GOI release on MDR tuberculosis cases; Media evaluation of the ground conditions & “The Human Rescue Team Research Repertory” prediction of turning it an epidemic

The Human Rescue Team & Research Repertory is predicting in limits of scientific reasoning that ” MDR
tuberculosis is going to be uncontrolled with available preventive
measures and destined to emerge as an epidemic, better we should research the
way to fix it the earliest  “

Press Information Bureau
Government of India
Ministry of Health and Family Welfare
20-January-2012 11:48 IST
Central Team Submits Report on Drug Resistant Tuberculosis Mumbai Cases
Centre Assures full Supply of DR-TB Drugs and Technical help
RNTCP Maharashtra to Adopt Identified Cases and Offer free Treatment

The Central Team that visited Mumbai to examine the reported Drug
resistant cases has submitted its report to the Union Minister of
Health and Family Welfare Shri Ghulam Nabi Azad. The following points
emerged unanimously from the consultations held at Mumbai:

–     The reported cases by Hinduja hospital fall only within the
category of Extensively Drug Resistant TB (XDR TB) based on standard
WHO definitions and not at all as “Totally Drug Resistant” TB (TDR
–     TDR TB is a non standard term, not endorsed by WHO
–     RNTCP Guidelines for quality diagnosis and management of XDR TB
are to be applied in all such cases
–     Diagnosis of XDR TB must be based on microbiological
confirmation from the accredited national reference laboratories
namely National Institute of Research in TB – Chennai, National TB
Institute –   Bangalore and LRS Institute of TB and Respiratory
Diseases- New Delhi.
–     Revised National Tuberculosis Control Programme (RNTCP)
Maharashtra will adopt all these cases and offer them the entire
treatment free of cost.
–     Isolation of these cases is not advocated as this is a chronic
disease and the transmissibility is reduced drastically by treatment.

Out of the reported 12 patients, 9 patients were traced and found to
be stable on the current treatment while 3 have since died. Seven of
these 9 patients are residents of Mumbai and one each from
Meera-Bhayandar Municipal Corporation and Ratnagiri district of

Municipal Corporation of Greater Mumbai (MCGM) and Government of
Maharashtra have taken the following decisions for immediate

•      Strengthen the TB service delivery systems in Mumbai by
immediately converting all the 24 wards of MCGM to 24 RNTCP districts,
with placement of 24 ——- DTOs under one Sr. Mumbai TB Officer with
infrastructure for 24 district TB drug stores and one additional State
level TB Drug store at Mumbai.
•      MCGM to decentralize basic Tuberculosis Unit (TU) from the
current population level of 1 TU per 5 lakhs to one TU per 2 lakhs
population for enhanced outreach and services delivery. Additional 35
TUs with Medical Officer TB Control and 20 Microscopic centers with
Lab technicians will be immediately created.
•      Three additional DOTS-Plus site along with additional culture &
Drug Susceptibility Testing (DST) laboratories will be established at
GTB Hospital under MCGM at Mumbai.
•      Immediate up-scaling of Drug Resistant TB services to universal
access criteria to test patients for MDR TB in Mumbai including those
from the private sector.
•      Widely publicize availability of free diagnostic and treatment
services for all types of TB, through regular and repeated
advertisements and publicity measures.
•      Ensure the implementation of the notification system under the
BMC Public Health Act for TB with punitive measures for non
•      Introduce mandatory laboratory notification for M/XDR TB from
all public and private sector laboratories of Mumbai, trace such
diagnosed drug resistant TB patients, re-test them from an RNTCP
accredited laboratory and treat all such confirmed drug resistant TB
cases under RNTCP.
•      Centre assured full supply of DR-TB Drugs to all such patients
along-with requisite technical assistance on regular basis.

It may be recalled that recently, a letter to Clinical Infectious
Disease Journal in December 2011 described four patients from Mumbai,
with extensively drug resistant tuberculosis (XDR TB), erroneously
labeled as “TDR-TB” by the authors.  A careful audit of their
prescriptions revealed that these three patients had received erratic,
unsupervised second-line drugs, added individually and often in
incorrect doses, from multiple private practitioners (on average from
four physicians during a 18-month period) in an attempt to cure their
multi-drug resistant (MDR) tuberculosis. The author also urged that
patients with MDR tuberculosis only be treated within the confines of
government sanctioned MDR TB treatment programs to prevent the
emergence and spread of further drug resistance. Subsequently, eight
more cases have been reported by Hinduja Hospital, subsequent to the
publication in the journal.

The Central team steered a scientific discussion at the KEM Hospital,
Mumbai with eminent experts on the subject from medical colleges in
Mumbai, some premium private hospitals, civil society representatives,
professional associations, chemist/pharmacist association to discuss
the present situation, the magnitude of the problem of drug resistance
and the way forward. The central team also met the higher authorities
of Municipal Corporation of Greater Mumbai (MCGM) and Maharashtra
state government.


Govt downplaying the tuberculosis threat?

Mumbai: The Maharashtra government has labelled a hospital’s claims of
a fatal tuberculosis strain as premature. The question is whether the
government is downplaying the disease.
1,000 Indians die of tuberculosis every day and 20 per cent of the
total TB deaths in the world take place in the country. The picture
seems to be getting darker with reports that show 12 cases of the
killer, totally drug resistant TB. But the government has been
downplaying the danger.
SK Jindal, Chairman, Central DOTS Committee, said, “There is no such
thing as totally drug resistant TB. They are all cases of XXDR TB,
which is, extremely drug resistant TB. The second thing is that this
is nothing new. It’s not like a new virus has hit India.”
A central team and the Maharashtra Health authorities have claimed
that seven out of the 12 cases of totally drug resistant TB reported
by the Hinduja Hospital have tested negative. Strangely, they were
vague about where exactly the tests were done.
One in six Indians under the age of 50 dies due to tuberculosis. Yet
the State Health Department and the team from the Centre is
downplaying the huge public health threat. They not only lashed out at
the Hinduja Hospital for claiming to find totally drug resistant TB,
but also say, the rate of transmission of TB has dropped down annually
in the country from 1.5 per cent to 1.1 per cent.
The government, however, maintains that it has an action plan to
combat what it calls extremely drug resistant TB. It said that the
number of TB officers in Mumbai will be increased to 24 from six now.
The government also said that the number of labs where drug resistance
tests will be done will be increased to 43 from the current 27. It
has, however, clarified that no suspected patient will be isolated.
But with studies having shown that one TB person infects at least 15
others in a year, these measures seem too little, too late.

Add -“The Code Blue”  Sequence of Triaging: The Art to Rescue  in REAL TIME

The Human Rescue Team

A Self Styled Laboratory of Neuroinformatics- Interlecting in  Nano Age


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