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Concerted effort needed to end TB: None of us are protected until everyone is protected

December 18, 2023

Did you know that every 20 seconds, a person dies of tuberculosis (TB) in the world?1 One of the oldest diseases recorded in the history of mankind, TB is caused by Mycobacterium tuberculosis, a bacterium that usually attacks the lungs.2,3 It is an airborne disease that spreads through the inhalation of tiny droplets from the coughs or sneezes of an infected person. It can also affect a person’s abdomen, glands, bones, and nervous system and is a potentially life-threatening disease. It causes immense economic devastation trapping families in an endless cycle of poverty. Globally, TB affected 10.6 million people and caused 1.6 million deaths in 2021.4

Often overlooked, the lack of awareness and preparedness about TB can cause the disease to spiral out of control quickly and affect immunocompromised communities. However, there is a severe underreporting of TB cases since the COVID-19 pandemic took the centre stage for infectious diseases over the last couple of years. After the coronavirus, TB is the second leading cause of death among infectious diseases.5

A persistent cough
Raman had a persistent cough for about a week. Initially, he thought it was due to his allergies or maybe the common cold. However, the cough became more serious and refused to subside even after three weeks. Along with the cough, he had other symptoms like pain in the chest, weakness or fatigue, chills, and sweating at night. One day, he coughed up blood, which immediately prompted him to rush to the doctor, who diagnosed him with TB.

Like Raman, many with TB do not go for screening until the symptoms become severe. A persistent cough that refuses to subside even after three weeks, along with additional symptoms can be an indicator of TB and needs immediate attention. Because of the contagious nature of TB, patients with chronic cough need to be diagnosed and treated early to protect community health. Therefore, it is important to be aware of the symptoms of the disease which are:

  • a persistent cough that lasts over three weeks
  • chest pain
  • blood in sputum (phlegm)
  • weakness or fatigue
  • sudden loss of weight
  • loss of appetite
  • chills
  • fever
  • sweating at night

Covid’s impact on fight against TB
The Covid-19 pandemic brought enormous social and economic changes and adversely affected essential healthcare services. It substantially shifted focus from TB management in several countries leading to disruption in the treatment and monitoring of TB patients. Moreover, its Covid-like symptoms deterred many patients from seeking help due to the stigma attached to it. This has led to many going undiagnosed and untreated, with an increased incidence of TB cases due to rapid transmission and deaths. This has taken global TB control back by 10 years.7

Therefore, in this post-pandemic era, it is essential to prioritise resource allocation and increase the budget and human resources for existing TB infrastructure. It is also important to mobilise community-based organisations and partners to advocate for more resources for care and prevention. It is also essential to ramp up prevention efforts by educating society and destigmatising the disease, encouraging cough etiquette practices, and implementing TB screening protocol among high-risk and vulnerable groups. Some of these include people with HIV and those with risk factors such as undernutrition, smoking, increased alcohol consumption, and diabetes.8

TB is a preventable and curable disease with nearly 74 million lives saved with timely diagnosis and treatment between 2000-2022.9 Moreover, seven high TB-burden countries have reached or surpassed the 2020 milestone of a 20% reduction in the TB incidence rate compared with 2015. However, there is a growing resistance to available TB drugs, which means the bacteria is getting deadlier and more difficult to treat. About two out of three drug-resistant TB cases go untreated around the world.10

The progress in TB control made so far has been reversed due to Covid-19 pushing global TB targets off track. If these trends continue, TB may once again be the leading cause of death worldwide due to a single infectious agent. Therefore, policymakers and other stakeholders need to regroup and prioritize TB prevention efforts. It is essential that access and provision to end-to-end TB services are expanded. In addition to community-based interventions, it is important to tackle TB risks such as undernourishment and lifestyle-related factors. This World TB Day, let’s pledge to work together to eradicate this deadly disease.

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