Tuberculosis in India: Epidemiology, Prevention, and Control

This report provides an overview of the state of Tuberculosis in India, including its epidemiology, prevention, and control measures. It highlights the rising burden of TB in the country and the challenges faced in its prevention. The report also discusses the actions taken by the Indian government to control the infection and compares the level of infection among different countries.

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Contents
Introduction................................................................................................................................1
Epidemiology.............................................................................................................................1
Infection, Prevention and Control..............................................................................................5
Conclusion..................................................................................................................................7
References..................................................................................................................................9

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Introduction
The topic selected for the report is Tuberculosis in India. It is considered as the major health
problem in India and is remarked as the top 30 TB burden countries in the world.
Tuberculosis is caused by bacteria known as Mycobacterium tuberculosis and usually attacks
the lungs and affects the other body parts. Tuberculosis in India is at a rising state because of
the pollution in the environment and many citizens in India are not able to afford the
treatment. The symptoms of TB include mucus, loss of appetite, fatigue, fever, weight loss,
and night sweats. The rationale for selecting the topic was the increasing burden of TB on
India. There are estimated 79000 multi-drug resistant TB patients each year. It is imperative
to make the population aware and create a desire for personalized care (TBFacts 2019). The
aim of the report is to describe the state of Tuberculosis in India and recommend the
measures to prevent it. The further paragraphs of the report will reflect upon the actions
taken by the Indian government to prevent and control the infection. It will cover the
challenges and the measures implemented to control the inflection and will conduct a
comparison of the level of inflection among different countries.
Epidemiology
Tuberculosis is considered as an infectious disease that majorly affects the lungs. This disease
is considered as the second biggest killer globally. This disease is infectious and affects 10-15
people who came close in the course of action. Tuberculosis is an airborne pathogen, which
spreads through the air from person to person. The tuberculosis is of two types Latent TB and
Active TB (CDC 2019). The latent Tb remains in the body in an inactive state and is no
contagious while the active TB causes symptoms and gets transmitted to other people. One-
third of the world’s population suffers from latent TB and has a 10 % chance to becoming

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active TB. Tuberculosis mainly affects the lungs and if not treated it gets spread into the other
parts of the body. It affects the brain, bones, liver, kidney, and heart. It is the underlying
cause of 1.3 million deaths among human immunodeficiency virus positive people. In 2017 1
million children get infected from disease and became the leading cause of death of 2, 30,000
children. It mainly affects an adult group of people and 95% of cases and death are in
developing countries. Isoniazid, rifampin, pyrazinamide, and ethambutol are the medicines
which are used to treat the patients (TBFacts 2019). The doctors use a combination of
medicines to treat the patients and uses sputum spear microscopy test to diagnose the disease.
The disease is curable and treatable. Active TB is treated within 6 months of course by
providing 4 antimicrobial drugs under the supervision of the doctor. From the year 2000 to
2017, an estimated 54 million lives were saved. The rising state of Tuberculosis in India is
still a major concern. According to the ministry of health and family welfare 2.15 million
new patients were discovered in the year 2018 (Mcintosh 2018).

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https://archive.indiaspend.com/cover-story/new-model-of-tracking-tb-patients-holds-promise-
for-india-20592
Tuberculosis is the worldwide problems, it is not restricted to a particular country or state, it
has been affected people from all around the world (Glaziou, Sismanidis, Floyd, and
Raviglione 2015). Higher than 1.7 billion individual (around 25 % of the global population)
are projected to be infested with M. tuberculosis. The worldwide occurrence of TB peaked
nearby 2003 and seems to be decreasing slowly (Dean, Cox, and Zignol 2017). World Health
Organization (2018), in 2017, reported that nearly 10 million persons became ill with
tuberculosis and 1.6 million deceased. An growing morbidity and mortality due to
tuberculosis in upcoming years is predicted for the globe at huge, 7.5 million improvement of
disease occurrence has been seen in 1990 to about 8.8, 10.2 and 11.9 million cases in 1995,
2002 and 2005 correspondingly; an upsurge occurrence of 58.6 % reported over the period of
15 years (Glaziou, et al., 2015). The amount of TB cases co-infested with humanoid immune-
deficiency virus (HIV) was likewise establish to be increasing The links with HIV and
cumulative multi-drug resilient tuberculosis (MDRTB) seemed to be a severe problem,
particularly for the developing countries like India (Sabhapandit, et. al., 2017).
According to the Global Tuberculosis report 2017 the projected occurrence of TB specifically
in India was nearly 28, 00,000 accounting nearly 23 % of the global TB cases (World Health
Organization, 2018). In the year of 2017, India re-projected its nationwide statistics of the
load of Tuberculosis including info from a broader collection of sources. Ten nations
accounted for nearly 80 % of the 3.6 million holes, headed by India with 26 %, Indonesia (11
%), Nigeria (9 %) (Singh, et. al., 2016) That particular gap was supposed to be produced by a
mixture of issues like lack of diagnosis sand reporting. According to this WHO report
particularly India accounted for nearly 27 % of the 10 million individuals who were suffering
from tuberculosis in 2017, the included amongst the top thirty TB burden nations in the world

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(Dean, Cox, and Zignol 2017). The 2018 version of the Worldwide TB Report delivered a
complete and up-to-date valuation of the TB prevalence and advancement in the reaction at
worldwide, regional and nation levels (MacNeil, 2019). That report revealed that worldwide,
the finest approximation is that nearly 10 million individuals developed this disorder 2017,
and among all those cases 5.8 million were males, 3.2 million females and one million kids
(MacNeil 2019). In 2016 among all the diagnosed patients, nearly one fifth of the individuals
were from the private subdivision (Sabhapandit, et al., 2017). There was widespread variation
in India from state to state in relation to the balanced reporting of Tuberculosis patients
belongs to different sectors. In Kerala the reported cases were also high as in other cities of
India (Singh et al., 2016).
https://archive.indiaspend.com/cover-story/success-of-tb-treatment-in-india-could-be-lower-
than-reported-and-why-that-matters-18503
Microbiology

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TB can be spread from individual to individual by airborne route. When an individual with
Tuberculosis sneezes, coughs, or talks, patient’s mucus and saliva, full with the contagious
microorganism are pushed into the environment (Merker, et. al., 2015). A particular sneeze
can discharge millions of M tuberculosis. This indicates that an individual with Tuberculosis
can contaminate a more 10–15 individuals over a year. In maximum cases, persons
unprotected to the micro-organism do not develop illness as their resistant system is capable
to regulate the primary infection. Though, the micro-organisms might not be totally removed
from the patient’s body. Impaired resistance, because of ageing, an unhealthy diet, or HIV
contamination, can upsurge the probability of latent bacteria reenergizing and the person
getting sick (Demers, Whitelaw, and Eisenach 2016).
https://www.hindustantimes.com/health-and-fitness/here-s-why-india-is-struggling-and-
failing-to-control-tuberculosis/story-urW7VnQiHM2S38yGNTgu7O.html
M. tuberculosis bacteria belongs to the Mycobacterium genus that comprises higher than than
80 additional species. Tuberculosis is well-defined as the sickness caused by associates of
the M. tuberculosis, which comprises the tubercle bacillus (M. tuberculosis), M. pinnipedi, M.
bovis, M. africanum, M. caprae M. microti, and M. Canetti. Mycobacterium tuberculosis is
actually the etiological agent of TB, the foremost cause of decease due to a particular
contagious agent, accounted for 1.7 million deaths in 2016. Mycobacterium tuberculosis is

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the obligate aerobic, non-motile, and acid-fast bacteria. The length of bacilli is 2-4 um and
has a precise sluggish generation period in the middle of 15 and 20 hours. Its cell wall is
distinctive and mainly composed of acidic waxes, especially mycolic acids. The tuberculosis
causing bacteria is remarkably resilient to drying and some chemicals, subsidizing to the
comfort with which it is communicated (Merker et al., 2015).
Some of the other features of these bacteria are:
Cell envelope: The cell envelope of this bacterium is made up of three essential
macromolecules including peptidoglycan, arabinogalactan, and mycolic acids, and the
lipopolysaccharide, lipoarabinomannan (LAM), which is supposed to be attached to the cell-
membrane (Desjardins, et. al., 2016).
Staining characteristics: The bacterium stains positive when performed Gram's staining.
The mycolic acid organization deliberates the capability to repel de-staining of acid alcohol
afterward being discolored by some aniline dyes (Glaziou, Sismanidis, Floyd, and
Raviglione, 2015). the most usually used method to detect TB is Microscopy (using Ziehl-
Neelsen or Kinyoun stain); a sample must comprise at least ten colony establishing units
(CFU)/mL to harvest the positive smear. The Microscopy of samples stained with the
fluorochrome dye like auramine O delivers a stress-free, more effective and more profound
substitute ((Desjardins, et al., 2016).
Growth characteristics: M. tuberculosis is actually aerobes. Their duplication or
reproduction is improved by the existence of 5-10 per cent CO2 in the environment. They are
able to multiply on the culture media in the presence of high lipid content, such as a medium
called Lowenstein-Jensen. The multiplication time of TB is around twelve to eighteen hours,
so that the cultures can be nurtured for 3 to 6 weeks at the temperature of 370C until the

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proliferation develops microscopically noticeable. Culture systems based on Broth to advance
the speed and the sensitivity of exposure has been established (Nguyen, et al., 2019).
Infection, Prevention and Control
As discussed above that TB is the disease that is caused by bacteria that are spread through
air from person to person. This type of disease is fatal if not treated properly. The infection
from TB can be cured if a healthy person is attracted with this bacteria, further a person can
also prevent TB from increasing by taking medicines time to time. It is important to note that
any person can get TB in the environment. The bacterial infections of TB spread through the
air when a person cough, sneeze, speak or sings and these bacteria are transferred to another
person when they perform the same actions in close environment. In most cases in India, TB
grows in lungs which can cause symptoms of a bad cough, chest pain and coughing up blood
or sputum (CDC 2019). Further, TB on parts of body has common symptoms of chills,
weight loss, fever, sweating at night and no proper appetite.

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At the initial stage, it is easy to cure TB through proper timely medication but it is very
important to complete the course of TB otherwise it can reoccur in the body of a person if the
batteries have not died from the body. Talking about the country India, the fact should be
noted that TB has severe most impact on the people of India. India is the highest TB
burdened country in the world. The statistics showed that TB is extensively spread in the
country due to which the Government of the country announced a plan to eliminate the
problem of TB from the country by the end of year 2025. Infection of TB increases in the
country only because of negligence and poor knowledge about the disease. India account
27% of the total population of TB affected candidates and 29% of total death happened due to
TB in the world (TBFacts 2019).
It is very important especially in India to prevent and control the problem of TB from
spreading because it is challenging the process of growth in the country. Based on different
environmental as well as economic conditions, the cure of TB is different in India as

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compared to other parts of the world. Like, in US there is no political pressure in treating the
disease while in India; there is high level of political commitment but less value in budget for
providing proper aid to people (Mayo Clinic, 2019). Whereas, poverty is another major factor
that increases the level of TB in the country. As compared to other countries like Australia
and New Zealand have lowest rate like 10 cases on 100000 people because there is less
poverty in the country. Apart from negligence, TB grows in India because people do not
have enough income to purchase the medicines and attain proper aid in the environment. As
TB is caused by a bacterial infection so the patients usually carry medicines like isoniazid,
pyrazinamide, rifampin and ethambutol with them to initiate antibodies in the immune system
for the disease (WHO 2019).
In the case of India, the disease of TB is majorly resistant to regular antibiotic treatment due
to which, it takes longer for the practitioner to treat them. Also, a combination of various
antibiotics is used in treating the Indian patients affected with TB. A vaccine is also now
available in the country to limit the reach of TB in the body. The Revised National TB
Control Program (RNTCP) of India has also seen an increase in the budget along with this,
the National Strategic Plan of the country also raised US$ 2.5 billion amount as the budget to
eliminate TB from the country. These two programs are working effectively to cure Tb from
people in the country and raise awareness regarding the same (BMJ Journal, 2019).
From the perspective of public health, it should be noted that control of TB is important
because it increase the burden on childhood TB. According to this perspective, TB is
determined by the community exposure to bacteria and other multiple variables linked to
poverty increases it. Further, it should be noted that the challenges in TB are the high growth
of HIV epidemic in the country along with growth of multidrug-resistance TB (MDR-TB) in
India due to which the practitioners have to give a combination of various drugs. Lack of

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advocacy, social mobilization and communication also acts as challenge in properly curing
the problem of TB in the country (TBFacts 2019).
Conclusion
Thus, in the limelight of above mentioned events, the fact should be noted that the above
mentioned paper highlighted information about the problem of infectious disease
Tuberculosis in the country India. India comes in the list of countries that have high rate of
TB mortalities and patients in the country. The above mentioned paper clearly depicted the
epidemiology along with microbiology of the disease. The latter report evaluated reason of
infection along with prevention and control in the country. TB is a precarious disease that not
only affects the health of people of the country but also make the country economically
backward as well. Thus, it is suggested that the government of the country India should aim
to spread a word about TB and should supply free vaccines and medicines to the people
belonging to below poverty line. Additionally it should be recommended to the country that
the government of the country is aim to spread awareness for the disease so that people can
also learn about its symptoms and track them in their body. Further, the medical industry of
India should also seek support from different countries having low TB rate like US, Australia
etc. The medical practitioners of US will help India in understanding how they eliminated the
problem of TB from their country. Also, it should be noted that just like other vaccines of
polio and tetanus, the government should make TB vaccines necessary in the country. Thus,
in this way India can reduce the increasing rate of TB among its people.

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