Basics of NTEP.pptx National tuberculosis Elimination programme

Basics of NTEP.pptx National tuberculosis Elimination programme

1. Basics of National TB Elimination Program

2. Mycobacterium Tuberculosis Causative agent of Tuberculosis Robert Koch announced discovery of M. TB on 24 th March 1882 Fairly large (2-4 μm x 0.2-0.5μm) non-motile rod-shaped bacterium Obligate aerobe Slow generation time15-20 hrs Has a waxy coating on cell surface due to mycolic acid Impervious to gram staining Needs acid fast stains (ZN/ Auramin -O) Mycobacterium tuberculosis  scanning electron micrograph; CDC . Mycobacterium tuberculosis Ziehl-Neelsen stain light microscopy CDC . Mycobacterium tuberculosis Colonial morphology ; CDC .

3. Mycobacterium Tuberculosis M. tuberculosis  is part of a complex that has at least 9 members:  M. tuberculosis,   M. africanum ,  M. canetti ,  M. bovis ,  M. caprae ,  M. microti ,  M. pinnipedii ,  M. mungi ,  and  M. orygis . Genome (H37Rv strain) has 4 million base pairs 3959 genes Important for identification of lineages Molecular diagnostics

4. TB Infection Common source is a pulmonary TB patient Airborne transmission by droplet nuclei Chances of getting infected depend on duration and frequency of exposure, load and virulence of bacilli and immune status of the individual M. Tb survive within macrophages Usually takes 6-8 weeks for establishment and manifestation of infection Infection is indicated by detection of Interferon Gamma Release by direct assay (QFT in Tube, T-Spot) or skin tests (Mantoux, C-Tb, Diaskin )

5. Pai et al 2016

6. Risk factors for TB after infection India has the highest estimated burden of tuberculosis infection (TBI) globally, with nearly 35-40 crore Indian population having TBI, of which 26 lakh (18-36 lakh) are estimated to develop tuberculosis (TB) disease annually 5–10% of those infected will develop TB disease over the course of their lives, usually within the first 2 years after initial infection The risk for TB disease after infection depends on several factors- The most important being immunological status risk is increased >25 times among contacts of bacteriologically confirmed TB patients compared to general populations, 16-21 times in case of HIV co-infection and 3-4 times in other immune-compromised status like diabetes, etc. 6

7. Review of literature 75% of people who develop TB disease after contact with a patient of active TB are estimated to do so within one year of TB diagnosis of the index patient and 97% within two years. Molecular fingerprinting studies further confirmed the probabilities of developing disease within one, two and five years as 45%, 62% and 83% respectively. R isk of developing TB disease after TPT decreases by approximately 60% and the reduction can be up to 90% among people living with HIV (PLHIV). Epidemiological modelling studies show that effective implementation of TPT alone in South-East Asia (SEA) region would result in an annual TB incidence decline of 8.3%, independent of other background interventions. 7

8. TB disease A Microbiologically confirmed u ntreated Pul TB case can transmit disease to at least 10 to 15 people in a year and remain infectious for 2-3 years Contacts of an active case are at 10 to 60 times higher risk of developing the disease

9. Broader TB Determinants Number of TB cases attributable to five risk factors (of 10 million annually) Undernourishment 2.2 million HIV Infection 0.8 million Alcohol Use Disorders 0.7 million Smoking 0.7 million Diabetes 0.4 million

10. Drug Resistant TB The bacilli may be resistant to one or more anti-TB drugs Among bacilli not exposed to drugs, 1x 10 -6 are naturally resistant to INH and 1x 10 -8 are resistant to Rifampicin Poor treatment increases the risk to develop resistance Monotherapy, irregular consumption, frequent interruptions, trial therapy…

11. Fate of Pulmonary TB under different programme conditions

12. The Clock is ticking……. #TBMuktBharat #TBHaregaDeshJeetega