This document contains information about tuberculosis (TB) infection and the problem of TB in India. It discusses that the chances of getting infected depends on duration, frequency and individual immune status of exposure. It also describes primary and post-primary TB infections. India has the highest TB burden in the world, accounting for over 1.9 million new cases annually. TB is one of the leading infectious causes of death in India, killing approximately 1000 people daily. Charts are also included showing quarterly TB case statistics for the block from 2014.

1. DR.MAMMEN P CHERIAN
MBBS, PGDOR
MEDICAL OFFICER IN
CHARGE, PHC NIRANAM
MOTC THIRUVALLA TU
RNTCP
Training for LSGD
MEMBERS
CHATHENKERY
24/04/2015

2. TB Infection
• Chances of getting infected
depends on:
1. The duration of exposure
2. The frequency of exposure
3. The immune status of an
individual

3. Infection
• Entry and establishment of organism in human body
• Takes about 6-8 weeks.
• Indicated by +ve tuberculin skin test.
1. Primary infection – infection occurring for the first time in a susceptible
• Individual exposed to M.tb.
• Primary complex
• Secondary bacillary multiplication that occurs at regional LN
• 2.Post primary TB – after a latent period of many months or even years after
primary infection.
• Risk of spread of infection:
• To 10-15 persons/year for 2-3 years
• Risk factors for developing disease:
• Strongest risk factor- HIV Co-infection, DM, SMOKING, ALCOHOL ABUSE

4. India is the highest TB burden country accounting for more than one-
fifth of the global incidence
Indonesia
6%
Nigeria
5%
Other countries
20%
Other 13 HBCs
16% China
14%
South Africa
5%
Bangladesh
4%
Ethiopia
3%
Pakistan
3%
Phillipines
3%
India
21%
Source: WHO Geneva; WHO Report 2009: Global Tuberculosis Control; Surveillance, Planning and Financing
Global annual incidence = 9.4 million
India annual incidence = 1.98 million
India is 17th among 22
High Burden
Countries (in terms of
TB incidence rate)

5. WHO estimates for TB in India (2013)
Incidence of TB
disease
2.2 million per
annum
(176 per 100,000
pop. per year)
Prevalence of TB
disease
2.8 million (230 per 100,000
pop. per year)
Mortality due to
TB
270,000 per
annum
(>900/day)
(22 per 100,000
pop. per year)

6. Problem of TB in India
• Incidence: >1.98 million new TB cases annually
– 0.8 million new infectious cases
– 75 NSP cases / 100,000 population / year
– Incidence more in north and less in south
– Incidence more in urban areas
– TB is more common among males
• Prevalence:
– WHO estimate (2007) – 3.3 million TB cases
• Deaths: about 2,76,000 deaths due to TB each year
– One of the leading infectious cause of death
– Nearly 1000 deaths due to TB per day; about 2 deaths every 3 minutes

7. Problem of TB in India..
• Infection: 40% (~400m) infected with tuberculosis bacteria
– Only 10% of them will develop TB disease in lifetime
– Co-infection with HIV increases risk of TB disease by 6 to 8 times
– Several other factors also increase this risk, e.g. diabetes, smoking, poor
nutrition, etc
• HIV :
1. 2.27 million people living with HIV; nearly 1 million co-infected with HIV and TB
2. About 5% of TB patients estimated to be HIV positive
3. HIV in TB varies greatly between districts and states (<1% to 14%)
4. More in south (except Kerala), north-east and some scattered districts
• Estimated Multi-drug resistant TB
1-3% in new cases
12-17% in re-treatment cases
• DM, SMOKING

8. Estimated* Incidence of TB in India
(No. of NSP Cases per 100,000 population, per year)
National 75
North Zone 95
East Zone 65**
West Zone 80
South Zone 50**
North
West East
South
* Estimated from ARTI survey
** For programme monitoring
purpose estimated cases in East &
South zones have been kept at the
national level of 75
ARTI survey by NTI 2001-2003

9. Annual Risk of Tuberculosis Infection(ARTI)
 Proportion of population that gets newly
infected ( or re-infected ) with tubercle
bacilli during the course of one year
 ARTI for the country is 1.5%.
For Kerala it is 1.0%
 203 cases per lakh population is
infected each year.
 135 cases/L/Year-Kerala
Type of case Occurrence /
lakh / year
NSP (Definitive) 75 cases
NSN (Probable) 75 cases
Previously
treated
38 cases
EP 15 cases
Total 203 cases
Type of case Occurrence /
lakh / year
NSP (Definitive) 50 cases
NSN (Probable) 50 cases
Previously
treated
25 cases
EP 10 cases
Total 135 cases

10. O
U
R
B
L
O
C
K

11. 0
1
2
3
4
5
6
7
NSP 1Q2014
NSP 2Q2014
NSP 3Q2014
NSP 4Q2014
NEW SMEAR POSITIVE CASES

12. 0
1
2
3
4
5
6
1
3
4
1 1
3
2
1 1 1 1 1 1 1 1 1
3
1
5
22
3
1 1 1
4
1 1
2 2
3
1
3
1 1
5
4
1 1 1
3
1
2 2
1
2
4
3
1
2 2
1
2
1
2
5
6
1 1
5
2
1 1
3
1
4
2
1 1 1
1Q2014 2Q2014 3Q2014 4Q2014
NEW SMEAR POSITIVE CASES

13. 0
0.5
1
1.5
2
2.5
3
3.5
NSN 1Q2014
NSN 2Q2014
NSN 3Q2014
NSN 4Q2014
NEW SMEAR NEGATIVE CASES

14. 0
0.5
1
1.5
2
2.5
3
3.5
4
1 1 1
2 2
1 1 1 1
2 2
11 1 1 1 1 11
3
2
1
2
3
1 1
4
22
1 1 1 1 1 1 1
1Q2014 2Q2014 3Q2014 4Q2014
NEW SMEAR NEGATIVE CASES

15. 0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
NEP 1Q2014
NEP 2Q2014
NEP 3Q2014
NEP 4Q2014
NEW EXTRA PULMONARY CASES

16. 0
1
2
3
4
5
6
7
1 1
2
5
1 1 1 1 1 1
4
2
3
1
2
4
1 1 1
2
1
2
1 1 1 1 1
3
1 1
2
7
1
2
1 1 1 1 1 1
2 2
3
2
1 1
3
2
1 1 1 1 1
1Q2014 2Q2014 3Q2014 4Q2014
NEW EXTRA PULMONARY CASES

17. 0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
1 1 1 1 11 1 1 1 1
1Q2014 2Q2014 3Q2014 4Q2014
PAEDIATRICS TB

18. THANK YOU