Wall Street Journal (01.19.12) - Tuesday, January 24, 2012
With the recent report of 12 TB cases in Mumbai resistant to
all current treatments, India is confronting weaknesses in its
national TB program. The cases were diagnosed in patients at
Hinduja National Hospital and Medical Research Center and
reported by Zarir Udwadia, one of Mumbai's leading private
pulmonologists, and colleagues.
"While this handful of cases is worrying, it's just the tip of
the iceberg," said Dr. Soumya Swaminathan, senior deputy
director of the National Institute for Research in
Tuberculosis. "The bottom line is we need to take TB much more
Indian health officials on Jan. 18 visited Mumbai to meet with
Udwadia and other pulmonologists to develop a course of
action. Since the 1997 launch of the current program of free
TB testing and treatment, India has cut TB mortality from
500,000 annually to 280,000 in 2010. About 1.5 million of its
2 million TB patients are treated by the program, according to
a 2011 government report.
To ensure treatment adherence, the national program requires
patients to take their medication in front of a nurse or
designated supervisor. However, the program needs more
funding, more local-level accountability and more labs that
can perform resistance testing, Swaminathan said.
In a survey conducted last year by Udwadia among doctors
treating TB in the Dharavi slum in Mumbai, 103 of 106
prescribed the wrong medications for the disease, he said.
"Two or three treatment errors is all it takes to create
multidrug-resistance," he said.