Letter to the Editor: Rising Tide of MDR-TB in state and Loopholes in Government TB department

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Naharol Choukhathanba Kanglup, Uripok,Imphal
Dated:-27/10/2014                                                                                                                        Ref:- 702-271014

“Rising Tide of MDR-TB in state and Loopholes in Government TB department”

Naharol Choukhathanba Kanglup - TBIn a shrinking world where diseases know no boundaries. The severe global TB epidemic poses a direct threat to all the countries. It is estimated that (1/3) of the world population (2 billions) is infected with Bacillus, although the majority of these cases are latent or asymptomatic. About 3.6% of new tuberculosis (TB) patients in the world have multi-Drug resistant strain(MDR-TB) level are much higher about 20% in those previously treated for TB. About 10% MDR-TB cases also resistance to the two important Second-line drug classes,or Extensively drug-resistant TB(XDR-TB).World Health Organization (WHO) estimated that there about 4,50,000 new (incident)MDR-TB cases in the world in 2012.More than 60% of the cases occurred in China, India &Russia. While India was home to 73,000 patient with MDR-TB.

WHAT ARE MDR-TB, XDR-TB AND RR-TB ?  

TB organisms resistant to the antibiotics used in its treatment are widespread and occur in all countries surveyed. Drug resistance emerges as a result of inadequate treatment and once TB organisms acquire resistance they can spread from person to person in the same way as drug-sensitive TB.

  • Multidrug-resistant TB (MDR-TB) is caused by organisms that are resistant to at least the two most effective anti-TB drugs, isoniazid and rifampicin.
  • Extensively drug-resistant TB (XDR-TB) is a form of TB caused by organisms that are resistant to isoniazid and rifampicin (i.e. MDR-TB) as well as any fluoroquinolone and any of the second–line anti-TB injectable drugs (amikacin, kanamycin or capreomycin).
  • Rifampicin-resistant TB (RR-TB) is caused by organisms that are resistant to rifampicin, with or without resistance to other drugs. Both MDR-TB and XDR-TB are forms of RR-TB.
  • These forms of TB do not respond to the standard six month treatment with first-line anti-TB drugs and can take two years or more to treat with drugs that are less effective, more toxic and more expensive. [© WHO October 2013 (GTB number C7)]

            As of our state is concern TB department is like a sinking Titanic in the middle of spreading MDR-TB epidemic .Through Revised National Tuberculosis Control Programme (RNTCP) and WHO-DOTS guideline TB patient are receiving free medicine according to the plan. In this the patient have to eat 12,000 pills for 24-28 months along with daily injection kanamycin or capreomycin for 1st six months(WHO- DOTS guideline).Some of the drugs like Cycloserine,Quinoline and/or etionamide cause severe side effect ranging from peripheral neuropathy ,psychiatric disturbance, ocular toxicity,renal toxicity, suicidal tendancy,severe depression and many more.

So for all of this, close monitoring of the patient is required along with regular counseling by a dedicated expert on this field. In our state there is no proper place for MDR-TB treatment where they can rely on as compare to other state of our country. As of now the Intermediate Reference Lab(IRL) R&D wing of Lamphelpat (Sound like Lincoln Lab of MIT ,USA) is the only hope and place where patient can work through. Interestingly the infrastructure is just small derelict condition huts which lean toward the well structure wall of Officer Club Lamphelpat. “What a great Juxtapose”.

Without proper places and facilities for close monitoring of the patient and proper counseling facility it is difficult to cure MDR-TB  it  is just like climbing Mt Everest without O2 cylinder. Instead of curing, more MDR-TB case will arises as MDR-TB is a purely man-made diseases due improper treatment , Wrong dosages or combination , premature termination due to lack of proper counseling and severe side effects. Even though Govt supply 12000 pills free of cost for curing MDR-TB it is becoming like near impossible. Dr R.K Laksana state TB Officer, Manipur informed that the “(MDR-TB) which surfaces due to improper and erratic use of Directly Observed Treatment (DOTS) has become a matter of serious concern  and he also stated that among  the 73 persons tested for MDR-TB in the state, a total of 28 persons have been tested positive which is about 38% as against country average rate of (12-18)% which is double the all India rate”.

Another severe problem face by MDR-TB patient is the daily injection of Kanamycin for 6 months. It is difficult to inject  by family alone for 6 months as it required certain expertise in this field and the TB department are also not looking in this mater seriously and they just left to poor family. In these context for time being if the Govt and state TB department tie up with all private &Govt hospital to give the said injection for free of cost as part of Revised National Tuberculosis Control Programme (RNTCP) to MDR-TB patient by simply giving certain register ID,then it would be like a boon to patient and family and a stepping stone toward eradication of MDR-TB in the state .

TB can happen anywhere,in any community exposure can happen at school, at work at home while travelling, or anywhere that people are on close contact with one another.That why TB prevention is a public health priory for the Nation for everyone.For the hope of tomorrow for all TB patient a new drug called PaMZ is going to be tested for clinical trial under clinical named STAND (Shortning Treatment by Advancing Noval Drug) and it will be a game changer for all,as announced by Bill &Malinda Gates foundation .With these new drug the treatment time will be drastically reduced from 24 months to only just  6 months.

So let’s fight this deadly but curable disease united and wipe out from the face of the world. “Support the cause, toward free Multi-Drug resistant-TB (MDR-TB)”.Lastly I appeal the Government and state TB department/cell/center or whatsoever please try to see the MDR-TB matter seriously, lots of loophole is arise like injection case .If you didn’t act now then lot of MDR cases will arise in our state in the near future and please remember the quote “timely stitch save seven times”.

 

Yours sincerely
Huirem Bharat Meitei
Secretary
Naharol Choukhathanba Kanglup
Email: [email protected]

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