February 25, 2020
Dr. Lawrence Domingo, M.D.
Tuberculosis (TB) is an infection that usually affects the lungs. The culprit is a bacterium called Mycobacterium tuberculosis. It can be passed on to another person through tiny droplets spread by coughing and sneezing.
In the Philippines, TB is the 6th leading cause of death. 73 Filipinos die every day of TB. An estimated 200,000 - 600,000 Filipinos have active TB. This condition makes the person sick and contagious to others. Active TB can occur in the first few weeks after infection with the bacteria. Signs and symptoms of active TB include cough, phlegm with blood, unexplained weight loss, fatigue, afternoon fever, night sweats, chills, and loss of appetite. According to the World Health Organizations (WHO), the Philippines is 9th worldwide amongst 196 countries which has a high burden of TB.
Each person with active TB can spread the disease to 10 other people. The treatment course for TB is 6-9 months of continuous TB medicines. Once active TB is treated, the person is no longer contagious after 3 weeks. An estimated 80% of Filipinos have latent TB. This means that Filipinos have TB infection, but is still in the inactive state. That is why they have no symptoms and are not contagious to other people.
Update from the 2017 WHO Global TB Report that the estimated TB Burden Mortality is 21/100,000 and incidence is 554/100,000. The Total Notified Cases is 345,144. Treatment Coverage is at 58% while treatment Success Rate (2015) is at 91%. Treatment Success Rate for multidrug resistance or rifampicin resistant TB (MDR/RRTB) in 2014 is 46%,
TB can affect other organs of the body. These organs are the kidneys, spine or brain. Symptoms depend on the organ affected. TB of the spine causes severe back pain, while TB of the kidneys can cause bloody urine.
Treatment of TB may not change your chest x-ray results back to normal. That is why many Filipinos do not pass job tests for abroad because of past or present TB infection. Studies show that once treatment for TB is completed, 30 percent of repeat chest x-ray may revert to normal, 30 percent improve but will still show a scar and 30 percent will remain the same.
The 2007 National TB Prevalence Survey (NTPS) found that the prevalence rate of smear (+) TB was 2 per thousand and culture (+) was 4.7 per thousand. The BCG vaccine against TB is not 100% effective. WHO recommends that BCG be given to all infants and young children in countries with high TB burden but the vaccine does not always protect people from TB. It does appear to protect the person from a more serious form of TB that is why it is part of the immunization program.
Another challenge is the emergence of a new drug-resistant strain of TB called MDR-TB. This new strain probably arose because TB patients did not adhere to their drug regimen. Because of this, the TB bacteria developed a resistance to the first-line drugs like Isoniazid and Rifampicin. MDR-TB is difficult and expensive to treat. Worldwide, in 2008, there were an estimated 440,000 new cases of MDR-TB and 150,000 deaths from MDR-TB. Estimates show that 3.3 percent of new TB cases are really MDR-TB. Scientists have discovered a third more terrible strain of TB. This is called extensively drug-resistant TB or XDR-TB. This means that XDR-TB is resistant even to the special drugs developed for MDR-TB. The WHO has reported that XDR-TB cases have been confirmed in 58 countries, including the Philippines.
The Department of Health (DOH) has RA 10767 in implementation. This is the Comprehensive TB Elimination Plan Act of 2016. Significant developments have been made in increasing case detection and treatment in the country. In 2007, the Philippines achieved a TB case detection rate of 75%, exceeding the WHO target of 70 percent. The Directly Observed Therapy Short Course (DOTS) is the internationally recommended strategy for TB control. DOTS simply means asking a relative or a health worker to directly observe the patient taking the anti-TB medicines daily. The Philippines’ DOTS treatment success is at around 88%, which is higher than the WHO target of 85%
Despite these accomplishments, many factors still need to be addressed such as reducing the stigma of TB patients, and increasing the public’s awareness of the disease, especially the need for treatment. Some infected TB patients still refuse treatment and continue to pose a danger to people around them.
The 2017-2022 Philippine Strategic TB Elimination Plan is to activate communities and patient groups to promptly access quality TB services by collaborating with other government agencies to reduce out-of-pocket expenses and expand social protection programs. This will harmonize local and national efforts to mobilize adequate and competent human resources. Innovative TB information generation and utilization for decision making is needed. There should be enforcement of standards on TB care and prevention and use of quality products. There should be engagement of national, regional and local government units/agencies on multi-sectoral implementation of TB elimination plan.
So now that we know what TB is and how it is affecting our country, we can devise plans to prevent it in the future and treat it to reach our country’s goal for TB elimination.