India has become the world hub for tuberculosis.

According to the latest World Health Organi-sation (WHO) report, India leads the world with around 25 lakh TB cases, ahead of China, which reports only 9 lakh patients.

The report titled ‘Global Tuberculosis Control 2011’ states that WHO registered 8.8 million cases of TB last year of which 2.5 million patients were from India.

The five countries with the highest incidence in 2010 were India (2.5 million), China (1.2 million), South Africa (0.59 million), Indo-nesia (0.54 million) and Pakistan (0.48 million). India alone accounted for an estimated 26 per cent of all TB cases worldwide, and China and India combined accounted for 38 per cent.

“TB remains a major killer in India, killing two persons every three minutes, nearly 1,000 a day. We should go beyond statistics and reach out to people,” said Dr Thomas R. Fri-eden, director of the Cen-tre for Disease Control and Prevention (CDC), in Atla-nta, who had recently visited the Tuberculosis Res-earch Centre in Chetpet.

In the US, Frieden said he had fought to ensure reduction in tobacco use through ban on smoking in public places and increase in taxation, in order to bring down TB incidence.

Experts here admit that tuberculosis is no longer a straightforward bacterial infection that can be treated with a reliable antibiotic regime — it has grown to become multi-drug resistant because patients tend to discontinue their medication as soon as their symptoms disappear.

In Tamil Nadu alone, the government has identified more than 1,000 patients with drug resistant TB who have to be treated with the DOTS-plus regi-me, costing around Rs 2 lakh per course. TB has also become synonymous with HIV and other co-morbidities. Anybody with a weakened immune system and even those who do not eat wholesome,nutritious food are at risk of contracting TB.

Every Indian above the age of 20 is at a 10 per cent risk of developing tuberculosis in his lifetime, but for those with HIV infection, the risk increases by 10 per cent every year, says Dr Prasanna Kumar Thomas, consultant respiratory physician at Apollo and Fortis Malar hospitals here. “Tuberculosis of the lymph nodes and the pleura are becoming increasingly common.

While we do not see as many patients with multi-drug resistant TB in the private set up, we do recei-ve patients with other chronic diseases like HIV, diabetes and cancer who contract MDR TB,” he exp-lains.

With India being the diabetes capital, the threat of a tuberculosis epidemic looms even larger.

“Occurrence of tuberc-ulosis inf-ection in people with diabetes is 3 to 4 times more than in non-diabetics. Diabetes accounts for 14.8 per cent of pulmonary TB and 20.2 per cent of smear positive TB, which is highly infectious,” said Dr Vijay Vishwanathan, stressing that treating TB in diabetics is a challenge.

However, infectious disease specialist Dr Dilip Mathai, CMC Vellore, highlights the positive side. “India may have the world’s biggest TB burden, but we have definitely reduced incidence of the disease, and halved the deaths due to TB from 42 per 100,000 population in 1990 to 21 in 2005. Our goal should be to halt and reverse the disease process by 2050 at least.

The only way is to educate people to get themselves tested for TB if the have a persistent cough for over 2 weeks, and to take their DOTS regime completely,” says Dr Dilip Mathai. In 2009, there were an estimated 9.7 million children who were orphans as a result of parental deaths caused by TB.

Globally, the absolute number of incident TB cases per year has been falling since 2006 and
the incidence rate per 100,000 population has been falling by 1.3 per cent per year since 2002.