This document discusses communicable diseases and focuses on tuberculosis (TB). It provides key statistics on the global and national burden of TB, including that 9.2 million new cases occurred worldwide in 2006, with India accounting for 1/5 of the global burden. India has an annual risk of TB infection of 1.5% and once infected, a 10% lifetime risk of developing active TB. The document also outlines epidemiological indices used to measure the TB problem, describes India's Revised National Tuberculosis Control Programme which uses DOTS, and mentions drug-resistant TB and the relationship between TB and HIV.

1. Communicable Diseases
Communicable disease:
An illness due to a specific infectious agent or
its toxic products capable of being directly or
indirectly transmitted from man to man, animal
to animal, or from the environment to man or
animal.

2. TUBERCULOSIS
Ancient Indians called it as Raj-Yakshama.
HIPPOCRATES called it as “Phthisis” means
wasting away.
Koch identified organism in 1882.

3. TUBERCULOSISProblem statement: WHO estimates that 9.2
million new cases of TB (139/100,000
population) occurred in 2006.
of these 4.1 million ( 62/100,000) new sputum
positive, & it includes 789,000(7.7%) TB with
HIV
14.4 million prevalent cases( 219/100,000)
1.7 million (25/100,000) died from TB, of
which 231,000 were TB-HIV,
S-E Asia accounts for 31% of total cases.

4. India, China, Indonesia, South Africa & Nigeria
rank 1st
to 5th
in terms of incidence.
WHO has set international standards for TB care.
INDIA : 1/5TH
OF GLOBAL burden, 2/3rd
of cases in
SEAR.1.8 Million develop TB ,0.8 million new
sputu smear positive
annual risk of becoming infected with TB is 1.5%
& once infected there is 10% life time risk of
developing TB disease.

5.  2 out of every 5 Indians are infected with TB
bacillus.
 everyday 5000 people develop disease.
 patient with infectious pulmonary
tuberculosis can infect 10-15 persons per
year.
 in India 0.37 million people die every year
DOTS launched in March 1997 covered whole
country by March 2006. more than 7.3 million
on DOTS

6. THE ECONOMIC & SOCIAL
BURDEN
Direct cost of the disease in India annually
estimated at about US$ 3 Billion ( more than
RS. 13000 CRORES).
Only authentic survey, on countrywide basis,
is National Sample Survey(1955-1958) by
ICMR , sample drawn from less than 50% of
population, tuberculin testing was not
included since extensive tuberculin testing &
BCG vaccination had already carried out.

7. National Tuberculosis Institute, Banglore carried
out 3 longitudinal surveys at Delhi, Banglore &
Chingleput.

8. Epidemiological indices
- needed to measure the TB problem in a
community, planning & evaluation of control
measures & for international comparison
1. prevalence of infection : % of individuals
who show a positive reaction to the standard
tuberculin test

9. 2. incidence of infection : (ANNUAL
INFECTION RATE)
% population under study who will be newly
infected with myco. TB among the non
infected of the preceding survey during the
course one year.
In developing countries 1% annual risk
corresponds to 50 new cases of smear positive
cases per year per 100,000 general population.
Also known as “tuberculin conversion” index,
this parameter is best indicator for

10. 3. Prevalence of disease or case rate: % of
individual whose sputum is positive for TB
bacilli. Best available practical index to
estimate the number of infectious cases or
case load in a community.
4. incidence of new cases: % of new
tuberculosis cases confirmed by
bacteriological examination
per1,000population during one year.

11. 5. prevalence of suspect cases : based on x-ray
examination
6. prevalence of drug resistance cases
7. mortality Rate:

12. Revised National Tuberculosis
control programme
DOTS ( Directly Observed Treatment Shortcourse)
CAT- I New sputum smear positive
seriously ill sputum smear negative
seriously ill extrapulmonary
CAT-II Sputum smear positive relapse
Sputum smear positive failure
Sputum smear positive treatment after
default

13. RNTCP Continue…..
CAT III New sputum smear negative, not seriously
ill
New Extra-pulmonary not seriously ill
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Preventive measure:
BCG Vaccine
Preventive chemotherapy

14. DRUG RESISTANCE TB
1. Multidrug resistance (MDR-TB)
DOTS-Plus for MDR-TB
2. Extensive drug TB ( XDR-TB)
Tuberculosis & HIV