DR.T.V.RAO MD 1

Dr.T.V.Rao MD

WORLD TB DAY 2012STOP TB IN MY LIFETIME

24TH MARCH

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• World TB Day is March 24. This annual event commemorates the date in 1882 when Dr. Robert Koch announced his discovery of Mycobacterium tuberculosis, the bacteria that cause tuberculosis (TB)

A TRIBUTE TO ROBERT KOCH

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• In 1982, on the one-hundredth anniversary of Dr Koch's presentation, the International Union against Tuberculosis and Lung Disease (IUATLD) proposed that March 24 be proclaimed as an official World TB Day

BEGINNING OF WORLD TB DAY

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TUBERCULOSIS• TB" is short for tuberculosis. TB disease is

caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal.

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ESTIMATED TB INCIDENCE RATES, 2009

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WORLD TB DAY• World TB Day, falling on March 24th each year,

is designed to build public awareness that tuberculosis today remains an epidemic in much of the world, causing the deaths of several million people each year, mostly in developing countries. It commemorates the day in 1882 when Dr Robert Koch astounded the scientific community by announcing that he had discovered the cause of tuberculosis, the TB bacillus

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SOME KEY FACTS ABOUT TUBERCULOSIS

• One-third of the 33 million people worldwide who are living with HIV/AIDS are co-infected with TB.

• TB in HIV-positive people is almost certain to be fatal if undiagnosed or left untreated.

• People who are infected with HIV are highly susceptible to TB infection due to their immune system’s inability to fight off disease.

• In general, while approximately 10 percent of those who become infected will develop active TB, HIV-positive people are 50 times more likely than HIV-negative people of developing the active form of the disease.

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SOME KEY FACTS ABOUT TUBERCULOSIS

• Just as HIV heightens the risk of developing active TB, so does TB accelerate the progression of HIV into AIDS. Without proper treatment, approximately 90 percent of HIV-positive people die of TB within months of infection.

• TB and poverty come together to perpetuate a vicious cycle. Poverty contributes to the spread of tuberculosis as people are forced to share close living quarters and are often in overall poor health. Simultaneously, costs associated with diagnosis and treatment create further hardship, both for patients and their families – including their children.

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• World TB Day is about commemorating the lives and stories of people that are affected by TB and has taken a treatment for it; nurses; doctors; researchers; community workers who has put in global fight against TB.

WORLD TB DAY IS ABOUT … CONCERN FOR INFECTED

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GOVERNMENT PROGRAMME ORGANIZES

• The government organizes Health education campaigns to inform on the importance of early diagnosis and Regular treatment for the patients. A screening programme to early detect the disease is also organized. Various other events like seminar and exhibition on tuberculosis are held with an aim to impart knowledge on all aspects of TB.

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• TB is spread through the air from one person to another. The TB bacteria are put into the air when a person with active TB disease of the lungs or throat coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected.

HOW TB IS SPREAD

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DIFFICULT TO DIAGNOSE BY CONVENTIONAL METHODS

• The two conventional techniques used to detect TB are acid-fast smearing and culturing. All detection techniques use sputum samples. Acid-fast smearing has very low sensitivity and specificity, and cannot distinguish between Mycobacterium Tuberculosis (the bacterium that causes TB) and other types of bacilli.

• The culture technique, on the other hand, has good specificity and sensitivity but typically

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• The Global Plan to Stop TB, 2006-2015 sets out the strategic directions of the Stop TB Partnership for the decade 2006–2015.

GLOBAL PLAN – STOP TB

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• Sputum smear microscopy is an essential tool of case-finding in Tuberculosis control. Tuberculosis control, aiming at the prevention of the transmission of infection, imparts a clear priority to the sputum positives which are the sources of infection in the community. Hence the need to detect as many sputum positives as possible

WHY SPUTUM MICROSCOPY

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WHO AIMS TO REDUCE THE BURDEN OF TB BY 2015

• WHO has developed a new six point Stop TB Strategy which builds on the successes of DOTS while also explicitly addressing the key challenges facing TB. Its goal is to dramatically reduce the global burden of tuberculosis by 2015 by ensuring all TB patients, including for example, those co-infected with HIV and those with drug-resistant TB, benefit from universal access to high-quality diagnosis and patient-cantered treatment

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• Bacteriology is one of the fundamental aspects of national tuberculosis (TB) control programmes (NTP's).. Improving sputum smear microscopy, the need to upgrade existing laboratory services and strengthen and build capacity to perform culture and drug susceptibility testing (DST) are essential.

UP GRADATION OF LABORATORY SERVICES

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GLOBAL LABORATORY INITIATIVE (GLI)

• Global policy guidance on appropriate laboratory technology and best practices

• Laboratory advocacy and resource mobilization • Laboratory capacity development and coordination • Interface design with other laboratory networks to

ensure appropriate integration • Standardized laboratory quality assurance • Coordination of technical assistance • Effective knowledge sharing

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DO YOU KNOW• That someone in the world is newly infected with TB

bacilli every second? • That one-third of the world population is currently infected by TB?• That there are two deaths per three minutes in India due to TB? • That over six lakh Indians are unaware that they suffer from TB? • That every TB patient infects 10-15 new persons on an average every year?

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HISTORY OF TB CONTROL IN INDIA • The first open air sanatorium for treatment and

isolation of TB patients in India was founded in 1906 in Tiluania, near Ajmer, and then at Almora two years later.

• Dr Frimodt Moller a medical superintendent, played a prominent role in TB control in India. This included training health workers, conducting surveys and introducing Bacillus Calmette Guerin (BCG) vaccination

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LIMITATION TO REVISED NATIONAL TB CONTROL

• India had switched over to the Revised National TB Control (RNTBC) Programme, which concentrates on the personal attention of the health staff on each TB patient. Thus, India hopes to cut down TB prevalence and death rate by half, by the year 2015.

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• In India today, two deaths occur every three minutes from tuberculosis (TB). But these deaths can be prevented. With proper care and treatment, TB patients can be cured and the battle against TB can be won

TUBERCULOSIS – A MAJOR CAUSE OF MORBIDITY AND MORTALITY IN INDIA

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• The WHO-recommended Directly Observed Treatment, Short Course (DOTS) strategy was launched formally as Revised National TB Control programme in India in 1997 after pilot testing from 1993-1996. Since then DOTS has been widely advocated and successfully applied. ....

WHO - DOTS

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DOTS - INDIA• Controlling TB in India is a tremendous challenge. The

TB burden in India is still staggering. Every year, 1.8 million persons develop the disease, of which about 800,000 are infectious; and, until recently, 370,000 died of it annually —1,000 every day. The disease is a major barrier to social and economic development. An estimated 100 million workdays are lost due to illness. Society and the country also incur a huge cost due to TB—nearly US$ 3 billion in indirect costs and US$ 300 million in direct costs.

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INDIA – DOTS LARGEST• India now has the second largest DOTS

(Directly Observed Treatment, Short course) programme in the world. However, India's DOTS programme is the fastest expanding programme, and the largest in the world in terms of patients initiated on treatment, placing more than 100,000 patients on treatment every month

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DOTS IS A SYSTEMATIC STRATEGY WHICH HAS FIVE COMPONENTS

• Political and administrative commitment.• Good quality diagnosis.• Good quality drugs. An uninterrupted

supply of good quality anti-TB drugs

monitoring and accountability

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• The quality assurance in sputum microscopy under RNTCP had been given a prime place. Microscopy has been an essential tool both for the diagnosis and follow up of the TB patients particularly in the RNTCP areas where declaring a patient cured is dependent on laboratory results

SPUTUM MICROSCOPY – MAJOR STRATEGY IN DOTS

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DOTS – A MASSIVE DISEASE CONTROL PROGRAMME

• Every day in India, under the RNTCP, more than 15,000 suspects are being examined for TB, free of charge. The diagnosis of these patients and the follow-up of patients on treatment is achieved through the examination of more than 50,000 laboratory specimens. As a result of these examinations, each day, about 3,500 patients are started on treatment, stopping the spread of TB in the community. In order to achieve this, more than 600,000 health care workers have been trained and more than 11,500 designated laboratory Microscopy Centres have been upgraded and supplied with binocular microscopes since the inception of the RNTCP

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DOTS A SUCCESSFUL PROGRAMME TO CONTROL TUBERCULOSIS

• Revised National TB Control Programme and its recent progress in DOTS expansion has been encouraging. As per Global TB Report 2003, 2/3rd of the additional sputum positive cases reported under DOTS in 2001, were found in India. In 2002, over 620,000 cases were placed on treatment of which nearly 250,000 were new smear positive cases. In the year 2003, more than 900,000 cases were placed on treatment.

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DOTS IN 2009• By June 2009, more than 10.2 million

patients have been initiated on treatment, saving more than 1.9 million additional lives. The success of DOTS in India has contributed substantially to the success of TB control in the world.

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REVISED NATIONAL TB CONTROL PROGRAMME

• The Revised National TB Control Programme now aims to widen the scope for providing standardized, good quality treatment and diagnostic services to all TB patients in a patient-friendly environment, in which ever health care facility they seek treatment from. Recognizing the need to reach to every TB patient in the country, the programme has made special provisions to reach marginalized sections of the society, including creating demand for services through specific advocacy, communication and social mobilization activities

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• MDRTB refers to strains of the bacterium which are proven in a laboratory to be resistant to the two most active anti-TB drugs, isoniazid and rifampicin. Treatment of MDRTB is extremely expensive, toxic, arduous, and often unsuccessful.

MDR TUBERCULOSIS

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DISTRIBUTION OF COUNTRIES AND TERRITORIES REPORTING AT LEAST ONE CASE OF XDR TB AS OF 2010

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DOTS CAN REDUCE MDR TUBERCULOSIS

• DOTS has been proven to prevent the emergence of MDRTB, and also to reverse the incidence of MDRTB where it has emerged. MDRTB is a tragedy for individual patients and a symptom of poor TB management. The best way to confront this challenge is to improve TB treatment and implement DOTS.

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WHAT THE WORLD NEED TO CONTROL TUBERCULOSIS

• Better TB diagnostics — that are rapid, practical and accurate in resource-poor settings — are critical to ensuring that people receive proper and timely treatment.

• New TB drugs — that will shorten treatment, be effective against susceptible and resistant strains, be compatible with antiretroviral therapies used for HIV/AIDS and that will improve treatment of latent infection — will dramatically improve TB treatment and control

• A new vaccine — that is both effective and safe for children, adolescents and adults, including people infected with HIV — will decrease TB incidence overall and, along with an effective drug therapy, could eventually control the disease.

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CONCERN FOR TB PATIENTS IS THE BACKBONE OF THE CONTROL PROGRAMME

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STOP TB EVERYONE'S CONCERN

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• Programme created by Dr.T.V.Rao MD for Medical and Paramedical Professionals in

the Developing World

• Email

• doctortvrao@gmail.com