Is Mumbai on the brink of a deadly tuberculosis epidemic?

Multiple drug-resistant (MDR) TB has claimed 83 lives in Mumbai this year. Recently 2011 CBSE class XII topper Shreeram Radhakrishnan was a victim to it. With his death, the focus has returned to the increasing number of MDR-TB cases in Mumbai. Also in 2012, four in the city have been victims to and 21 infected with extremely drug-resistant (XDR) TB, another fatal strain of the disease with a lesser incidence.

According to the BMC, 1,497 of those who tested positive for MDR-TB have been put on treatment. ‘In all, 106 are from outside Mumbai, 88 are seeking treatment in private hospitals, 68 are not traceable and 135 should be put on treatment in the next two weeks,’ said Manisha Mhaiskar, Additional Municipal Commissioner (health). 

MDR-TB has grown by 40 times in the last two years. Mhaiskar said that better diagnostic techniques in the city have helped in better detection of the disease. ‘MDR-TB has always been prevalent. But after the introduction of criteria ‘C’ by the central government, new diagnostic facilities like gene expertise and data collection from all hospitals and laboratories have ensured that there is better diagnosis of the strain,’ she said. 

Criteria ‘C’ which ensure free treatment to patients include patients suffering from MDR-TB under the government-run Revised National Tuberculosis Control Programme (RNTCP). It also includes those previously on private treatment.

‘It was only earlier this year, when the extra-extensively drug resistant (XXDR) TB strain was brought to the notice of the authorities, did the government become alert towards MDR-TB. Prior to this, most doctors tried various drugs and would then come to a conclusion on if the strain was multiple drug-resistant. By the time the correct treatment was found, the patient would die. What’s more, MDR-TB+ cases were hardly reported and deaths would be marked as TB deaths,’ said a senior chest doctor from a private hospital as reported by TOI.

With TB no longer being a poor man’s disease, doctors in the city feel that the trend of the BMC to reach out to people from the lower strata of society should change.

‘TB can affect even a rich person as it is a contagious, air-borne disease. We are seeing more and more patients from all sections of society. One has to be more cautious as there are no new medicines available for totally drug-resistant (TDR) tuberculosis patients,’ said Dr Yatin Dholakia, secretary and technical advisor, Maharashtra State Anti-Tuberculosis Association.

‘People have always hesitated to approach government facilities for a disease like TB. Social stigma associated with the disease will reduce only through awareness. People, irrespective of their class, have to come forward if they are diagnosed with the disease,’ added Dr Dholakia.

According to World Health Organisation Global Tuberculosis Report 2012, India has only 37 laboratories to test the growing number of deadly multiple-drug resistant tuberculosis (MDR-TB) patients which means there is one specialised laboratory for every five crore Indians. As per WHO standards, it should be one for 50 lakh people.

From 2010, Centre has scaled up infrastructure for testing facilities, but states such as Uttar Pradesh and Bihar that are low on infrastructure are doing poorly, according to Dr KS Sachdeva, chief medical officer, Central TB division. Mumbai has three of the seven laboratories to test MDR-TB in Maharashtra.

Directly observed treatment, short course (DOTS can be availed for free only by a patient tested in an accredited laboratory for MDR-TB. A two-year treatment costs between Rs. 2 lakh to Rs. 5 lakh. We want patients to avail of free DOTS because there is a specific treatment protocol not followed by private practitioners, says Dr BD Nanavare, state TB officer, Directorate of Health Services (DHS).

According to Blessi Kumar, vice-chairman of Stop TB Partnership, there is a need for mechanism to ensure that a patient can access the available facilities. In Mumbai, laboratories accredited for drug susceptibility testing are Hinduja Hospital at Mahim and Super Religare. JJ hospital laboratory conducts the line probe assay test. The laboratory at Sewri TB Hospital has applied for accreditation.

Source :      2012/12/30 12:08

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