World Tuberculosis Day 2023: Your post-pandemic guide to TB prevention and treatment

A child being examined for signs of tuberculosis in Faridabad, Haryana. (Image: JP Davidson via Wikimedia Commons 2.0)

With World Tuberculosis Day observed on March 24 every year to spread awareness about the contagious disease and how best to combat it, the country is on a consistent march to make the nation TB-free by 2025. But what about the post-pandemic spin offs in rankling coughs, the return of the erratic mask culture prevalent during Covid, and the lack of clarity around the BCG vaccine for TB that many of us took, or didn’t take, in the first month of life, and whether we need booster shots of the Bacillus Calmette-Guerin vaccine in adulthood?

What causes tuberculosis?

Tuberculosis is an infection caused by Mycobacterium tuberculosis. It can practically affect any organ of the body. The most common ones are lungs, pleura (lining around the lungs), lymph nodes, intestines, spine, and brain.  TB of the spine, brain, disseminated TB are all considered severe forms of tuberculosis.

How does TB spread?

“It is an airborne infection, that spreads through close contact with the infected, especially in densely populated spaces with poor ventilation,” explains Dr Nimish Shah, consultant, pulmonology, Jaslok Hospital and Research Centre, Mumbai. “Earlier, susceptible TB was drug-sensitive, and fully curable. With time, TB has evolved into variants including multi drug resistant (MDR) strains – (which is) more difficult to treat, demanding greater compliance from patients, and carrying side effects. In immuno-compromised cases, when you have pre-existing conditions like poorly controlled diabetes, or HIV, the treatment is more challenging. Yet there is success rate through perseverance.”

TB prevention and treatment

So, is TB curable and preventable? “If diagnosed on time and appropriate treatment is taken for the same as advised by the doctor. If the treatment is left halfway, the chances of (getting) drug-resistant TB go up exponentially,” says Dr Namrata Jasani, senior consultant pulmonology, Global Hospitals, Parel, Mumbai

TB in India

India accounts for roughly 28 percent of TB cases in the world, as per the Global TB Report 2022. So, the general paranoia in the wake of the pandemic is understandable as our hearts beat faster when someone coughs incessantly in front of us. Check this. While all TB patients may not cough incessantly, they could be afflicted with latent tuberculosis.

“They display no symptoms, and are not considered infective,” says Dr Jasani. “It is possible however to contract TB years after the bacteria has gestated inside your body. Primary TB in infection could occur in childhood, with the affected individual displaying symptoms years later. The symptoms will be as per the organ involvement. For example, a lung TB patient can suffer from prolonged cough, blood in sputum, chest pain.”

But who should get tested for TB? “The general symptoms of TB include lower grade fever, especially with evening rise for couple of weeks to months, loss of appetite, and weight loss,” she adds.

BCG vaccine and booster for adults

Most of us received the TB vaccine – BCG (bacille calmette-guerin) –  as infants, with a bulbous nodule appearing on our forearms as a sign of vaccine acceptance by the body. It healed by itself within weeks. But does this event spell a lifelong cover against TB?

“The BCG vaccine given at birth generally protects against getting the severe forms of TB like TB meningitis, disseminated Miliary TB. But you can still get TB if the body’s immunity goes down owing to reasons like stress, diabetes, immunosuppression, malignancy. The immunity of BCG vaccine generally lasts for 10-15 years,” says Dr Jasani.

Meningitis is a swelling in one part of the brain. Immunosuppression or suppressed immunity is often seen in people with health conditions like HIV-AIDS, cancer, chronic high blood sugar, but may also occur for other reasons including the intake of certain drugs.

So, what happens if you missed the BCG jab at birth?  “A child less than 5 years should be given BCG vaccination immediately if the dose is missed at birth. Else as an adult you need to observe intense precautions like wearing a mask, and maintaining your immunity through healthy eating and regular exercise and reducing stress in life... Maintain a safe distance from people, avoid being around the sick and crowded places, and wash hands after touching any surfaces such as doorknobs, handles, furniture, and faucets. Rest well, do not spit on roads, cover the mouth while coughing or sneezing, and disinfect frequently touched surfaces,” adds Dr Sanggita Checker, consultant chest physician, Wockhardt Hospitals, Mira Road, Mumbai.

TB prevention

Nothing succeeds like sound immunity builders. Dr Checker recommends going big on protein. “Rev up the intake of Vitamin B-rich foods in leafy, dark greens like kale and spinach. Opt for whole grains, olive oil, tomatoes, cherries, and blueberries. Bring in eggs, dairy foods, nuts, lentils, salmon, chicken, milk and seeds. Add Vitamins A, E, and C to your intake through orange, mango, papaya, sweet pumpkin, and carrots which contain Vitamin A. Moreover, vitamin C-rich foods such as guava, amla, orange, tomato, sweet lime, lemon, and capsicum also fortify your immunity. Stay away from bakery items, sodas, sweets, colas, Chinese food, junk foods including namkeens. Avoid sugar, white bread, white rice, tobacco, and alcohol, and limit caffeine intake. Try to do breathing exercises that are beneficial for the lungs. Do light exercises on a daily basis for at least 30 minutes,” she says.

With the resurfacing of Covid in localised bits and spurts, perhaps prudence lies in masking up and soldiering on with the personal hygiene protocol

How to control the spread of TB

For any respiratory illness, observe these rules to prevent passing on infections to others around:

1.    If you've been diagnosed with TB, take the medication recommended by your doctor. Typically, TB drugs are given for six-eight months for non-drug resistant TB. Treatment also involves the five steps of DOTS or directly observed therapy shortcourse - this ensure government support, adequate supply of TB medicines and monitoring the patient so they carry on the treatment till the doctor gives them a clean bill of health.

2.    Wash hands after coughing or sneezing

3.    Isolate yourself at home

5.    Avoid touching, kissing, or shaking hands with others

6. Wear a mask for minimum 2 months of treatment if diagnosed with

pulmonary tuberculosis.

7. Screen household contacts of patients suffering from tuberculosis.

8. Avoid overcrowded and poorly ventilated spaces