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Drug resistant TB: 5 lakh and rising

Multidrug-resistant tuberculosis (MDR-TB) is an ever growing threat in India and globally. If not properly addressed, the situation presents a possibility of TB strains that are both infectious and all but untreatable plaguing both India as well as the rest of the globe.

TB-free India.
Activists campaigning for a TB-free India.

India accounts for 27 percent of the global disease burden due to TB — far in excess of India’s proportion of the global population. While this number may be falling according to World Health Organization (WHO) monitoring, it is not falling fast enough. 

While there is a steady fall in TB cases — though notably slower than deadlines set by both the Indian government and the WHO — instances of MDR-TB are rising. In excess of five lakh cases of MDR-TB were identified last year in India. As a proportion of the overall burden of TB, drug resistant strains are becoming ever more prevalent. As such, efforts to curb the overall disease count in order to hit targets may eventually hit a wall when the remaining cases are all but immune to first line medication.

Experts suggest that a key driver in the rise of MDR-TB is the common practice of taking half the course of the recommended prescription. It has been found that individuals who are on a nine-month course of medication will frequently see symptoms alleviate within the first three months. After this point, many simply stop taking the medication.

The reasons for this may be both complex and diverse. Some may simply have little knowledge of the disease, leading them to believe they are entirely cured. Others may see a lapse in symptoms and due to economic situations may no longer buy the prescription hoping that the disease is cured. 

In either case, the use of antibiotics over a partial period can allow for the disease to show a resurgence in the individual. This secondary infection is often more severe, as well as harder to treat. The remaining bacteria are those who have endured the initial course of antibiotics — though not necessarily immune to the antibiotics and so treatable with an extended course. 

This creates a situation that is akin to an artificial case of natural selection. Those bacteria most resistant to the antibiotics will have survived and so any person infected by this individual afterwards will receive a strain of TB that is slightly more resistant to the previously used antibiotic. If this occurs over a number of individuals, the resultant circulating strain may be all but entirely resistant to the antibiotic.

Information is key to preventing this. Patients need to be informed of the consequences of not completing a full course of antibiotics. The consequences to themselves can often be lethal, as the resurgent infection often causes more symptoms than the original. The potential for the development of drug resistance alters their choices from an issue that is isolated to themselves to one which is visibly causing issues on a global level.

Mass underreporting of the true burden of TB in India adds to this issue. Experts have referred to the individuals wandering undiagnosed as an “unquarantined health hazard”. The fact that these individuals go unchecked by the health system allows the disease to spread unchecked. This matter has been discussed previously by Health Issues India. Due to India’s densely populated urban areas, an individual on public transport across a city to a busy workplace and then back to their home could expose the disease to thousands of individuals within a single day.

Due to this, the true scale of the issue of TB in India may be vastly underestimated. Disease estimates may be far lower than the actual value. Those who are not picked up by the healthcare system run the risk of allowing the proliferation of MDR-TB strains, often without even realising TB is the source of their symptoms.

This is not a situation limited to India. If MDR-TB is to truly be addressed it must be tackled simultaneously by all endemic countries. If any areas remain reservoirs for the condition, resistant strains could develop and then resurge back to nations that have made progress in reducing disease instances.

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