39% TB cases found during T.N. TB survey had no symptoms
Context:
A TB prevalence cross-sectional survey was conducted in Tamil Nadu from February 2021 to July 2022 by the National Institute for Research in Tuberculosis (ICMR-NIRT), Chennai.
- The survey aimed to improve TB detection methods and highlighted the importance of chest X-rays in identifying TB cases, including subclinical cases that exhibit no symptoms.
Relevance:
GS-02 (Health)
Key Highlights:
- Survey Findings: Among 130,932 participants, 244 microbiologically confirmed TB cases were identified. Notably, 39% of these cases had no symptoms, indicating subclinical TB.
- Detection Methods: Chest X-rays proved crucial, as 92.6% of TB cases had X-ray abnormalities. Molecular tests (CBNAAT) detected 91.8% of cases, while smear microscopy detected only 50.4%.
- Symptomatic vs. Asymptomatic: Among symptomatic TB cases, CBNAAT diagnosed 89% compared to 50% by smear microscopy. Subclinical cases, which would have been missed without chest X-rays, accounted for a significant portion of detections.
- State Recommendations: The study recommends prioritizing chest X-rays for early detection and upscaling molecular tests to enhance TB case yield.
- National Comparison: The findings align with the National TB Prevalence Survey (2019-2021) which reported 42.6% of bacteriologically positive TB cases without symptoms.
Tuberculosis:
- TB, caused by Mycobacterium tuberculosis, is a treatable and curable disease with a long history dating back to 3000 BC in Egypt.
- Spread through the air when infected individuals cough or sneeze, TB commonly affects the lungs but can also impact other organs.
- MultiDrug Resistant Tuberculosis (MDR-TB) and Extensively Drug Resistant Tuberculosis (XDR-TB) pose significant health threats.
- The BCG vaccine, developed in 1921, plays a crucial role in TB prevention. Initially introduced in India in 1948, BCG became part of the National TB Control Programme in 1962.
- Besides TB protection, the vaccine safeguards against respiratory infections, mycobacterial diseases, and serves as immunotherapy for certain cancers.
- Interestingly, BCG’s efficacy varies geographically, demonstrating higher efficiency in countries farther from the equator.
Government Schemes for TB Patients:
-
National Tuberculosis Elimination Program (NTEP): Aims to eliminate TB in India by 2025 through early diagnosis, complete treatment, and addressing the social determinants of TB.
- Nikshay Poshan Yojana: Provides nutritional support to TB patients, offering a financial incentive of INR 500 per month during treatment.
- TB Harega Desh Jeetega Campaign: Focuses on community engagement, awareness, and mobilization to end TB.
- Universal Immunisation Programme (UIP): Includes the BCG vaccine to prevent TB among children.
Suggested Measures:
- Enhanced Screening: Use chest X-rays as a preliminary screening tool alongside molecular diagnostics to detect subclinical TB.
- Modernized Forecast Models: Develop Kerala-specific weather forecast models to address unique topographical and seasonal challenges.
- Increased Resources: Allocate ample resources and personnel to institutions like the Institute for Climate Change Studies in Kottayam for better weather prediction and TB detection models.
- Active Case Finding: Improve active case finding in high-risk groups by including chest X-rays to increase detection rates.
Way Forward:
- Policy Implementation: Implement the study’s recommendations to prioritize chest X-rays and upscale molecular tests in the State TB programme.
- Integrated Approach: Combine symptom screening, chest X-ray examinations, and molecular tests for comprehensive TB detection.
- Public Awareness: Increase awareness about subclinical TB and the importance of early detection to reduce transmission.
- National Strategy: Align State efforts with national TB elimination goals, ensuring that all high-risk and vulnerable populations are adequately screened and treated.
- Research and Development: Continue research to refine TB detection methods and address challenges posed by subclinical TB and global climate change impacts on health.
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