Clamour for declaring TB notifiable disease grows louder

Published: January 17, 2021

NEW DELHI: India’s Tuberculosis (TB) control division has asked the Union health ministry to declare it a “notifiable disease” across the country.

If approved, all private doctors, caregivers and clinics will have to report every case of the air-borne disease to the government.

A ministry note says though a large number of TB patients in India are diagnosed, they are not referred to or notified to the Revised National TB Control Programme (RNTCP).

“Develop and deploy systems for notifying patients at TB diagnosis from all sources. With improved notification, RNTCP could improve case management and reduce TB transmission and the spread of drug-resistant TB,” the note said. Highly infectious diseases such as plague, polio, H5N1 (bird flu) and H1N1 ( swine flu) are in the list of notifiable diseases.

The clamour to give TB the status of a notifiable disease has got louder following the advent of totally drug-resistant TB in Mumbai. India’s 12th five year Plan for TB control says, “All diagnosed TB cases will be notified irrespective of their treatment or registration status.”

Some experts say India plans to develop the “TB register”. According to the ministry, the private sector is the first point of contact for health services for 50%-60% of the population. A ministry official said, “It is of utmost importance that the private sector reports all TB cases to the RNTCP which has high-tech labs to test for resistance and provides high quality drugs and testing free of cost to all patients.”

Ministry officials admit that universal access for TB will largely hinge on the private sector’s participation.

Undiagnosed and mistreated cases continue to drive the epidemic in India. In 2010, an estimated 2.3 million TB cases occurred, and 360,000 patients died of TB, or about 1,000 deaths per day. Nearly one in six deaths among adults aged 15-49 are due to TB. Nearly 100,000 cases of serious multi-drug-resistant TB (MDR-TB) are estimated to occur in the country annually, and each MDR TB case costs more than Rs 1 lakh to diagnose and treat.

Health ministry has lashed out at Mumbai’s Hinduja Hospital for claiming to have found totally-drug-resistant TB (TDR TB).

According to the ministry, Hinduja Hospital laboratory is not accredited by the RNTCP for culture and sensitivity for second line drugs to diagnose Extensively Drug-Resistant (XDR)/Totally Drug Resistant (TDR) cases and is only accredited for conducting Drug Susceptibility Testing (DST) by liquid culture and sensitivity for first-line drug.

RNTCP has accredited only three labs for conducting quality-assured second-line anti-TB drug susceptibility testing - National TB Institute (Bangalore), LRS Institute of TB and Chest Disease (New Delhi) and National Institute of Research in Tuberculosis (Chennai).

“In addition, the term totally-drug-resistant TB is non-standardized. Testing for resistance beyond XDR-TB is not advocated by WHO and poor clinical response to treatment has not yet been correlated with diagnosis of drug resistant TB without laboratory confirmation from accredited labs. For now these cases are defined as XDR TB according to WHO definitions and accordingly can be managed by national XDR-TB treatment guidelines,” the ministry said.

WHO recommendations advice against the use of the Drug Susceptibility Testing (DST) results for second- line drugs beyond those used to identify XDR-TB to guide treatment.

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Published January 17, 2021 by in news
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