‘Preventive testing, medication essential to face tuberculosis challenge’

Replying to a question on what India needs to do to track its estimated 1 million “missing” TB cases, Dr Klag, who is also a consultant in the Global Burden of Disease Study, said: “Making TB notifiable is essential but not enough. When you find a TB patient you have to track all the contacts and trace them and see if they have been infected. People who have been infected but do not have active TB — with one drug you can prevent them from becoming active. This is essential to facing the TB challenge, especially in children who are very susceptible. There is an easy test, a skin test called the tuberculin test. The strategy is everybody positive should get treated; those who have been infected recently are at higher risk.”

According to the National Strategic Plan for Tuberculosis Elimination 2017-25 unveiled earlier this year, “TB kills an estimated 4,80,000 Indians every year and more than 1,400 every day.” The plan concedes that there are still a million missing cases. Despite a host of measures to ensure drug compliance, including tracking of patients through IVRS and deploying bike-borne treatment advisers to trace them, health ministry officials say the rate of increase of TB is not high enough for the system to feel convinced that all patients have been reached.

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Nevertheless, a recent World Health Organisation report that lauded India for upping the spend on TB control also said that India tops the number of countries with high TB incidence. Such high numbers and congested living conditions make exposure to the TB pathogen almost inevitable, which means most Indians would actually test positive in the skin test.

Would he then recommend mandatory administration of the preventive TB drug to all Indians?

“A third of all the people in the world are infected with TB but do not have an active infection… I am always sensitive to the fact that people come from different countries and different health systems. I wouldn’t say this is what India should do but this is what we do in the US. That is the standard for care,” said Dr Klag, who is in the city to attend a board meeting of the International Institute of Health Management Research.