TUBERCULOSIS

Presented by,
K.MANASA
PHARM.D
INTERN
 CONTENTS

• DEFINITION
• EPIDEMOLOGY(INDIA AND WORLD)
• HISTORY
• KEY FACTS
• NTEP GUIDELINES
• CASE DEFINITIONS
 TUBERCULOSIS

Tuberculosis (TB) is an infectious disease that most often affects

the lungs and is caused by mycobacterium Tuberculosis. It
spreads through the air when infected people cough, sneeze or
spit.
 EPIDEMOLOGY
TB Burden in India :

• As per the Global TB Report 2021, the estimated

incidence of all forms of TB in India for the year 2020
was 188 per 100,000 population.
• The total number of incident TB patients (new & relapse)
notified during 2021 was 19,33,381 which was 19%
higher than that of 2020 (16,28,161).
• TB notifications that was observed around the months
when the two major covid waves happened in India.
• Though factors such as changes in the health seeking
behaviour of patients with chest symptoms (patient related) as
well as diversion of the human and material resources
(provider-related) were seen across the country.
• Measuring presumptive TB examination rate is an important
measure of effort to find all cases in the community.
• As the gap between cases found and the estimates reduces, the
number needed to get one case TB will increase. Both passive
and active case finding efforts will contribute to achieving the
target of 2025.
 KEY FACTS
•A total of 1.6 million people died from TB in 2021 (including
187 000 people with HIV). Worldwide, TB is the 13th leading
cause of death and the second leading infectious killer after
COVID-19 (above HIV and AIDS).

•In 2021, an estimated 10.6 million people fell ill with

tuberculosis (TB) worldwide. Six million men, 3.4 million
women and 1.2 million children. TB is present in all countries and
age groups. But TB is curable and preventable.
•An estimated 74 million lives were saved through TB
diagnosis and treatment between 2000 and 2021.

•Ending the TB epidemic by 2030 is among the health

targets of the United Nations Sustainable Development
Goals (SDGs).
 HISTORY OF TUBERCULOSIS

• TB in India around 1500 BCE.TB in India is an ancient

disease.

• In Indian literature there are passages from around 1500

BCE in which consumption is mentioned, and the
disease is attributed to excessive fatigue, worries,
hunger, pregnancy and chest wounds.
• In 1993, the WHO declared TB, an airborne infectious
disease, a global public health emergency and urged
coordinated efforts by all nations to avert millions of
deaths in the coming years.
• Each year, we recognize World TB Day on March 24.

• This annual event commemorates the date in 1882 when Dr.

Robert Koch announced his discovery of Mycobacterium
tuberculosis, the bacillus that causes tuberculosis (TB).

• World TB Day is a day to educate the public about the

impact of TB around the world.

• It is no longer known as the Revised National TB Control

Programme (RNTCP), and has been rechristened as
the National Tuberculosis Elimination Programme.
• The TB problem in India was first recognised through a
resolution passed in the All India Sanitary Conference, held at
Madras in 1912. The TB picture started becoming clear with
the introduction of tuberculin testing.

• The Bhore committee report (1946 ): 2.5 million patients

required treatment in the country with only 6,000 beds
available.

• The first open air institution for isolation and treatment of TB

patients was started in 1906 in Tilaunia near Ajmer and
Almora in the Himalayas in 1908.
• The anti-TB movement in the country gained momentum
with the TB Association of India was established in 1939.

• WHO and UNICEF took keen interest in providing

assistance for introducing mass BCG vaccination with low
cost in 1951.

• In the 1940s streptomycin and PAS were introduced in

the west followed by thiocetazone and INH is 1950s.
• National Tuberculosis Control Programme (NTP) was
formulated in 1962 which was implemented in phased
manner.

• The deficiency in NTP was identified in 1963 and

Revised National TB Control Programme (RNTCP) was
developed.

• There is a commitment for Government of India to

expand RNTCP to cover the entire country by 2005.
World Tuberculosis Day 2023: Slogans

1. Imagine a world without TB.

2. Say no to TB, say it to all.

 NTEP GUIDELINES

• NTEP (National Tuberculosis Elimination Program)

• It is one of the components under the National

Health Mission which is a flagship scheme under
Govt. of India.

• The overall allocation is made on the basis of

population of the states, disease burden and socio-
economic status.
• The financial management procedures for RNTCP are well
established and administered by the Finance Cell of the
Central Tuberculosis Division (CTD).

• These procedures are documented in manuals and guidelines

available on the program's website (www.tbcindia.gov.in)
 NTEP Organogram NTEP structure comprises of five levels:
• National,
• State,
• District,
• Sub-district and
• Peripheral health institution level.

National Level:
Central TB Division (CTD) manages the National TB
Control Programme for the entire country at the central level
through a National Programme manager, Deputy Director
General TB
 STATE LEVEL:

• State Health Society or its equivalent under National

Health Mission of the state manages the TB Control
Programme.

• A full-time State Tuberculosis Officer (STO), trained

at national level and based at the State TB Cell
(STC), is responsible for planning, training,
supervising and monitoring the programme in all the
districts of their respective states.

• STO is administratively accountable to the State

Government, technically follows the instructions of
the CTD, and coordinates with CTD and the districts
and is assisted by other technical & secretarial staff.
Organization structure

SUPPORTING FACILITIES:
• National Institutes (3) ·
• National Reference Laboratories (6) ·
• Intermediate Reference Laboratories (29) ·
• State TB Training and Demonstration Centre (26).
• Culture and DST Laboratories (42) ·
• Nodal DR-TB Centre (154) ·
• CBNAAT Laboratories (1180)
Ministry of Health & Family
Welfare

Central TB Division

State TB Cell 37 states / Uts

Organogram
District TB Centre 767 Districts

TB Unit One per 1.5 – 2.5 lakh

population

Designated Microscopy Centre

50,000 to 1 Lakh population

Peripheral health institute

 CASE DEFINITIONS

• Pulmonary tuberculosis (PTB):

TB involving lung parenchyma or tracheo-bronchial tree.

• Extra Pulmonary tuberculosis (EPTB):

TB involving organs other than lungs e.g. pleura, lymph
nodes,intestine, genitourinary tract, joint and bones, meninges of
the brain etc.
• New case - A TB patient who has never had treatment for TB
or has taken anti-TB drugs for less than one month.
• Previously treated patients have received 1 month or more of
anti-TB drugs from any source in the past.

• Recurrent TB case - A TB Patient previously declared as

successfully treated(cured/treatment completed) and is
subsequently found to be microbiologically confirmed TB
case.
• Mono-resistant (MR): A TB patient, whose biological
specimen is resistant to one first line anti-TB drug only.

• Poly-Drug Resistant (PDR): A TB patient, whose biological

specimen is resistant to more than one first-line anti-TB drug,
other than both INH and Rifampicin.

• Multi Drug Resistant (MDR): A TB patient, whose

biological specimen is resistant to both isoniazid and
rifampicin with or without resistance to other first line drugs,
based on the results from a quality assured laboratory.
• Rifampicin Resistant (RR): resistance to rifampicin
detected using phenotypic or genotypic methods, with
or without resistance to other anti-TB drugs excluding
INH. Patients, who have any Rifampicin resistance,
should also be managed as if they are an MDR TB
case.

• Extensively Drug Resistant (XDR): A MDR TB

case whose biological specimen is additionally
resistant to a fluoroquinolone (ofloxacin, levofloxacin,
or moxifloxacin) and atleast one additional group-
A[betaquiline and linezolid or both].