Is Tb Making A Comeback?

WORDS ABRAHAM MATHEW SAJI

Every year March 24th is recognized as World TB Day to commemorate the discovery of Mycobacterium tuberculosis, the bacteria that causes TB. It was on this date in the year 1882 Dr. Robert Koch announced this discovery. In conjunction with World TB Day and having reviewed the statistics and facts, let’s understand this condition better and spread the knowledge around to others.

Tuberculosis, also commonly known as TB was a major cause of morbidity and mortality in the yesteryears and is slowly feared to be making a comeback. Let’s take a peek into some alarming statistics on TB, as stated by the World Health Organization (WHO):

• TB is one of the top 10 causes of death worldwide.
• In 2017, 10 million people fell ill with TB, and 1.6 million died from the disease (including 0.3 million among those with HIV).
• In 2017, an estimated 1 million children became ill with TB and 230,000 children died of TB.
• About one-quarter of the world’s population has latent TB, which means people have the TB bacteria within their body, but the bacteria are present in very small numbers, are kept under control by the body’s immune system and do not cause any symptoms.
• People infected with TB bacteria have a 5-15% lifetime risk of falling ill with TB. (including children with HIV associated TB).
• People with active TB can infect 10-15 other people through close contact over the course of a year (ie, via inhalation of infectious droplets from cough, sneeze, spit, etc.).
• TB is a leading cause of death among those with HIV. Without proper treatment, TB has a 10-year case fatality or death rate of around 70% among HIV negative and around 83% among HIV positive persons.
• Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat. WHO estimates that there were 558,000 new cases with resistance to rifampicin – the most effective first-line drug – of which 82% had MDR-TB.
• Globally, TB incidence is falling at about 2% per year. This needs to accelerate to a 4-5% annual decline to reach the 2020 milestones of the End TB Strategy.
• An estimated 54 million lives were saved through diagnosis and treatment between 2000 and 2017.
• TB can occur in every part of the world. In 2017, the largest number of new TB cases occurred in the Southeast Asia and Western Pacific regions, with 62% of new cases, followed by the African region with 25% of new cases.
• In 2017, 87% of new TB cases occurred in 30 high TB burden countries. Eight countries accounted for two thirds of the new TB cases, namely India, China, Indonesia, Philippines, Pakistan, Nigeria, Bangladesh and South Africa.

TB in Malaysia

• Every year more people die of TB than from dengue- and HIV-related complications. In 2016, there were 1,945 deaths from 25,739 cases which is a 14.7% increase compared to 2015 (1,696 deaths from 24,220 cases).
• TB cases reduced from more than 30,000 in 1960 to less than 6,000 in the mid-1980s.
• But cases have been increasing since 2008. 
• New TB cases registered in 2017 was 26,168.

The hike in the number of cases from the above statistics leaves us with the question “Is TB making a comeback?”

Here are some additional fast facts about this highly dreaded disease.

• TB is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs.
• TB is curable and preventable. Most cases are cured with antibiotics for a duration of about 6 to 9 months.
• TB is spread via droplet transfer. When people with lung TB cough, sneeze or spit, they propel the TB bacteria into the air. A person needs to inhale only a few of these bacteria to become infected.
• Drinking unpasteurized milk products from cows infected with Mycobacterium bovis may also cause TB.
• People with compromised immune systems, such as people living with HIV, malnutrition diabetes, or people who smoke, have a much higher risk of falling ill due to infection by TB.
• When a person develops active TB disease, the symptoms (such as cough, fever, night sweats, or weight loss) may be mild for many months. This can lead to delays in seeking medical attention, thereby resulting in worsening of the infectious condition and also transmission of the infection to others.
• TB can also affect other parts of the body like the brain, bone, lymph nodes and heart.
• The death rate due to TB is the highest among all infectious diseases including dengue, HIV and malaria.

Here are the answers to a few pertinent questions on TB:

How is TB spread?

TB is contagious, but it is not easy to contract. The bacteria grow and multiply slowly. You usually have to spend a lot of time around a person who has TB before you become infected. That is why it is often spread among co-workers, friends, and family members. The TB bacteria does not thrive on surfaces. You cannot contract the disease from just shaking of hands with someone who has it, or by sharing their food or drink.

What are the types of TB?

There are two common forms of the disease:

Latent TB: You have the bacteria in your body, but your immune system stops them from spreading. That means you don’t have any symptoms and the infection is not contagious. However, the latent bacteria are still alive in your body and can one day become active.

Active TB disease: This means the bacteria multiplied and can make you sick. You can spread the disease to others. Of all the adult cases of active TB, 90% are from the reactivation of a latent TB infection.

What are the Symptoms of TB?

There are no symptoms for latent TB. Only a skin or blood test can confirm the presence of any latent infection.

On the contrary, active TB manifests itself with a wide range of symptoms that include cough that lasts more than 3 weeks, chest pain during coughing, coughing out blood, fever, fatigue, lack of appetite, chills, night sweats, and weight loss.

Who is at Risk?

A healthy immune system fights TB bacteria. In general, young children and the elderly are at greater risk because young children’s immune system has not fully formed while the elderly’s is weakened.

If you have one or more of the following conditions, your immune system might not be able to fight TB infection:

• HIV or AIDS
• Diabetes
• Severe kidney disease
• Head and neck cancers
• Cancer treatments, such as chemotherapy
• Low body weight and malnutrition
• Taking medications for organ transplants
• Taking certain drugs to treat rheumatoid arthritis, Crohn’s disease, and psoriasis.

Can TB be prevented?

It may sound like a disease of the past, but TB, is still a real concern today. The best way to prevent TB is to avoid the infection in the first place.  Hence, doctors advise those who have active TB disease to stay home and away from other people as much as possible, until they’re no longer infectious.

If you’re found to have TB, follow these tips to help prevent others from getting TB during your first few weeks of treatment, or until your doctor says you’re no longer infectious:

• Take all of your medicines as prescribed by your doctor.
• Go for all your follow-up doctor appointments.
• Always cover your mouth with a tissue when you cough or sneeze. Seal the tissue in a plastic bag, then throw it away.
• Wash your hands after coughing or sneezing.
• Avoid visiting other people and don’t invite others to visit you.
• Stay home from work, school, or other public places.
• Use a fan or open windows to move around fresh air.
• Avoid use of public transportation.

In Malaysia, BCG vaccination is given to all children at birth. It helps to protect against childhood forms of TB such as TB meningitis and disseminated TB, hence there is a low incidence of these childhood forms in our country.

Can TB be treated?

With proper treatment, TB is almost always curable. Doctors prescribe antibiotics which must be taken for 6-9 months. The medications and the duration will depend on the severity and seriousness of the patient’s condition.

Sometimes, antibiotics don’t work and this form of the disease is known as drug-resistant TB. Those with drug-resistant TB may need to take stronger medications for a longer duration.

Depending on one’s risk factors, latent TB can reactivate and cause an active infection. So, doctors may prescribe antibiotics such as isoniazid and rifampicin as a precautionary measure. For active TB, doctors usually prescribe antibiotics such as ethambutol, isoniazid, pyrazinamide and rifampicin.

Your doctor may order a few tests to verify if the treatment is actually working against the TB infection. Based on the results and overall health condition, your dose of medications will be modified. You will probably start to feel better after a few weeks of treatment. But only a doctor can tell you if you’re still contagious and require treatment.

The Road Ahead

Having gained some knowledge about this dreaded disease that was thought to be on its way to extinction and is now making a comeback, let’s be wary of the symptoms, associated risks and treatment options. Please consult your doctor upon noticing any of the symptoms and diligently follow their advice.

We need to stand united in this battle against TB considering the rate at which TB incidence is rising. On this World TB Day, all of us including doctors, policy makers and the public need to aggressively take up the cause and pursue the challenges of controlling TB and move towards a TB-free Malaysia. Every effort counts! HT

References:

1. World Health Organization. Retrieved from: www.who.int/news-room/fact-sheets/detail/tuberculosis.

2. The Star Online. Retrieved from: https://www.thestar.com.my/news/nation/2017/07/19/infectious-diseases-making-comeback-more-deaths-from-tuberculosis-than-dengue-and-hivrelated-complic/.

3. World Health Organization. Retrieved from: https://www.who.int/tb/country/data/profiles/en/.

4. Free Malaysia Today. Retrieved from: www.freemalaysiatoday.com/category/nation/2018/03/06/ministry-rise-in-tb-leprosy-cases-in-2017/.

5. U.S. Centers for Disease Control and Prevention (CDC). Retrieved from: www.cdc.gov/mmwr/preview/mmwrhtml/mm5424a4.htm.