World TB Day – Reaching the missing millions

Published on Monday, 24 March 2014

Published by Dr. Jean-Jacques Bernatas on Monday, 24 March 2014

Today’s World TB (tuberculosis) day provides an important occasion to raise awareness about a disease that continues to affect millions of people around the globe.

Here in the Philippines the incidence of TB remains significant, with the country ranked 15th among 22 high TB burden nations―or those that account for 80% of the notified tuberculosis cases around the world. The mortality rate due to TB in the Philippines’ general population is 24 persons per 100,000 or three times the mortality rate due to traffic accidents. However, not everyone’s risk exposure is the same, and there are common misunderstandings about who might get TB and how.

TB feeds on poverty because its transmission requires tiny, dark, unventilated rooms shared for hours by people who typically have low immunity (due to malnutrition or immunosuppressive conditions such as HIV). There is also strong evidence to suggest that tobacco smoking plays a  huge role in lung TB, with smokers, and those exposed to large amounts of second-hand smoke,  falling more frequently and severely ill. Certainly among the poor in the Philippines, smoking is a common risk factor for lung TB.

This year’s World TB Day slogan is “Reach the 3 million.” It refers to the need to reach out to the estimated one third of 9 million people who get sick from TB each year but who are missing out on diagnosis and treatment.  These include migrants, drug users, sex workers, and others who simply don’t know about the disease.

What can medical professionals and communities do to change this? In the first instance we need to establish a clearer understanding of the disease, its modes of transmission. and to convey clear messages about those at risk, For example, in the case of someone who is diagnosed with lung TB with a sputum smear examination that doesn’t show any tuberculosis bacilli it is unlikely they will be able to transmit TB to anyone around them.

The only efficient treatment is to follow the “DOTS” or directly observed short-course treatment system. This involves the daily observation of the intake of medicines by someone other than the sufferer.  It could either be a healthcare worker or someone else from the patient’s community. This strategy is widely and well implemented in the Philippines.

In 2012, the treatment success rate in the Philippines was 90% among new contagious lung TB cases, exceeding 85%―the threshold above which TB is supposed to remain under control. However, the main challenge is to improve the quality of the diagnosis, especially in the private sector, where there is an obvious overdiagnosis of lung TB due to a lack of sputum examination requests.

In Latin, the expression 'in medio stat virtus' refers to the truth lying in the middle between an overestimation of risk, and denial of any. Knowledge can help bridge the gap, especially in the case of TB.