.

    Nearly two-thirds of people with TB symptoms did not seek treatment, according to a 2019-21 nationwide government survey released on World TB Day on Thursday.

    Ashna Ashesh, 29, diagnosed with multidrug-resistant tuberculosis four years ago, saw how patients, many isolated and jobless because of lockdowns, struggled for support.

    ALSO READ | Tuberculosis on the rise in Covid survivors in Karnataka

    “They were incredibly afraid… They were reaching out for any kind of information that could be offered about how to access tests and medication,” the public health professional with the Survivors Against TB collective told AFP.

    “The impact has been immense… Covid has set back the fight against TB quite significantly. A recovery plan for TB is critical, both in India and globally.”

    India now faces an uphill battle to meet Prime Minister Narendra Modi’s goal of ending the spread of TB by 2025, five years earlier than the UN’s target.

    Experts and survivors are calling for intensive grassroots campaigns to find “missing” cases, more vaccine funding and support to combat malnutrition, a major trigger for TB.

    Kuldeep Singh Sachdeva from the International Union Against Tuberculosis and Lung Disease said states need to increase services such as house-to-house visits and mass screenings.

    “That’s the only way now where you can eliminate TB,” Sachdeva, who previously led the government’s National Tuberculosis Elimination Program, told AFP.

    Silver lining

    Officially Covid has killed almost 520,000 Indians, but experts believe the true toll to be far higher.

    The pandemic — which saw Covid replace TB as the world’s deadliest infectious disease — did however have one silver lining: increased mask-wearing.

    Sachdeva estimates this might have cut TB transmission by 20 percent. Additional diagnostic machines procured for Covid could be redeployed for TB, he added.

    ALSO READ | Post-Covid, tuberculosis cases among young population increasing in Delhi

    Mumbai — a megapolis of 20 million people and a TB hotspot — has rolled out a programme with young survivors such as Seema Kunchikorve, who was diagnosed with TB five years ago at 20, to keep current patients on track with medications.

    “The treatment has a lot of (side) effects which patients can’t take,” Kunchikorve told AFP during a TB awareness play staged at a school in India’s biggest slum Dharavi.

    Vijay Chavan, who treats patients with drug-resistant TB at a Doctors Without Borders (MSF) clinic in Mumbai, said the Covid battle had shown the way to fight the older pandemic.

    At the clinic, which treats children as young as five, patients spend hours undergoing check-ups beside brightly coloured wallpapers featuring famous comic characters, before collecting a large tray of pills for their treatments.

    “If there is a political will for TB, just like Covid, it definitely will give us good results,” he said.

  • Mansukh Mandaviya takes charge as Stop TB Partnership Board chairman

    By ANI

    NEW DELHI: Union Health Minister Mansukh Mandaviya on Thursday took charge as the Chairman of Stop TB Partnership Board.

    “India’s leadership in the global fight against TB continues with Minister @mansukhmandviya’s appointment as next Chairperson of @StopTB Board which supports global efforts in achieving UN goal to end TB by 2030. Leading by example remains committed to ending TB domestically by 2025,” tweeted the Permanent Mission of India at the United Nations.

    Taking to Twitter, the union minister said, “Honoured to take on as the Chairman of @StopTB Partnership Board and lead global efforts against TB. I look forward to working with partners and volunteers to take sustained steps to end TB worldwide by 2030 and realise PM @NarendraModi ji’s vision of ending TB in India by 2025.”

    He also lauded the initiatives of former Health Minister Dr Harsh Vardhan who was charing the board.

    “I express my gratitude to the outgoing Chair of Stop TB, @DrHarshVardhan, and appreciate the initiatives taken by the partnership under his guidance. I am also looking forward to working with the incoming Vice-Chair, Austin Arinze, when he takes over on January 1, 2022,” added Mandaviya.

    The Stop TB Partnership is a United Nations-hosted partnership program that aims to fight against tuberculosis collectively.  

  • Researchers from BRICS nations to study impact of severe Covid on TB patients

    By PTI

    NEW DELHI: BRICS countries are working on a programme to study the impact of severe COVID-19 conditions on tuberculosis (TB) patients, the Department of Biotechnology said on Monday. 

    The SARS-CoV-2 NGS (Next Generation Sequencing)-BRICS consortium is an interdisciplinary collaboration to advance COVID-19 health-relevant knowledge and to contribute to improvements in health outcomes, it said.

    The consortium, comprising researchers from Brazil, Russia, India, China and South Africa (BRICS), will accelerate translation of genomic data from clinical and surveillance samples, the government’s Department of Biotechnology (DBT) said.

    This will be done utilising high-end genomic technologies, and epidemiologic and bioinformatics tools and this information will be used in diagnostic assays and tracking transmission dynamics of COVID-19 and other viruses, as well as lead to clinical and public health research and interventions, it said.

    “The Department of Biotechnology, Ministry of Science and Technology, in collaboration with BRICS countries is implementing the SARS-CoV-2 NGS-BRICS consortium and multi-centric programme to study the impact of severe COVID-19 conditions on TB patients,” the DBT said.

    The Indian team has members from the National Institute of Biomedical Genomics (Prof. Arindam Maitra, Prof. Saumitra Das, Dr. Nidhan K Biswas), the Centre for DNA Fingerprinting and Diagnostics (Dr. Ashwin Dalal) and the Indian Institute of Science (Dr. Mohit K Jolly), it said.

    Dr. Ana Tereza Ribeiro de Vasconcelos of Brazil’s National Laboratory for Scientific Computation, Prof. Georgii Bazykin of Russia’s Skolkovo Institute of Science and Technology, Prof. Mingkun Li of China’s Beijing Institute of Genomics, Chinese Academy of Sciences, and Prof. Tulio de Oliveira of South Africa’s University of KwaZulu-Natal are the other members of the consortium, the DBT said.

    In a second multi-centric programme, an interdisciplinary team of researchers from India, Brazil and South Africa will investigate the impact of severe COVID-19 on transient peripheral immunosuppression and lung hyperinflammation conditions in TB patients for epidemiology and comorbidity, the department said.

    This team consists of members from the India’s National Institute of Research in Tuberculosis (Dr. Subash Babu, Dr. Anuradha Rajamanickam, Dr. Banurekha Velayutham and Dr. Dina Nair).

    Besides them, the members from Brazil are Dr. Valeria Cavalcanti Rolla and Dr. Adriano Gomes da Silva of the Lapclin-Tb/ INI-FIOCRUZ, Dr. Maria Cristina Lourenço of the LBB/INI-FIOCRUZ and Dr. Bruno de Bezerril Andrade from IGM-FIOCRUZ; and from South Africa are researchers Dr. Bavesh Kana, Dr. Bhavna Gordhan, Dr. Neil Martinson and Dr. Ziyaad Waja of the University of the Witwatersrand, the DBT said.

    “This collaborative study is expected to provide valuable co-morbidity data pertaining to pulmonary TB patients with or without COVID-19 co-infection that is expected to be generated for better disease management,” it said.

    Secretary in the DBT Renu Swarup said the department has taken small steps in the right direction towards collaboration with BRICS countries.

  • Doctors observe rise in tuberculosis cases among post-Covid patients

    By PTI
    NEW DELHI: Doctors at two private facilities have seen a rise in cases of tuberculosis (TB) among people who have recently recovered from COVID-19, and have attributed the rise in such instances to diabetes, altered immunity and use of steroids.

    Moolchand hospital has had a turnout of around 10 cases of active TB patients in the OPD in the last four to six weeks, according to a statement from the hospital.

    Dr Bhagwan Mantri, Pulmonologist, Moolchand Hospital stated that up to 60 per cent of them aged below 40 years of age.

    “All these TB patients had received steroids during their Covid treatment and many had diabetes. Six of them were below 40 years,” he said.

    Divulging on the clinical diagnosis of the cases, Dr Mantri said, “They presented with complaints of cough many weeks after recovery from Covid and a few of them also had mild low-grade evening fever for three to four weeks post-Covid. X Ray and sputum test showed cavitary pneumonia with sputum positive smear for Acid-Fast Bacillus (AFB).” AFB causes tuberculosis and other infections.

    Citing a case, the doctor said a young man presented with massive pyo-neumothorax (Air and Pus in the pleural cavity) post Covid which later turned out to be due to tuberculosis.

    The senior doctor said multiple factors weighed in the development of the lung disorder among the presented patients.

    “The reason for increased likelihood of tuberculosis in post-Covid patients can be explained by factors like altered immunity, lung inflammation and stress due to Covid, use of steroids for Covid treatment and worsening of blood sugar control,” he explained.

    Meanwhile, he suggested that the patients need to look out for certain markers after recovering from Covid for early diagnosis of TB.

    “A delay in diagnosis of TB also has been reported since symptoms of tuberculosis are similar to symptoms of post covid/Long Covid. So If you are having any symptoms that are persistent after Covid like a low-grade fever, cough, decreased appetite, weight loss, night sweating or any other complaints you need to visit a pulmonologist to rule out active tuberculosis,” he added.

    Aakash Healthcare has seen a 15 to 20 per cent surge in cases of tuberculosis compared to earlier years.

    This is a trend of concern rising among adolescents and young adults as these patients are presenting with complications involving more than one part or organs in the body.

    There is also an increase in recurrent tuberculosis cases (patients who have had tuberculosis earlier and have completed the full course of anti-tubercular treatment).

    The reasons can be many, from ignoring the health and attributing the fever or other constitutional symptoms to some other viral fever, to apprehensions regarding going to hospital for the fear of catching Covid.

    “Many patients had a history of Covid and hence attributed their general poor health to the after effects of Covid. Cases of misdiagnosis can also add on to the increased burden of TB during the pandemic. Many times, people attribute the fever to typhoid-like illness, manifestations for which include prolonged fever and weakness.

    Hence, a comprehensive evaluation is required for any fever lasting more than two weeks, or weight loss or poor appetite or prolonged cough/diarrhoea – any change in health status needs to be monitored by a qualified health professional,” the hospital advised in a statement.

    The hospital has introduced bi-directional screening of TB-COVID and TB-ILI/SARI as per the new guidelines from the Ministry of Health and Family Welfare.

    “These tests are being conducted at our normal OPDs and Covid wing to ensure tuberculosis screening for all patients showing persistent cough /fever/ cavitation lesions/new Lung infiltrates in lungs/abdominal symptoms/deteriorating general condition,” said Dr Parinita Kaur, senior consultant- internal medicine, Aakash healthcare in Dwarka.

  • Covid can make one more susceptible to developing active tuberculosis: Health Ministry

    By PTI
    NEW DELHI: COVID-19 can make a person more susceptible to developing active tuberculosis as it is an “opportunistic” infection like black fungus but currently there is not enough evidence to suggest TB cases have risen due to the viral disease, the Union Health Ministry said on Saturday.

    The ministry said notification of tuberculosis cases had decreased by about 25 per cent in 2020 due to Covid-related restrictions and special efforts are being made to mitigate this impact through intensified case findings.

    In a statement, the Health Ministry said there have been some news reports alleging that a sudden rise in TB cases have been noticed among patients infected with COVID-19 recently, leaving doctors, who have been receiving around a dozen similar cases every day, worried.

    “It is clarified that tuberculosis screening for all COVID-19 patients and COVID-19 screening for all diagnosed TB patients has been recommended by Ministry of Health and Family Welfare,” it said.

    The ministry said SARS-CoV-2 infection can make an individual more susceptible to developing active TB disease, as it is an “opportunistic infection like black fungus”.

    There is not enough evidence currently to suggest that there has been an increase in TB cases due to COVID-19 or due to increased case finding efforts, it said, adding states and Union Territories have been asked for convergence in efforts for better surveillance and finding of TB and COVID-19 cases as early as August 2020.

    Also, the health ministry has issued multiple advisories and guidance reiterating the need for bi-directional screening of TB-COVID and TB-ILI/SARI.

    “Due to the impact of COVID-related restrictions, case notifications for TB had decreased by about 25 per cent in 2020 but special efforts are being made to mitigate this impact through intensified case finding in OPD settings as well as through active case finding campaigns in the community by all states.”

    The dual morbidity of tuberculosis and COVID-19 can be further highlighted through the fact that both diseases are known to be infectious and primarily attack the lungs, presenting similar symptoms of cough, fever and difficulty in breathing.

    But TB has a longer incubation period and a slower onset of disease, the health ministry said.

    “Furthermore, TB bacilli can be present in humans in a dormant state and has the potential to start multiplying when the individual’s immunity is compromised for any reason.

    “The same is applicable in a post-Covid scenario when an individual may develop decreased immunity due to the virus itself or due to the treatment, especially immune-suppressants like steroids,” the Health Ministry said.

  • TB continues to be one of India’s most critical health challenges: Health Minister Harsh Vardhan

    By PTI
    NEW DELHI: With an estimated 2.64 million TB patients, India has the largest burden of TB globally in terms of absolute numbers, Union Health Minister Harsh Vardhan said Thursday, adding the disease continues to be one of most critical health challenges facing the country.

    He made these remarks while addressing his first ‘Stop TB Partnership’ meet after assuming the Chairmanship of the Board, through video-conference here on Thursday.

    The meeting gains additional importance in the run up to World TB Day observed on March 24, a health ministry statement said.

    He also stressed on TB as a critical health challenge in India that has prompted the political leadership to target its elimination by 2025.

    “Tuberculosis continues to be one of India’s most critical health challenges which may have devastating health, social and financial consequences for the patients and communities at large.

    With an estimated 2.64 million TB patients, India has the largest burden of TB globally in terms of absolute numbers,” he was quoted as saying in the statement.

    Detailing the treatments provided in India and the journey of fight against TB, Vardhan noted that over the past few years, “we have significantly ramped up India’s diagnostic capacity for TB”.

    “Our National TB Elimination Programme has advanced leaps and bounds in the services being provided for TB.

    The National Program deployed all possible efforts to ensure uninterrupted TB services across the country.

    Initial responses were focused on essential services such as ensuring uninterrupted supply of drugs for patients on treatment and maintaining diagnostic services,” he said.

    Innovative approaches were adopted, including the use of community health workers to aid in specimen collection and transportation and home delivery of TB medicines, he said.

    The program was improvised based on need and embraced the use of technology for treatment adherence monitoring, and real-time community-led monitoring initiatives for COVID-19 and TB, he said.

    “We now have at least one rapid molecular diagnostic facility available in each district and are aiming to decentralize it down to the block level.

    We have introduced All Oral Regimens and newer drugs for effective treatment of Drug Resistant TB.

    Our health systems not only focus on the detection and treatment of TB disease, but also try to address all co-morbidities and social determinants of the TB patients and working rigorously towards prevention of the disease,” he was quoted as saying in the statement.

    In the last three years, more than Rs 1,000 crores have been disbursed as Direct Benefit Transfer for nutritional support to TB patients, he added.

    On the challenges faced by India’s TB Elimination Program during the pandemic, Vardhan spoke on the Rapid Response Plan that was developed and shared with all states and Union Territories.

    Bi-directional screening of TB and COVID-19 was initiated to aid in case of finding of both the diseases with 24 per cent of the TB patients having knowledge of their COVID-19 status in 2020.

    The Union Health Minister stated India has taken a bold and ambitious decision for a TB-free India five years ahead of the global target, in 2025.

    “We are planning an extensive nationwide Jan Andolan to enhance awareness about not only the disease, but its treatment with the collaborative efforts of all stakeholders across the centre and States/UTs,” he informed.

    “Constant engagement with all stakeholders will help us achieve this ambitious goal that we have set for ourselves along with the most productive, efficient and targeted utilization of resources,” he stressed.

    PTI PLB TIR TIR 03182202 NNNN