Tuberculosis

• Tuberculosis (TB) is an infectious disease that most often affects the lungs and is caused by a type of
bacteria (Bacillus Mycobacterium Tuberculosis).
• Tuberculosis can spread when a person with the illness coughs, sneezes or spits. This can put tiny
droplets with the germs into the air. Another person can then breathe in the droplets, and the germs
enter the lungs.
• Tuberculosis spreads easily where people gather in crowds or where people live in crowded conditions.
• People with HIV/AIDS and other people with weakened immune systems have a higher risk of catching
tuberculosis than people with typical immune systems.
• Tuberculosis is preventable and curable.
• Tuberculosis is classified into pulmonary TB and extra pulmonary TB. When it affects the lungs, it's called
pulmonary TB. TB outside of the lung is called extra pulmonary TB. It can also be categorized as being either
active or latent. Active TB is contagious and causes symptoms.
• The period from infection to development of the primary lesion or significant tuberculin reaction is about 3–
9 weeks.
Risk factor
• Close contact with some one who have active TB.
• Immuno compromised status.
• Drug abuse and alcoholism.
• People lacking adequate health care.
• Pre existing medical conditions( diabetes mellitus, chronic renal function)
• Immigrants from countries with higher incidence of TB.
Sign and symptoms
• A TB infection may be in one of three stages. Symptoms are different in each stage.
• The first stage is called the primary infection.
• Symptoms during a primary infection are low fever, tiredness, cough.
• Latent TB infection occur after the initial infection, with the immune system containing TB germs in the
lungs. While the germs are controlled, they remain alive, causing no symptoms.
• Active TB disease results when the immune systems fails to control the infection ,leading to the spread of
germs causing disease in the lungs or the other body parts. It can occur shortly after primary infection or
more commonly, months or years after latent TB infection.
• Symptoms of active TB include: Cough, Coughing up blood or mucus, Chest pain, Pain with breathing or
coughing, Fever, Night sweats, Weight loss, Not wanting to eat, Tiredness, Not feeling well in general.
Sign and symptoms
• Active TB disease outside the lungs: TB infection can spread from the lungs to other parts of the body. This is called extra
pulmonary tuberculosis. Symptoms vary depending on what part of the body is infected. Common symptoms may include:
Fever, Chills, Night sweats, Weight loss, Not wanting to eat, Tiredness, Not feeling well in general, Pain near the site of infection.
• Active TB disease in children. Symptoms of active TB disease in children vary. Typically, symptoms by age may include the
following:
Teenagers: Symptoms are similar to adult symptoms.
1- to 12-year-olds: Younger children may have a fever that won't go away and weight loss.
Infants: The baby doesn't grow or gain weight as expected. Also, a baby may have symptoms from swelling in the fluid around the
brain or spinal cord, including:
Being sluggish or not active.
Unusually fussy.
Vomiting.
Poor feeding.
Bulging soft spot on the head.
Poor reflexes.
Diagnosis/ Vaccines
Prevention and control
• Stay home. Don't go to work or school.
• Isolate at home. Spend as little time as possible among members of your household. Sleep in a separate
room.
• Ventilate the room. Tuberculosis germs spread more easily in small, closed spaces. If it's not too cold
outdoors, open the windows. Use a fan to blow air out. If you have more than one window, use one fan to
blow air out and another to blow air in.
• Wear face masks. Wear a mask when you have to be around other people. Ask other members of the
household to wear masks to protect themselves.
• Cover your mouth. Use a tissue to cover your mouth anytime you sneeze or cough. Put the dirty tissue in a
bag, seal it and throw it away.
TB a global emergency
• Tuberculosis (TB) is a communicable disease which is a major public health problem globally. It is one of the
top 10 causes of death worldwide more dangerous than HIV.
• 30 high TB burden countries account for almost 90% of those who fall sick with TB each year.
• TB is a disease of poverty, and economic distress, vulnerability, marginalization, stigma and discrimination
are often faced by people affected by TB. TB is curable with medicine (nearly 90% cure rates) and
preventable.
• Globally, an estimated 10.6 million people (6.6 million males and 4.0 million females) fell ill with TB in 2021.
There were an estimated 1.6 million TB deaths, 1.4 million among HIV negative people and 1,87,000 among
HIV positive people.
• The global TB notifications is 6.4 million with a partial recovery from 5.8 million in 2020. Men (aged
≥15years) accounted for 57.0% and children (aged <15 years) for 11.0%
TB in Nepal
• Nepal, an estimated 69,000 fell ill with TB in FY 2078/79.
• The National Tuberculosis Program (NTP) registered 37,861 all forms of TB cases (38% female and 62%
male). Out of 37,861 all forms of TB cases, 37,287 (98.5%) cases were incident TB cases, 21,628 (57%) were
pulmonary bacteriologically confirmed (PBC) cases, 5677 (15%) were pulmonary clinically diagnosed (PCD)
cases and 10556 (28%) were extra pulmonary TB cases.
• Geographically, most people who reported TB were from Terai region (60%).
• At provincial level, Madhesh Province (23.7%), Bagmati Province (23.3%), and Lumbini province (21.4%)
contributed the highest proportion of notifications.
• Altogether, these 3 provinces comprised 68.4% of the total TB cases notified in NTP.
 Introduction
1.Program Launch: The Tuberculosis Control Program was initiated by the Government of Nepal nearly six decades ago.
2.1937 Establishment: The 'Tokha Sanatorium' was established in 1937, located north of Kathmandu city.
3.1951 Central Chest Clinic (CCC): The Central Chest Clinic (CCC) was established in 1951, providing diagnosis and treatment services for
TB patients on a domiciliary basis.
4.1965 Systematic Organization: In 1965, the TB Control Program was systematically organized through a tripartite agreement between
the Government of Nepal, WHO, and UNICEF.
5.Nationwide Expansion: Following the 1965 agreement, the TB Control Program expanded nationwide, offering preventive measures
such as BCG vaccination, case-finding, and drug distribution.
6.Amalgamation in 1989: In 1989, the Central Chest Clinic and TB Control Program were amalgamated to form the National
Tuberculosis Centre.
7.National Tuberculosis Centre: The National Tuberculosis Centre, located in Thimi, Bhaktapur, operates at the central level.
8.Regional Tuberculosis Centre (RTC): In 1989, with cooperation from the Japan International Cooperation Agency, the Regional
Tuberculosis Centre (RTC) in Pokhara was established at the regional level.
1.Objective 1: Case Notification and Diagnosis
•Increase health facility-based diagnosis for TB.
•Raise children's diagnosis from 6% (baseline) to 10% by 2021.
•Expand diagnosis among vulnerable groups like PLHIV and those with diabetes mellitus.
2.Objective 2: Treatment Success Rate
•Maintain a treatment success rate of 90% for all TB patients through 2021.
3.Objective 3: Drug-Resistant TB Management
•Provide DR diagnostic services for 50% of presumptive DR TB cases by 2018, reaching 100% by 2021.
•Aim for a successful treatment rate of at least 75% for diagnosed DR patients.
4.Objective 4: Case Finding Expansion
•Expand case findings by involving providers from public, medical colleges, NGOs, and private sectors
through PPM schemes.
•Formal engagements (MoUs) for TB case notifications.
5.Objective 5: Strengthening Community Systems
•Strengthen community systems for TB patient management, advocacy, support, and rights.
•Enable the detection and management of TB cases in 60% of districts by 2018, reaching 100% by 2021.
6.Objective 6: Health System Strengthening
•Contribute to health system strengthening through HR management, capacity development, financial
management, infrastructures, and procurement in TB.
7.Objective 7: Comprehensive Surveillance and Monitoring
•Develop a comprehensive TB Surveillance, Monitoring, and Evaluation system.
8.Objective 8: Emergency Preparedness
•Develop a plan for the continuity of NTP services in the event of a natural disaster or public health
emergency.
• Vision: A world free of TB Zero deaths, disease, and suffering due to TB
• Goals: End the Global TB Epidemic
• Milestones for 2025:
• 75% reduction in TB deaths (compared with 2015)
• 50% reduction in TB incidence rate (less than 55 TB cases per 100,000 population)
• No affected families facing catastrophic costs due to TB
• Targets for 2035:
• 95% reduction in TB deaths (compared with 2015)
• 90% reduction in TB incidence rate (less than 10 TB cases per 100,000 population)
• No affected families facing catastrophic costs due to TB
• Principles:
• Government stewardship and accountability, with monitoring and evaluation
• Strong coalition with civil society organizations and communities
• Protection and promotion of human rights, ethics, and equity
• Adaptation of the strategy and targets at the country level, with global collaboration
Dots
• DOTS (Directly Observed Therapy, Short-Course) involves patients being observed while taking medication.
• A nominated person records the patient taking the medicine to ensure regular intake.
• DOTS involves meeting with a healthcare worker daily or several times a week.
• Monitoring ensures medicines work effectively, and the healthcare worker watches for side effects.
• Direct observation ensures treatment for entire course with right drugs, right doses, at the right interval.
• DOTS strategy initiated in 1996 with four pilot sites.
• NTP in Nepal adopted and successfully implemented DOTS.
• By late 1999, over half the population had access to DOTS services.
• The 1998–2003 NTP Plan projected nationwide DOTS coverage by the end of 2000.
Dots
• TB drug resistance is a major problem that threatens the success of DOTS.
• Drug resistance arises due to the improper use of drugs in chemotherapy of drug-susceptible TB patients.
• This improper use is a result of a number of actions, including administration of improper treatment
regimens by health care providers and failure to ensure that patients complete the whole course of
treatment. Essentially, drug-resistance arises in areas with poor TB control programs.
• The DOTS-Plus program is developed by WHO and partners to manage Drug Resistant-TB (DR-TB) using
second-line Anti-TB drugs.
• DOTS Plus program for treatment of Drug Resistant TB (DR TB) started by Nepal NTP in September 2005.
Initial approval is for Nepal NTP to register 350 DR TB cases over a two year period. DOTS Plus programme
started at 5 main centers and 16 sub-centers.