TUBERCULOSIS: India: The outcasts of Tuberculosis

July 10, 2010
Mumbai: It may be curable but Tuberculosis (TB) remains a stigma in our country especially for women. Over a lakh Indian women are thrown out of their homes each year because they have TB.NDTV brings you the story of a woman who was deserted by her husband one year after marriage because she was diagnosed with TB.The 21-year-old woman's only fault was that she was infected with tuberculosis."I had been married for a year. Three months after the wedding I started coughing and was admitted to a clinic. An X-Ray showed I had TB. My husband and his family insisted my mother take me home. After that my husband has not come to see me even once. When the doctor told them I had TB my husband said he did not want me. He told my mother I would infect everyone in the family," said TB patient.
She is not alone in her isolation. Every year, one lakh women in India are thrown out of their homes because they have tuberculosis.India accounts for one third of the world's TB cases but it's women who bear the brunt of the social stigma.It's a curable disease and yet every year one million women die of tuberculosis worldwide. One of the main reasons experts say, is because women delay seeking diagnosis afraid of rejection.At the government TB hospital in Mumbai, one of the largest facilities in the country, of the 200 women admitted for treatment most have been abandoned by their families."In our country when women get the infection they are largely ill-treated by the family. Often the husbands leave them here and go away. They don't take them back home," said Dr Vijay Jumar Narvengkar, Dean, Government TB Hospital, Mumbai.The disease may have a cure but the stigma doesn't
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TUBERCULOSIS: CDC Issues New Guidelines for TB Testing

Jun 28, 2010
The U.S. Centers for Disease Control and Prevention estimates that between 9 and 14 million Americans are tuberculosis (TB)-infected and asymptomatic -- with three-quarters remaining undiagnosed -- and at risk of progressing to a highly contagious form of TB disease. On Friday, CDC issued new and important guidelines on the detection of Mycobacterium tuberculosis infections, the causative agent of TB. In the guidelines, the agency advises that Interferon Gamma Release Assay (IGRA) blood tests are now preferred over the 100+-year-old tuberculin skin test (TST) for diagnosing TB infection in certain populations, including people who typically do not return for the necessary reading of TST results, and those who have received Bacille Calmette-Guérin (BCG) as a vaccine or for cancer therapy.
The CDC report, "Updated Guidelines for Using Interferon Gamma Release Assays to Detect Mycobacterium tuberculosis Infection -- United States, 2010," along with a companion implementation guide, appears in the June 25 issue of CDC's Morbidity & Mortality Weekly Report (MMWR, Volume 59, No. RR-5). In making its recommendations, CDC factored in TST's drawbacks, which its says include a higher risk for false positives, especially in people who have been BCG-vaccinated; irritating TB-extract that must be injected under the skin; and the need for a second doctor's visit.
According to the World Health Organization, about one person dies of TB every 17 seconds, causing nearly 2 million deaths annually. TB continues to be a contagious scourge in developing countries, and with the world shrinking rapidly due to global migration, it is a major public health threat in developed nations as well, including the United States. Each infected person represents a potential yet preventable future outbreak.
TB bacteria usually attack the lungs, but can affect any part of the body such as the kidney, spine, and brain. If not treated properly, TB can be fatal. TB bacteria is spread through the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings, which may lead people in close proximity to become infected.
The populations specified by the new CDC guidelines represent a majority of those being screened for TB infection. Better, more reliable testing for TB infection is vital in order to efficiently identify the appropriate persons for treatment and thereby prevent its spread, the agency said.
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TUBERCULOSIS: BANGLADESH: TB rates plummet, but still high among poor and uneducated

DHAKA, 2 August 2010 (IRIN) - The tuberculosis (TB) prevalence rate in Bangladesh has plummeted to 79 per 100,000 people from 800 in the 1990s, with the majority of cases among the rural, poor and uneducated, according to the Nationwide Tuberculosis Disease-cum-Infection Prevalence Survey 2007-09 [http://www.whoban.org/Full_report_TB-10.html]."The association between poverty and TB is well recognized, and the highest rates of TB are found in the poorest section of the community," said K Zaman, an epidemiologist with the International Centre for Diarrhoeal Disease Research, Bangladesh (ICCDR, B) [http://www.icddrb.org/], who led the survey with the National Tuberculosis Control Programme (NTP) [http://ntpban.org/]."TB occurs more frequently among low-income group people living in overcrowded areas and persons with little schooling."Zaman said government and NGO activities since 1993 to implement the Directly-Observed Treatment, Short Course programme (DOTS) [http://www.who.int/tb/dots/en/] throughout the country led to vast improvements in detection and treatment.In 2009, 109,311 new smear-positive cases - when TB bacteria is found in a patient's sample of mucus or phlegm - were detected, compared with 38,457 in 2000, indicating a high detection rate.Populations most affectedBangladesh ranks sixth among countries with the highest burden TB in the world [http://www.whoban.org/communicable_dis_tb.html], with 300,000 new cases and 70,000 deaths each year, according to the World Health Organization (WHO).Most affected are the poor and uneducated: in rural areas, 86 adults in every 100,000 suffer from TB, against 51 in urban areas; 159.7 per 100,000 are among those who earn less than US$43 a month, against 45.7 among those who earn more than $143 a month; and 138.6 per 100,000 among those with no education, compared with 39.3 among people with a secondary education."Poverty may result in poor nutrition, which may be associated with alterations in immune function. On the other hand, poverty results in overcrowded living conditions, poor ventilation, and poor hygiene habits, which are likely to increase the risk of transmission," said Zaman of ICCDR,B.Comparatively poor treatment facilities in remote areas may contribute to the higher prevalence rates in rural areas, Zaman said, compounded by lack of awareness. Health Minister AFM Ruhal Haque pointed out that very few people in rural areas knew about the disease and its treatment.However, the government has expanded care across the country, with 1,050 DOTS centres at the sub-district level where TB treatment is free, said Nazrul Islam, NTP programme manager.Bangladesh has achieved the Millennium Development Goal for 70 percent case detection and an 85 percent cure rate.