Drug-Resistant TB Cases In Mumbai Up 36 percent In 3 Years

MUMBAI, 24 MARCH 2018: The menace of drug-resistant TB grew by 36% in the city in the last three years, shows latest data by the BMC’s public health department. While 3,608 multi-drug resistant (MDR) TB patients were identified in Mumbai in 2015, the number climbed to 4,891 in 2017.

The fiercer variant, called extensively drug resistant (XDR) TB, has increased by 21% in the same period: from 556 patients in 2015 to 670 patients in 2017. The BMC data sheet attributed the increased numbers to two factors: Better notification by both public and private sector doctors in the city; and an increase in diagnostic facilities to facilitate easy detection of cases. This is borne out by the 18% increase in the number of standard TB cases in three years, said BMC officials.

“More private sector doctors are notifying us, leading to a sudden increase in numbers,” said a civic doctor.

State officials say Mumbai not only accounts for nearly 70% of Maharashtra’s MDR TB cases, but also has the highest default rate.

“While there are many factors contributing to this, migration is perhaps one of the biggest. It is common for migrant labourers to take medicines for 2-3 months, then take a break and start again. The adherence issue is huge and one of the main challenges we are trying to address through counsellors and by building a better doctor-patient relationship,” said Dr Sanjeev Kamble, state TB officer.

Despite the detection of over a lakh fresh TB cases every year, Dr Kamble said the elimination goal of 2025 is not an “impossible one” for the state. But experts differ and say eliminating TB is still a distant dream.

“Better diagnostics have no doubt helped, but the increase is mainly due to the disease spreading rampantly in our overcrowded city,” said former head of pulmonary medicine at civic-run KEM Hospital and TB specialist Dr Ashok Mahasur.

“The earlier government-run TB-control programmes created resistance among the community and we have still not been able to control the after-effects.”

Until six years ago, TB patients were asked to complete their medicines for six months before being tested for resistance. In this period, resistance worsened in some patients. In 2012, the centre introduced special anti-TB control measures for Mumbai, leading to an increase in GeneXpert machines and easy availability of higher antibiotics.

Dr Yatin Dholakia of the NGO Maharashtra State AntiTB Association said, “Despite the steps introduced six years back, we are still on the slow track. We still do not offer individualized treatment (where patients are given drugs that work for them as against a standard box of medicines). Active case finding (house-to-house search for TB cases) needs to be carried out more often.’’ He said there is a high component of “silent disease” in Mumbai.

“It wouldn’t be surprising if Mumbai’s TB burden increases a bit more.” In terms of measures, Kamble said doctors will be granted Rs 500 for notifying every new case and an equal sum on completion of treatment. “The treatment of MDR TB spans over two years and it’s imperative that doctors share a bond with patients and motivate them to complete treatment,” he said.ET Healthworld