Global TB Report: WHO

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    Context

    • Recently, the Global TB report was released by the World Health Organization (WHO).

    Major Highlights of the report

    • Data analysis: 
      • WHO estimates that some 4.1 million people currently suffer from TB but have not been diagnosed with the disease or have not officially reported to national authorities. This figure is up from 2.9 million in 2019.
    • Contribution of countries: 
      • The countries that contributed most to the global reduction in TB notifications between 2019 and 2020 were 
        • India (41%)
        • Indonesia (14%)
        • the Philippines (12%) 
        • China (8%). 
        • 12 other countries accounted for 93% of the total global drop in notifications.
    • Impact of Pandemic:
      • The COVID-19 pandemic has reversed years of global progress in reducing the number of people who die from TB, with the first year-on-year increase (of 5.6 per cent) since 2005 and the total number of deaths in 2020 returning to the level of 2017.
      • The biggest impact was felt in terms of the detection of new cases. This means a large number of cases went undetected due to highly curtailed access to diagnostics and restrictions imposed to contain the pandemic. 
    • From 2016-2019, the number of new cases rose continuously but fell dramatically to 20 per cent in 2020.
    • Preventive treatment: 
      • There was also a reduction in the provision of TB preventive treatment.
        • Some 2.8 million people accessed this in 2020, a 21% reduction since 2019.  
        •  In 2020, more people died from TB, with far fewer people being diagnosed and treated or provided with TB preventive treatment compared with 2019, and overall spending on essential TB services falling.
        • The increase in the number of TB deaths occurred mainly in the 30 countries with the highest burden of TB. 
    • Challenges :
    • The first challenge was a disruption in access to TB services and a reduction in resources
    • In many countries, human, financial and other resources had been reallocated from tackling TB to the COVID-19 response, limiting the availability of essential services
    • Many people with TB were not diagnosed in 2020
      • The number of people newly diagnosed with TB and those reported to national governments fell from 7.1 million in 2019 to 5.8 million in 2020.
    • Global investment for TB fell and the funding in the low- and middle-income countries that account for 98% of reported TB cases remained a challenge. 
    • less willingness and ability to seek care in the context of lockdowns and associated restrictions on movement.
    •  The stigma is associated with similarities in the symptoms related to TB and COVID-19. 
    • Suggestions : 
      • The recent data must serve as a global wake-up call to the urgent need for investments and innovation to close the gaps in diagnosis, treatment and care for the millions of people affected by this ancient but preventable and treatable disease.
      • To improve the diagnosis, countries need to increase the proportion of cases that are confirmed bacteriologically either through bacteria culture or rapid tests. The share of rapid tests especially needs to go up as only 33 percent of total cases were diagnosed through it.

    Tuberculosis

    • It is caused by Mycobacterium tuberculosis (bacteria) and it most often affects the lungs.
    • Transmission:
      • TB is spread through the air when people with lung TB cough, sneeze or spit. 
      • A person needs to inhale only a few germs to become infected.
      • With TB infection, a person gets infected with TB bacteria that lie inactive in the body. This infection can develop into TB disease if their immune system weakens. 
    • Symptoms:
      • Prolonged cough, chest pain, weakness/fatigue, weight loss, fever, etc.
      • Often, these symptoms will be mild for many months, thus leading to delays in seeking care and increasing the risk of spreading the infection to others.
    • Diagnosis:
      • In the case of suspected lung TB disease, a sputum sample is collected for testing for TB bacteria.
      • For non-lung TB disease, samples of affected body fluids and tissue can be tested.
      • WHO recommends rapid molecular diagnostic tests as initial tests for people showing signs and symptoms of TB.
      • Other diagnostic tools can include sputum smear microscopy and chest X-rays.
    • Treatment:
      • Both TB infection and disease are curable using antibiotics.
      • It is treated by the standard 6-month course of 4 antibiotics. Common drugs include rifampicin and isoniazid.
      • In drug-resistant TB, the TB bacteria do not respond to the standard drugs. Its treatment is longer and more complex. It is treated by Bedaquiline.
      • In case of infection (where the patient is infected with TB bacteria but not ill), TB preventive treatment can be given to stop the onset of disease. This treatment uses the same drugs for a shorter time.
    • Global TB Burden:
      • A total of 1.5 million people died from TB in 2020 (including 214 000 people with HIV). Worldwide, TB is the 13th leading cause of death and the second leading infectious killer after COVID-19 (above HIV/AIDS).
      • Most of the people who fall ill with TB live in low- and middle-income countries, but TB is present all over the world.
      • TB occurs in every part of the world. In 2020, the largest number of new TB cases occurred in the WHO South-East Asian Region, with 43% of new cases, followed by the WHO African Region, with 25% of new cases and the WHO Western Pacific with 18%.
      • In 2020, 86% of new TB cases occurred in the 30 high TB burden countries. Eight countries accounted for two-thirds of the new TB cases: India, China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa.
    • Efforts Taken:
      • Global Efforts:
        • Global Tuberculosis Programme and Report, 1+1 initiative & Multisectoral Accountability Framework for TB by WHO.
        • Ending the TB epidemic by 2030 under UN SDG target 3.3.
        • Moscow Declaration, 2017 to End TB. 
      • Indian Efforts:
        • The government aims to have a TB-free India by 2025, five years ahead of the global target of 2030.
        • National Tuberculosis Elimination Programme: National Strategic Plan to end TB by 2025 under pillars of Detect-Treat-Prevent-Build (DTPB).
        • Universal Immunisation Programme.
        • Revised National TB Control Programme under the National Health Mission.
        • NIKSHAY portal and TB Sample Transport Network.
        • Development of National Framework for Gender-Responsive approach to TB.

    Source: TH