LONDON: Over 9.3 lakh Indians with the world’s most dangerous air borne disease – tuberculosis, are currently going undetected and being ‘missed’ by the country’s health system. Around 3 million people - equal to one in three people falling ill with TB are not being detected globally.
What is bad news for India is that 31% of those are in India. India is presently home to around 26% of the world TB patients – 1 in 4 globally.
World Health Organisation’s World TB Report 2013 released on Wednesday said 75% of the estimated missed cases – people who were either not diagnosed or diagnosed but not reported were in 12 countries.
In order of total numbers, India led the list followed by South Africa, Bangladesh, Pakistan, Indonesia, China, Congo, Mozambique, Nigeria, Ethiopia, Philippines and Myanmar. There were an estimated 4.5 lakh new cases of multi drug resistant TB (MDR-TB) worldwide in 2012. More than half of these cases were in India, China and the Russian Federation.
Around 94,000 TB patients eligible for multi-drug resistant (MDR-TB) treatment were detected in 2012: 84,000 people with confirmed MDR-TB (resistance to both rifampicin, the most powerful TB drug and isoniazid), along with 10,000 with rifampicin resistance detected using Xpert MTB/RIF.
This was a 42% increase in detected cases eligible for treatment compared with 2011.
Another bad news for India is that the largest increases between 2011 and 2012 were in India, South Africa and Ukraine.
India saw 2.7 lakh deaths caused by TB in 2012.
India and South Africa together accounted for about one-third of global TB deaths.
The five countries with the largest number of incident cases in 2012 were India (2 million), China (0.9 million), South Africa (0.4 million), Indonesia (0.4 million) and Pakistan (0.3 million).
India and China alone accounted for 26% and 12% of global cases, respectively.
Of the 8.6 million incident cases, an estimated 0.5 million were children and 2.9 million occurred among women.
Dr Mario Raviglione, WHO director of the Global TB Programme said “far too many people are still missing out on such care and are suffering as a result. They are not diagnosed, or not treated, or information on the quality of care they receive is unknown. WHO estimates that 75% of the three million missed cases are in 12 countries”.
WHO recommends priority actions that could make a rapid difference between now and 2015.
“Reach the 3 million TB cases missed in national notification systems by expanding access to quality testing and care services across all relevant public, private or community based providers, including hospitals and NGOs which serve large proportions of populations at risk”.
WHO also calls countries to “address with urgency the MDR-TB crisis. Failure to test and treat all those ill with MDR-TB carries public health risks and grave consequences for those affected. Intensify and build on TB-HIV successes to get as close as possible to full antiretroviral therapy (ART) coverage for people co-infected with TB and HIV,” the report says.
TB treatment has saved the lives of more than 22 million people, according to the WHO.
The report also reveals that the number of people ill with TB fell in 2012 to 8.6 million, with global TB deaths also decreasing to 1.3 million. While the number of people detected worldwide with rapid diagnostic tests increased by more than 40% to 94 000 in 2012, three out of four MDR-TB cases still remain without a diagnosis, warned WHO.
Even more worrying, around 16000 MDR-TB cases reported to WHO in 2012 were not put on treatment, with long waiting lists increasingly becoming a problem.
“The unmet demand for a full-scale and quality response to multidrug-resistant tuberculosis is a real public health crisis,” says Dr Raviglione. “It is unacceptable that increased access to diagnosis is not being matched by increased access to MDR-TB care. We have patients diagnosed but not enough drug supplies or trained people to treat them. The alert on antimicrobial resistance has been sounded; now is the time to act to halt drug-resistant TB.”
A further challenge identified relates to the TB and HIV co-epidemic with less than 60% receiving antiretroviral drugs in 2012.