Pandemic a setback for TB eradication efforts

Tuberculosis (TB), one of the major public health challenges India is facing today, is aimed to be eradicated in a couple or more years.
For representational purposes
For representational purposes

KOCHI: Tuberculosis (TB), one of the major public health challenges India is facing today, is aimed to be eradicated in a couple or more years. The Covid pandemic, however, has plunged into disarray the efforts undertaken in the state, which, to an extent, had succeeded in notifying and diagnosing TB in the community. However, due to delays in diagnosis, caused due to patients’ reluctance to visit hospitals, experts fear an imminent increase in TB mortality rates.

According to the Centre’s annual TB report for 2020, the total number of presumptive cases identified in Kerala was over five lakh. From both the public and the private sectors, 20,832 TB patients were notified in the state, while in 2019, 25,617 TB patients and 1,473 paediatric TB patients were notified. The cure rate for 2019 was at 73%, while 1,828 succumbed to the illness. In 2018, 24,572 TB patients were notified and the cure rate was 79%, while 1,163 succumbed to the illness.

According to WHO, the number of TB deaths has increased globally, with the pandemic having reversed years of global progress in tackling tuberculosis for the first time in over a decade. The TB case notification had gone down in Kerala by 50% during April-July 2020, as Covid had affected patients’ access to hospitals and the health system was overwhelmed with Covid care efforts.

“Community-based TB elimination efforts, including prevention, diagnosis and improved treatment, were hit due to the pandemic. Even as it adversely affected TB care services, early detection of the disease, which is vital for effective treatment, was worst hit. In case of delayed diagnosis, lungs could be irreversibly damaged with formation of cavitations,” said an official with the National TB Elimination Programme.

Though the diagnosis of TB and its care got affected across the nation, an integrated TB-Covid screening programme has managed to identify most of the missed-out cases. “It is important to keep track of the TB cases. Due to the delay in diagnosis, patients could be spreading the infection to their family members and others. In Kerala, almost 20% of the TB cases are spread within households. Therefore, it is important to identify and treat TB patients at the earliest. Since both Covid and TB exhibit similar symptoms, we do not know if any undocumented TB deaths are taking place even before diagnosis,” said Dr Monu Varghese, a pulmonologist based in Kochi.

In a 2018 survey, the state identified about 20 lakh vulnerable individuals who faced the risk of infection and active disease, from about 3.48 crore population surveyed. Also, as per the Kerala state NTEP team, there was a slight increase in the number of presumptive TB examinations at OPDs in March 2020 as compared to 2019.

The state used to offer, on average, around 1,600 TB tests per week until February 2020, which came down to an average of 661 tests per week since mid-March 2020. There is a 50% decline in the test numbers as well. Analysing the ages of notified TB patients in southern states including Kerala, the proportion of TB patients in the 15-30 age group was found to be between 18% and 29%.

“To an extent, the Covid protocol in place, including wearing masks and maintaining social distancing, protects oneself from TB infection. However, it is not a solution to eradicate the disease. All screenings, awareness campaigns and programmes conducted to ensure public health and awareness should be resumed in full swing,” said Dr Abraham M, a senior pulmonologist based in Kollam.

Situation in state

5L presumptive cases identified in Kerala in total

25,617 TB patients were notified in the state in 2019

1,473 paediatric patients were notified in the same year

TB case notification had gone down in Kerala by 50% during April-July 2020

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