Putting the brakes on the rise in tuberculosis

Only a few TB bacteria, which spread through microscopic droplets released into the air, are necessary to cause an infection. — TNS

WORLD Tuberculosis (TB) Day is commemorated on March 24 annually.

This date was the day in 1882 when German physician and bacteriologist Dr Robert Koch (1843-1910) announced the discovery of the bacterium that causes TB.

The objective of the day is to increase public awareness about the devastating health, social and economic consequences of TB and to increase efforts to end the global TB epidemic.

Through the air

TB is a curable bacterial disease that is spread through the air when an infected person coughs, sneezes, spits or speak.

The bacteria can stay in the air for several hours, depending on the environment.

It takes only a few of the bacteria to cause an infection.

New infections occur in about 1% of the population annually, of which about 90-95% are asymptomatic (have no symptoms).

However, most infections do not cause the disease.

Persons who breathe in the air containing TB germs can become infected; this is called latent TB infection.

It has been estimated that about a third of the world’s population have latent TB.

There are TB bacteria in the bodies of those who have latent TB, but they are not sick because the bacteria are inactive.

These people do not have symptoms of TB and they cannot spread it to others.

However, they may develop the disease in the future, with a 10% lifetime risk of that occurring. They are often prescribed treatment to prevent them from developing TB.According to the World Bank, the incidence of TB in Malaysia has been rising over the past two decades.According to the World Bank, the incidence of TB in Malaysia has been rising over the past two decades.

Affects multiple organs

TB is a multisystemic infection. It can affect the lungs (pulmonary), genito-urinary tract, gastrointestinal tract, skeleton and meninges (membranes lining the brain and spinal cord).

Its sufferers are sick because the active bacteria are multiplying and destroying the tissues in their bodies.

The classic symptoms in pulmonary TB are cough, weight loss, poor appetite, fever, night sweats, haemoptysis (coughing out blood) and fatigue.

The symptoms of genito-urinary TB include flank pain; painful and/or frequent urination; painful scrotum in males; and symptoms of pelvic infection and/or infertility in females.

People with active TB are capable of spreading the disease.

They are prescribed treatment for the disease.

Drug resistance

A problem in the control of TB is drug resistance. Such resistance may involve one drug, as well as more than one drug.

It has been estimated by the World Health Organization (WHO) that only one in four multidrug-resistant TB patients is detected, and one in two cured.

HIV (human immunodeficiency virus) sufferers are more likely to get infected by TB because HIV weakens the body’s immunity, which makes it harder for the body to fight the TB bacteria.

According to the WHO, there is a need to scale up anti-retroviral treatment, treatment of latent TB infection and other key interventions.

Ending the TB epidemic

The WHO adopted a strategy at the World Health Assembly in 2014, to end the global TB epidemic as part of the Sustainable Development Goals (SDGs).

The strategy serves as a blueprint to achieve a 95% reduction in the number of TB deaths by 2035, compared with 2015; a 90% reduction in TB incidence rate by 2035, compared with 2015; and zero TB-affected families facing catastrophic costs due to TB by 2035.

The principles of the WHO strategy are:

> Government stewardship and accountability, with monitoring and evaluation.

> Strong coalition with civil society organisations and communities.

> Protection and promotion of human rights, ethics and equity.

> Adaptation of the strategy and targets at country level, with global collaboration.

The components of the WHO strategy are:

> Integrated, patient-centred care and prevention

• Early diagnosis of TB, including universal drug-susceptibility testing, and systematic screening of contacts and high-risk groups.

• Treatment of all people with TB, including drug-resistant TB, and patient support.

• Collaborative TB/HIV activities, and management of co-morbidities (other illnesses the patient has).

• Preventive treatment of persons at high risk, and vaccination against TB.

> Bold policies and supportive systems

• Political commitment with adequate resources for TB care and prevention.

• Engagement of communities, civil society organisations, and public and private care providers.

• Universal health coverage policy, and regulatory frameworks for case notification, vital registration, quality and rational use of medicines, and infection control.

• Social protection, poverty alleviation and actions on the other determinants of TB.

> Intensified research and innovation

• Discovery, development and rapid uptake of new tools, interventions and strategies.

• Research to optimise implementation and impact, and promote innovations.

There are milestones to achieve to reach the targets stated in the SDG and WHO goals by 2030 and 2035.

The targets of the SDG and WHO were to reduce the TB incidence rate by 80% and 90% in 2030 and 2035 respectively; reduce TB deaths by 90% and 95% in 2030 and 2035 respectively; and zero TB-affected families facing catastrophic costs by 2030 and 2035 respectively.

The theme for this year's World Tuberculosis Day is "Yes! We can end TB!".One of the main problems with TB is that it can become resistant to the drugs used to treat it. — MSFOne of the main problems with TB is that it can become resistant to the drugs used to treat it. — MSF

TB increasing in Malaysia

According to the World Bank, the incidence of TB in Malaysia in 2021 was 97 per 100,000 population (it was 134 per 100,000 population globally), compared to 68 per 100,000 population in 2002.

Since 2004, the incidence of TB has been on an upward trend.

Previously, the TB incidence declined from 151.5 per 100,000 population in 1961 to 50.0 per 100,000 population in 1990, and a range of 50-70 per 100,000 population in the 1990s.

The death rate from TB in Malaysia in 2021 was 7.01 per 100,000 population, which is the second highest of all communicable diseases, below that of Covid-19 (94.98 per 100,000 population).

TB affects Sabah disproportionately.

In an epidemiological study from 2012-2018, the incidence reported was 128 per 100,000 population during that period, with hotspots in urban population hubs and points of migration.

There was evidence of late presentation and diagnosis with chest X-ray and sputum smear positivity rates of 58% and 81% respectively.

Malaysia has made commitments to the SDG goals and currently holds the vice-president at the World Health Assembly, the governing body of WHO.

We have to do better by setting an example to other countries with positive actions to address the TB epidemic by arresting the increasing incidence in our country, then decreasing it to attain the targets above.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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