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A Status Update on Tuberculosis

By: Ivan Olegario, MD A Status Update on Tuberculosis

Tuberculosis (or TB) is an old problem — scientists have been able to find evidence of tuberculosis in a man who lived 6,000 years ago. However, unlike diseases such as smallpox, we have not yet been able to eradicate this hardy bug. In fact, the National TB Prevalence Survey shows that it is making a comeback.

In 1983, there were 8.6 TB patients confirmed by culture per 1,000 Filipinos. In 2007, it dropped to 4.7 TB patients per 1,000 Filipinos. This drop was mostly due to increased public awareness and strengthened TB control programs, which included national screening and treatment of patients to prevent deterioration and further spread.

However, the 2016 National TB Prevalence Survey showed that the number slightly increased to 5.1 TB patients per 1,000 Filipinos (i.e. 512 patients per 100,000 Filipinos) despite the continuation of the national programs. In fact, the Philippines ranks 4th (after China, India, and Indonesia) among countries with the highest number of people infected with TB.

The survey also revealed that those most affected are:

  • Males;
  • Smokers;
  • Older patients (aged 45 years and older);
  • Those with diabetes;
  • Those that had been treated for TB in the past; and
  • Those who are economically disadvantaged.

Neglect of TB

Because of the Internet and social media such as Facebook and Twitter, people now have easier and faster access to health information. The Internet nowadays is filled with information on major diseases such as heart disease, cancer, and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). While being informed of these diseases are well and good, it seems people may have forgotten the importance of our old nemesis, TB.

Here are some reminders of what TB is all about:

  • TB is a deadly infection that usually affects the lungs.
  • TB is contagious.
  • TB spreads through droplets in the air released through coughing, sneezing, talking or spitting.
  • The spread of TB can be prevented by covering your mouth when coughing, sneezing or talking. Avoid spitting indiscriminately.
  • Symptoms of TB include one or more of the following: cough >2 weeks, chest pain, weight loss, fever/night sweats/chills or fatigue.
  • Any person with one of these symptoms should see a health professional.
  • TB can be effectively treated with at least 6 months of therapy.

At present, the World Health Organization estimates that 65,000 Filipinos with TB remain undetected and untreated. These are called the “missing TB cases”. Given the rising trend of TB, we should be more vigilant than ever in fighting TB through prevention, early detection, and effective treatment.

Stronger bugs

A second reason why TB is making a comeback is the emergence of stronger bugs —TB bacteria known as multi-drug resistant TB (MDRTB). Around 15,000 Filipinos are infected with MDRTB and this number is growing. MDRTB are TB bacteria that have usually been exposed to drugs used to treat TB and eventually became resistant to them. This happens mostly when people start TB treatment and then stop in the middle.

As mentioned, TB usually needs to be treated for at least 6 months for all the bacteria to be killed. Any bacteria that survives because of shortened treatment are likely to be resistant to one or more of the drugs used to treat it. These resistant bacteria can then multiply and cause a more aggressive infection. When this happens, the more aggressive infection would usually require more drugs to treat. Some of these drugs have worse side effects. Furthermore, treatment may need to be extended to a longer duration.

Therefore, it is very important to avoid TB from getting resistant. If you have been advised to be treated for TB, make sure to finish the full treatment course and go on regular follow-up visits with your doctor or health professional.

Continuing treatment

A 2014 study found that the most common reasons stated by patients for stopping TB early were the following:

  • Fear of treatment side effects;
  • Development of actual side effects during treatment;
  • Improvement of TB symptoms; and
  • Lack of money.

However, patients undergoing TB treatment should also be aware of the following:

  • The side effects of TB medication can be managed by their doctor or nurse.
  • The improvement of TB symptoms is expected and is not a sign that treatment can be stopped because some bacteria may still be alive.
  • Barangay health centers are able to provide TB medications for free.

TB patients are therefore encouraged to complete their treatment for the whole duration of therapy as recommended.

In conclusion, TB is a re-emerging disease that can become harder to treat the second time around. Therefore, we should be vigilant in combatting TB through proper education, good personal hygiene, early diagnosis, and complete TB treatment.

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