By Leandrae T. Lapinig
Tenacious tuberculosis (TB), a disease of the past, is still taking a toll.
“TB causes 1.3 million deaths each year and affects millions more, with enormous impacts on families and communities,” deplored the Geneva-based World Health Organization (WHO).
About a quarter of the global population is estimated to have been infected with TB bacteria, the WHO said. About 5–10% of people infected with TB will eventually get symptoms and develop TB disease.
Those who are infected but not (yet) ill with the disease cannot transmit it. “When a person gets TB disease, they will have symptoms,” the WHO said. “These may be mild for many months, so it is easy to spread TB to others without knowing it.”
The more common symptoms of TB include prolonged cough (sometimes with blood), chest pain, weakness, fatigue, weight loss, fever, and night sweats.
“The symptoms people get depend on where in the body TB becomes active,” the WHO said. “While TB usually affects the lungs, it also affects the kidneys, brain, spine, and skin.”
We can end TB
The good news: Global efforts to combat TB have saved an estimated 75 million lives since the year 2000.
During World TB Day last March 24 (whose theme was: “Yes, We Can End TB), the WHO released an investment case for TB screening and preventive treatment. It highlights the impact to be achieved from expanding TB screening and preventive treatment.
The analysis shows that modest investments could lead to significant health and economic benefits, with a return on investment up to US$ 39 gained for every dollar invested.
“The investment case outlines the health and economic rationale for investing in evidence-based, WHO-recommended interventions on TB screening and prevention that can contribute to advancing universal health coverage,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “Today, we have the knowledge, tools and political commitment that can end this millennia-old disease that remains one of the world’s top infectious killers.”
According to the investment report, implementing TB screening plus preventive treatment can substantially reduce TB incidence and mortality. It argues that these crucial public health investments are essential for addressing the needs of vulnerable populations and achieving the End TB targets.
Treatment
TB disease is usually treated with antibiotics and can be fatal without treatment. Treatment is recommended for both TB infection and disease.
The most common antibiotics used are isoniazid, rifampin, pyrazinamide, ethambutol, and streptomycin.
“To be effective, these medications need to be taken daily for 4–6 months,” the WHO said. “It is dangerous to stop the medications early or without medical advice. This can allow TB that is still alive to become resistant to the drugs.”
Tuberculosis that doesn’t respond to standard drugs is called drug-resistant TB and requires more toxic treatment with different medicines.
“Drug resistance emerges when TB medicines are used inappropriately, through incorrect prescription by health care providers, poor quality drugs, or patients stopping treatment prematurely,” the WHO explained.
MDRTB
Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not respond to isoniazid and rifampicin, the 2 most effective first-line TB drugs. MDR-TB is treatable and curable by using second-line drugs. However, second-line treatment options require extensive medicines that are expensive and toxic.
In some cases, more extensive drug resistance can develop. TB caused by bacteria that do not respond to the most effective second-line TB drugs can leave patients with very limited treatment options.
MDR-TB remains a public health crisis and a health security threat. “While an estimated 410 000 people developed multidrug-resistant or rifampicin-resistant TB in 2022, only about two in five people accessed treatment,” the WHO said.
The bad news: Progress in the development of new TB diagnostics, drugs and vaccines remains constrained by the overall level of investment in these areas. “It is clear much more efforts are needed to combat TB, which remains one of the world’s leading infectious killers,” the WHO said.
A Philippine health crisis
In the Philippines, about 70 people die from TB every day.
“We are only one of the eight countries that account for two-thirds of the estimated global cases,” said Dr. Maria Rosario Vergeire, of the Department of Health, during the World TB Day celebration last year. “The Philippines is also the fourth-largest contributor of TB cases at 7 percent of the global total.”
She added, “Our problem with TB is a vicious cycle. This disease primarily affects the poor as poverty exposes individuals to TBs risk factors, such as poor nutrition, crowded, and poorly ventilated environments, smoking, alcohol use disorders, HIV, and diabetes.”
Filipino actors Rene Requiestas and Narding Anzures also died of the disease. Even President Manuel L. Quezon was not spared.
“After subjecting me to a rigorous physical and fluoroscopic examination, the doctor diagnosed my case as tuberculosis of the lungs,” Quezon said in a speech delivered during the dedication ceremonies of the Quezon Institute, a sanatorium for TB. “I was then ignorant of this disease. I had always felt vigorous and healthy throughout my life and had never thought seriously of diseases.” – ###
