A Q&A interview with Dr Amit Dias
As the nation steps up the fight against tuberculosis by launching the 100-day TB Elimination Campaign, we spoke to Dr Amit Dias from the department of Preventive & Social Medicine at the GMC to get to know more about this killer disease. He says, “The dream of elimination of tuberculosis this year, seems far-fetched, but if we collaborate and cooperate, we can certainly get closer to the goal… on World TB Day observed on March 24, let us Unite, Commit, Invest and Deliver.”
Goan Observer: Doctor you mentioned about the 100-day TB Elimination Campaign. Could you throw more light on it?
Dr Amit Dias: The 100-Day TB Elimination Campaign was launched on December 7 last year, as an initiative under India’s National TB Elimination Program (NTEP), designed to accelerate progress toward a TB-free India by 2025. This campaign focuses on strengthening diagnostics, treatment services, and outreach efforts, especially for high-risk groups who are more vulnerable to TB infection and its complications such as prisoners, slum dwellers, those with TB in the past, those in contact with a TB patient, those who are immune-compromised.
Enhanced TB screening and diagnosis is done by strengthening early detection and diagnosis using advanced technologies like CBNAAT, TrueNat, and digital X-rays. We hope to expand the active case-finding efforts in high-burden areas. Mega health camps were held in Goa for screening for tuberculosis.
Improved Access to Treatment and Care: Ensuring free and complete treatment under Directly Observed Treatment, Short-course (DOTS).
March 24 is World TB Day and we hope to spread this message of hope through a socially sensitive publication like yours. The media has an important role to play in the fight to eliminate TB. We need to raise awareness in order to fight the myths and stigma that surrounds TB.
Q: We assure you of our support. TB has affected our family and we are committed to the fight against TB. Let’s start the awareness campaign with a very basic question, tell us what causes tuberculosis?
A: Tuberculosis (TB) is an infectious disease, caused by a bacteria called Mycobacterium tuberculosis (M tuberculosis). The bacteria, or germ, usually affects the lungs. However, TB germs can attack any part of the body, such as the lymph nodes, intestines, kidneys, bones, spine or brain. It can attack any part of the body where blood reaches, which means any part except the nails and the hair. It’s classified into two categories — Pulmonary TB (where the lungs are affected) and Extra Pulmonary (which affects other parts of the body).
Q: How and where does TB spread?
A: TB is spread through the air from one person to another, just like COVID-19. The TB germs are spread into the air when a person with infectious TB disease of the lungs or throat coughs, speaks or sings. People nearby may breathe in these TB germs and become infected.
When a person breathes in TB germs, the TB germs can settle in the lungs and begin to grow. From there, the TB germs can move through the blood to other parts of the body, such as the kidney, spine, lymph nodes, reproductive organs, pleura, meninges and a number of other organs.
Q: When you mention “Elimination of TB,” what exactly are you trying to achieve?
A: Globally, the World Health Organization (WHO). aims to end the TB epidemic by 2030 as part of the Sustainable Development Goals. India, however, has set a more ambitious target to eliminate TB by 2025.Elimination of TB refers to reducing the incidence of TB to less than one case per million population per year. It represents a point where TB transmission becomes difficult.
Q: Is there a reason why World TB Day is observed on March 24?
A: Yes, there is! It was on this day in 1882, that Dr Robert Koch announced his discovery of Mycobacterium tuberculosis, the bacterium that causes tuberculosis. This pivotal discovery paved the way for diagnosing and treating TB. We have come a long way since then and hope to eliminate this disease that is a major public health problem. We are hoping to achieve the SDG targets for TB which are 80% reduction in incidence, 90% reduction in mortality and zero TB patients and their households which face catastrophic costs as a result of this disease.
Robert Koch could not find the cure for TB, but the good news is we now have a cure and the medications are available free of cost at your nearest health center.
Q: Where can one get the drugs for treating TB?
A: The drugs are available free of cost under the National Tuberculosis Elimination Program. They are good quality drugs and care will be taken by the doctor even at the Primary Health Center to ensure that the patient is compliant with the medications. Remember, one will have to take multiple drugs for a long period, at least for six months, to ensure that all the TB bacilli in the system are killed. Or else, they can change into resistant forms and attack once again and this is difficult to treat.
Q: I am aware of these drugs, can you explain why a patient given so many drugs for TB?
A: That is because each of them has a different mechanism of action. The combination of drugs shortens the duration of treatment, reduces the chances of disease relapse, and lowers the rate of drug resistance development compared to mono-therapy. Newer drugs have been introduced for the management of resistant TB.
Q:. Do these drugs have side effects?
A: This is a war, and in a war there is injury and damage. All drugs have side effects… remember, here you are taking multiple drugs against a powerful bacteria. However, the benefits of taking the medication, far outweigh the side effects and one SHOULD take the treatment. We now have advanced tests that tell us about the sensitivity pattern of the bacilli and can ensure that the person gets the right drugs right from the start. If you do get side-effects, consult the doctor for an alternative treatment regimen.
Q: What progress have we made in India ? What is the current situation?
A: According to the MOHFW, India is progressing towards the SDG goals at a far greater pace than the global average, with a decline in TB incidence by 16% and in TB deaths by 18% from 2015 to 2022.
Estimated Incidence: 2.82 million new TB cases in 2022 — 199 cases per 100,000 population with and estimated mortality: 331,000 deaths in 2022 — 23 deaths per 100,000 population. In 2022, out of the estimated global annual incidence of 10.6 million TB cases; 2.8 million were estimated to have occurred in India.
Q: Are there people who are more vulnerable to TB?
A: Yes, as I mentioned earlier, this is the focus of the 100-day TB Elimination campaign. We are focusing on the vulnerable groups — people who have contact with someone who has infectious TB disease, People who are immune-compromised — have HIV infection, diabetes, are on steroids, have cancer, malnourished, substance use (taking drugs), kidney disease, the elderly, prisoners, etc. Healthcare workers who constantly come in contact with patients with TB are also at high risk. All age groups are at risk of developing the disease.
Q: How can recognize the signs of TB Infection?
A: The most common form of TB infection is pulmonary TB. The person will present with a cough. We recommend screening for TB in every patient who has a cough for more than two weeks. Person can have weight loss, evening rise of temperature which could be low grade, night sweats, they may cough out blood. In addition to this the new guidelines state that if a person is immune-compromised or has uncontrolled diabetes, we can screen for TB even in a person who has a cough for a week. The bottom-line is that we need to detect TB early and initiate treatment so that they get better soon and do not infect others.
One should be aware of symptoms of TB in other parts of the body:
TB of the larynx-hoarseness.
TB of the kidneys — blood in the urine.
TB meningitis (covering of brain) — headache or confusion.
TB of the spine — back pain, neurological problems.
Q: Is there a vaccine for TB? How effective is it?
A: Yes, BCG, which is given at birth, is the vaccine for TB. All of us will have a scar on the left arm which is the BCG mark. However, the vaccine is only known to protect us from severe forms of TB and does not entirely prevent TB.
Q: What is your advice to our readers?
A: This year’s theme, “Yes! We Can End TB: Commit, Invest, Deliver,” is a bold call for hope, urgency and accountability. The key message I would like to give is that once diagnosed with tuberculosis, please take the medications correctly for the right duration of time, even if you feel better. Medicines are available free of cost and the government has ensured that the best quality anti-TB drugs are made available to the people. The rise of multi-drug resistant and extremely resistant forms has made treating tuberculosis and achieving the elimination of TB very difficult. In India, we are aiming to eliminate TB this year in 2025, which is five years before the global goal. This may seem impossible, but if we work together and the patients and doctors are in perfect partnership, then we can at least get closer to the goal.
TB Harega, Desh Jeetega !!
