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TB News from India: March-April 2006
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Health and Development Initiative-India, (www.healthinitiative.org),
publishes
'TB News from India' once every two months. The objective of
newsletter is to highlight issues related to Tuberculosis and
HIV/AIDS control in India and enlist political, public, professional
and administrative support for its cause. Health and Development
Initiative-India is a not-for-profit organization and the news
items have been quoted from various sources for fair use and
in public interest. Reproduction of the material published is
welcome provided a reference is made to the original source
of the news item and TB News from India.
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A
road map for TB control in Southeast Asia
While acknowledging the key achievements of Southeast Asian countries
in implementing DOTS, the new Global Plan to Stop TB (2006-2015)
has laid out a road map for TB control programmes of the region.
The plan calls for continuation of strong political commitment and
a raise in current level of funding in order to continue to
improve access to quality TB services. It cautions that with
an estimated 35% of cases still not being reached through existing
DOTS services, significant and sustained efforts will be needed
to continue the current positive trends.
The Global TB Plan informs that South-East Asian Region is second-hardest
hit by the HIV-epidemic, after sub-Saharan Africa. More than
6 million people were estimated to be living with HIV in December
2004. The extent of the epidemic of TB/HIV co-infection in the
Region will depend on the future course of the HIV epidemic,
as well as on efforts to control TB.
Yet another challenge facing the region is low coverage of drug resistance
surveillance mainly because of limited data from Bangladesh,
India and Indonesia, thus making it difficult to assess the
regional MDR-TB situation. Most national TB programmes in the
Region do not at present diagnose and treat MDR-TB patients.
The plan unfolds the priority activities for the region in the next
decade. The first and foremost being sustaining adequate human
resource capabilities to deliver quality DOTS services, a tall
order for most state health departments in India. A number of
state governments in India have embargoed fresh recruitments
and replacements for retiring health providers are a rarity.
The second identified activity is to increase the reach of DOTS,
through scaling up the participation of the large and vibrant
private sector in the Region. The encouraging results from pilot
public-private mix projects have paved the way for expansion
this critical participation In India. The lessons learnt from
PPM endeavor in country will help develop similar initiatives
in other countries of the region.
The plan also moots decentralization of TB services so as to involve
health and social workers at the grass-roots level to help reduce
barriers to access for women and children. Understandably, community
outreach activities, as well as education, information and communications
campaigns need to be brought to the fore.
The call for establishing surveillance for HIV amongst TB patients
in new Plan marks a paradigm shift in the policy for integration
of the control programmes for two pandemics. Both the public
and private health sectors in most countries of the region would
need to reposition themselves in order to move ahead in this
direction.
The implementation of proposed activities for Southeast Asian countries
pose a formidable challenge. The TB programme now has to emerge
from within the confines of health facilities to embrace a new
team. The players of this new-look team would be general practitioners
and corporate hospitals; community volunteers and opinion leaders;
priests and politicians; medical researchers and social scientists;
cured patients and families of the sick and anybody or everybody
willing to extend a helping hand. The turning point in our crusade
against TB would be as to how we address the issue of HIV amongst
TB patients. Southeast Asians cannot afford to circumvent this
query; they have to meet it face-to-face.
Global Plan to Stop TB (2006-2015): http://www.stoptb.org/globalplan/default.asp
TB
cases on the decline: Anbumani Ramadoss
Source: The Hindu (27th February 2006)
The annual increase of tuberculosis in India has shown a downward
trend in the last three years, according to Union Health Minister
Dr Anbumani Ramadoss.
"Three years ago there were about 2 million new cases of TB
annually, which has come down to 1.8 million", he said
today after inaugurating the Golden Jubilee Celebrations of
the TB Research Centre (TRC) here and dedicating to the nation
a HIV vaccine trial centre at the TRC complex.
Stating that the WHO had appreciated the steps taken by the country
to control TB, he attributed the drop in cases to the revised
national TB control programme.
Referring to DOTS (Directly Observed Treatment Short course) programme
initiated in 1993 and scaled up in 1997, he said TRC had to
be given credit for introducing the programme, under which over
5.2 million persons had benefited, including 1.2 million last
year.
The mortality rate of TB cases had dipped from 29 per cent to four
per cent while the success rate stood at 84 per cent, he said.
http://www.hindu.com/thehindu/holnus/004200602261623.htm
Tuberculosis
Research Centre Completes Fifty Golden Years
The prestigious Tuberculosis Research Centre (TRC), Chennai is celebrating
its Golden Jubilee this year. TRC is one of the International
Centers for Excellence in Research, funded by NIAID/NIH U.S.A.
The centre recently established a HIV Vaccine Trial Centre funded
by IAVI, New York.
TRC was initially started as Tuberculosis Chemotherapy Centre in
1956 as a 5-year project, under the joint auspices of the Indian
Council of Medical Research (ICMR), the Government of Tamil
Nadu, the World Health Organization (WHO) and the British Medical
Research Council (BMRC).
Many of the research findings of the Centre have received worldwide
acknowledgement and, indeed, some of them have had a great impact
on the formulation of tuberculosis control programmes in Asia,
Africa, South America and some parts of Europe. It must be emphasized
that although the main aim of the studies at this Centre is
to evolve inexpensive, effective and practicable methods of
treatment for tuberculosis patients in India, the logical sequence
of the investigations undertaken, complemented by appropriate
laboratory investigations, has resulted in invaluable knowledge
of the principles of chemotherapy and of the bacteriology of
tuberculosis.
The first controlled clinical trial, which established unequivocally
the value of out-patient treatment for pulmonary tuberculosis,
has received world-wide acclaim as the classic "Madras
Study". The finding that tuberculosis patients can be effectively
treated as outpatients and continue to live in their homes without
added risk to their family contact has revolutionized the whole
concept of the management of tuberculosis. Later, the Centre
evolved supervised intermittent chemotherapy as an alternative
system of treatment, especially for urban areas and large cities.
United
Kingdom plans
to help fight tuberculosis in India
Source: Web India, January 30, 2006
The United Kingdom plans to spend an additional 41.7 million
pounds to help fight tuberculosis in India. The new funds come
in addition to the UK's recent doubling of its contribution
to the Global Fund to fight AIDS, Tuberculosis, and Malaria,
to 100 million pounds per year for 2006 and 2007. The World
Health Organization (WHO) and the Stop TB Partnership will administer
the funds in India.
Urging other donors to similarly increase their support, UK's Secretary
of State for International Development, Hilary Benn said: ''More
must be done to help reach the poor and underserved areas in
India, where more than 1,000 people die from TB every day. Together,
we can do even more to combat this disease that often drives
families into poverty.'' This latest DFID funding for India
will help procure anti-TB drugs which will directly benefit
over four million TB patients. It will also support a five year
plan to provide technical assistance through the WHO to the
Government of India's revised National TB Control Programme
(RNTCP).
WHO is already providing technical support to RNTCP in partnership
with DFID, as well as with the Canadian International Development
Agency (CIDA) and the United States Agency for International
Development (USAID). The Organisation is committed to continuing
such support during Phase-II of RNTCP for the period 2006-2010.
Dr Samlee Plianbangchang, Regional Director, WHO South-East Asia
Region, welcoming this development, said, ''The rapid strides
that the Revised National TB Control Programme in India has
made in recent years is today driving global progress in TB
control. I welcome this generous support from the Department
for International Development UK which is one of our key partners
in this Region. I view this as a sound investment in improving
the health of people across the globe.''
According to Dr S J Habayeb, WHO Representative to India, ''India
has made remarkable progress in expanding the internationally
recommended DOTS strategy to 97% of the country. The challenge
is to sustain good quality services, widen the reach through
involvement of a wider network of health care providers, and
deal with newer challenges posed by TB/HIV co-infection and
drug resistance.''
http://news.webindia123.com/news/showdetails.asp?id=235185&n_date=20060130&cat=Health
TB
stalks 7,000... & more
Source: Statesman News Service, 13th January 2006
A sizeable portion of the Kolkata population suffers from tuberculosis.
More than 7,000 people, most of whom from slum areas, visited
civic TB treatment centres last year. The number of TB patients
in the city is increasing every year, Dr Deb Dwaipayan Chattopadhyay,
Kolkata Municipal Corporation's chief municipal health officer,
said today.
Data available with Kolkata Municipal Corporation health department
shows that the maximum number of patients visit the Manicktola
TB clinic, followed by other centres located at Behala,
Manashatola, Alipur and Tollygunge. Officials said people suffering
from TB mostly live in and around these areas.
The civic body treats TB patients through 10 tuberculosis clinics
located in various parts of the city. Though the disease is
a completely curable one, it persists since most of the patients
do not complete the full course of medication. Under the pan-India
DOTS programme, civic health officials want to keep patients
under sustained medication by providing medicines to them.
City civic health officials said since more patients were coming
to the clinics, the number of patients seems to be increasing.
World Health Organisation has been saying, however, that keeping
several factors in mind, more people must be suffering from
the disease.
"Kolkata Municipal Corporation health department has been working
with several NGOs, private hospitals, private laboratories and
private practitioners to help eradicate the disease from the
city. The problems mostly arise when after first dose of medicine,
patients stay away from regular medication. They relapse with
further complications. More than 15 per cent cases are being
detected at private clinics," said Dr. Deb.
Tuberculosis, primarily an illness of the respiratory system,
spreads through coughing and sneezing. So there is always fear
of the disease spreading through droplet infection. To root
out the disease, patients need to continue proper treatment,
which most poor people cannot afford.
"Free medicine is available from tuberculosis clinics in the
city. Besides this, under the DOTS programme, medicines are
being provided and patients are being treated with special care.
If fever continues for several days, people should immediately
contact chest clinics," Dr Chattopadhyay added.
Free
from tuberculosis certificates for dhaba workers
Source: The Tribune, 13/1/2006
With a view to prevent the spread of tuberculosis in the southern
Sangrur district of north India state of Punjab, the Deputy
Commissioner on Tuesday asked owners of dhabas (traditional
eating joints), hotels and restaurants to get "free from
TB " certificates for their workers from the health department.
Mr. Husan Lal, Deputy Commissioner, presiding over a meeting of the
district TB Control Society here yesterday, further
said procurement of free from TB certificates would be beneficial
for workers as well as general public because a worker infected
with TB could spread the disease among those persons to whom
he served eatables. The meeting was held to review the progress
of RNTCP, aimed at controlling the spread of TB in district.
Dr. Nirpal Singh Civil Surgeon said TB patients should be motivated
and compelled to complete treatment as an incompletely treated
or untreated patient could infect 10-15 healthy persons every
year.
This
TB hospital is in need of intensive care
Source: News Today, Jan 3rd 2006
Some portions of the campus of Thiruvotteeswarar TB hospital
(Tamil Nadu) at Otteri are completely desolated and badly maintained
making one wonder how a health care centre could be reduced
to this state.
The rains, which lashed the city in the past two months, had caused
inundation of low-lying areas within the campus, which has led
to breeding of a large number of mosquitoes causing discomfiture
among the patients. Another blemish is an abandoned building,
which is not being utilised as it is alleged to be infested
with snakes.
The hospital is equipped with 222 beds and every day 300-400 patients
visit the outpatient section from different parts of India such
as Gujarat, Andhra Pradesh, Karnataka. There are four patients
with TB due to Human Immuno-deficiency Virus in the hospital
and around 30-40 HIV-related TB patients visit the Hospital
every month.
'Due to certain myths about the disease the patients are ostracized
and are left to lead a solitary life', according to Dr Meenakshi
, Medical Superintendent of the hospital. She called upon various
social organizations to chip in and help the patients, 'Social
welfare organizations can send volunteers to the hospital and
spend some time with the patients which will give tremendous
psychological strength to them'.
http://newstodaynet.com/03jan/rf4.htm
Free
X-ray facility for suspected TB patients
Source: The Tribune News Service, 21st February 2006
The Punjab Health Systems Corporation (PHSC) has directed all Civil
Surgeons of the state to conduct x-ray of chest, free of cost
of all those suspected TB patients whose all three samples of
sputum are found negative for TB germs i.e. Acid Fast Bacilli
(AFB).
Earlier only in the case of a suspected TB patient, whose one sputum
sample, out of three, was found positive for AFB, x-ray of chest
was done free of cost in government hospitals.
http://www.tribuneindia.com/2006/20060222/punjab1.htm#16
Update
from Research Labs
India comes up with TB breakthrough
By: Sanchita Sharma
Hindustan Times, February 4th, 2006
In perhaps the biggest tuberculosis breakthrough in two decades,
Delhi's National Institute of Immunology (NII) has identified
five key genes that enable Mycobacterium tuberculosis to acquire
the iron it needs to grow and promote the infection in humans.
Experts say targeting genes within this cluster would help evolve
better drugs to cure TB, which affects 15.4 million people worldwide.
http://www.hindustantimes.com/news/5922_1617432,0015002500000000.htm
Newly Identified
Mechanism Helps Explain Why People of African Descent Are More
Vulnerable to TB
Source:
UCLA News
A team of scientists has identified a cellular mechanism that may
help explain the puzzle of why people of African descent are
more susceptible to tuberculosis infection and why, once infected,
they develop more severe states of the disease than whites.
The team includes researchers from UCLA and the Harvard School
of Public Health
Innate immunity, which has been retained in evolution from fruit
flies to humans, is the rapid immune response of host scavenger
cells to recognition of certain patterns of molecules found
on pathogens. A set of receptors on macrophages in humans called
"Toll-like receptors" contributes to innate immune
responses. The researchers describe a novel pathway used by
human macrophages that may be critical to resisting infection
with certain pathogens and that turns out to be critically dependent
on vitamin D.
Scientists have long known that blacks have less vitamin D than whites
and that blacks are more vulnerable to TB. This study helps
to resolve two of the puzzles of tuberculosis, the differences
between mice and human antibacterial mechanisms, and the susceptibility
of people of African and possibly Asian descent to tuberculosis.
The researchers suggest a need for clinical trials to investigate
the effect of vitamin D supplementation.
"Tuberculosis is a devastating disease that strikes vulnerable
populations particularly hard," said immunologist Barry
R. Bloom, dean of the faculty at the Harvard School of Public
Health and a co-author of the paper. "This study provides
a new mechanism for innate immunity in humans and demonstrates
how variations in vitamin D synthesis may make individuals susceptible
to TB infection. It is exciting to consider the possibility
that innate immunity to tuberculosis and other infections in
vulnerable populations might be enhanced by providing a simple
vitamin that would cost only pennies a day."
http://www.newsroom.ucla.edu/page.asp?RelNum=6856
Letter
to Editor
TB
Control Programme: A Sacred Mission
I do welcome your Editorial note (Oct-Nov 2005) on the Patients'
Charter of the Tuberculosis Community. TB patients have their
rights and their responsibilities as well.
All health providers summarized as "the Programme workers"
take up full responsibility to, as far as possible, guarantee
a cure for each and every patient under their care. Due to irregular
treatment, we all know too well, the disease may relapse and
(multi) drug resistant mycobacteria may be cultivated and patients'
suffering become immeasurable.
TB Control Programme has three main functions: detecting, treating
and curing tuberculosis patients.
Responsibilities of TB Programme workers comprise that all TB patients
be correctly diagnosed. World Health Organization guidelines
stipulate that every year 70% of the prevailing sputum positive
cases in a given area be detected by sputum smear examination.
The number of cases detected however depends on the availability
of anti-TB drugs. I wonder what is the sense of case-detection
if the cases found do not receive the sufficient supply of drugs?
And once under treatment, every case must be cured. Since what
is the sense of treatment if it were not for cure?
The Programme workers have to see to it, that all patients
get right drugs, in correct doses under a pre-determined drug
regimen.
All Programme workers must be prepared and committed to actually
achieve the targets of a successful TB Programme at all times
and whatever be the conditions. This is the Mission which every
Programme worker has to accomplish. It is a "sacred
mission" because an unaccomplished mission proves to be
disastrous for the patient.
Says Sir John Crofton, "TB can be cured, patient's life is in
your hands."
Let's save our patients.
Dr Muherman Harun
Pneumo-phthisiologist
St.Carolus hospital, Jakarta
mhjkt@attglobal.net
Web Call:
TB Education Materials in South Asian Languages
Bureau of Tuberculosis Control, The New York City Department of Health
and Mental Hygiene has produced highly readable educational
materials for public in a number of South Asian languages. The
patient brochures cover a number of topics including, Contact
with TB, What you need to know about TB and Stop TB. The brochures
explain the difference between latent TB infection and TB disease
provides information on preventing the development of TB disease.
A brochure also explains what a person should do if he/she has
spent time with someone who has tuberculosis has also been explained.
These easy to easy to download and print brochures are available
in Hindi, Urdu and Bengali.
http://www.nyc.gov/html/doh/html/tb/tb1.shtml
_____________________________________________________________________________
Editorial Team:
Dr. Dinesh Kumar Sharma, dineshkumarsharma@gmail.com
Dr. Jatinder Singh, jatindersingh@vsnl.com
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