Drug-resistant TB cause for worry

India’s first survey of multi-drug resistant tuberculosis (MDR-TB) cases in the country that was conducted by the Union Health Ministry last year had claimed that Karnataka had zero new MDR-TB cases and of those previously treated for TB, just 1.23% -- the lowest in the country — had the MDR variant. However, the situation on the ground in the state is reported to be far more serious. According to the joint director (TB programme) of Karnataka’s Department of Health and Family Welfare, as of December 2018, around 3% of the roughly 83,000 people suffering from TB were found to have the MDR variant. Worryingly, the number of new MDR-TB cases is growing at a rapid pace. According to a World Health Organisation official, in the past three months alone, 540 new cases were registered and by the end of 2020, the number of new MDR-TB cases in the state is expected to touch 2,000. Resistance to TB drugs is a formidable obstacle in the way of effective prevention and treatment of the disease. MDR-TB is a variant where patients don’t respond to two first-line drugs - Rifampicin and Isoniazid. There are other variants of drug resistance as well. Those with extensively drug-resistant TB or XDR-TB, for instance, do not respond to at least four of the core anti-TB drugs. The rising number of MDR-TB is alarming as it has a 20% fatality rate. Treating drug-resistant cases are expensive, difficult and time-consuming, too. For instance, treatment for XDR-TB costs nearly Rs 5 lakh per patient, with treatment extending over a two-year period.

Not only is India home to the largest number of people suffering TB but also, it accounts for a fourth of all the world’s patients with MDR-TB. Resistance to TB drugs is fuelled by improper treatment of patients, poor management of supply and quality of drugs, and airborne transmission of bacteria in public places. India needs to address these problems to fight MDR-TB. However, this battle will be hamstrung if we do not have a correct picture of the magnitude of the problem. Thus, the Union Health Ministry’s goof-up on incidence of MDR-TB data relating to Karnataka would have weakened the state’s efforts to tackle the disease.

Among the major problems in treating TB is the social ostracism attached to this disease. As a result of fear of isolation, many patients prefer to keep their suffering a secret, do not register themselves at health facilities or seek treatment. As a result, the untreated TB patient ends up infecting dozens of others. Government and private health facilities as well as civil society must work together to create awareness. TB is treatable if patients follow the drug regimen.