tuberculosis

Caribbean: 1 In 5 Unaware Of TB Diagnosis, Says Health Organisation

The Pan-American Health Organization (PAHO) says one in five people infected with tuberculosis in the Americas, including the Caribbean, remains unaware of the disease.

PAHO said this is due to “failure to access health services or because they are not properly diagnosed.” In 2012, PAHO said regional countries reported 220,000 cases of tuberculosis, and an estimated 19,000 people died from the disease.

But it said an additional 60,000 people are believed to have TB, who have not yet been diagnosed.

“This situation not only endangers their lives, it also facilitates further transmission of TB, producing more disease and generating socioeconomic costs for individuals, families and communities,” PAHO warned.

It issued the statement in commemoration of World TB Day that sought to raise awareness on the tuberculosis burden in the world, as well as the efforts made for its prevention and control.

Throughout the years, PAHO said this commemoration has offered the opportunity to mobilize the political, economic and social commitment for the prevention and control of TB in the countries.

For the 2014 campaign, PAHO said it will follow the worldwide focus on TB diagnosis and case detection of those still not reached, “with emphasis in the Americas on vulnerable populations, social determinants and large cities.”

Source; National news agency of Bernama

Drug-resistant TB a “global health security risk,” WHO says

Half a million people fell sick with dangerous superbug strains of tuberculosis (TB) in 2012, but fewer than one in four were diagnosed, putting the rest at risk of dying due to the wrong medicines or no treatment at all.

Latest data from the World Health Organization (WHO), which says drug-resistant TB is a “global health security risk,” showed a third of the estimated 9 million people who contract TB in any form each year do not get the care they need.

This has led to drug resistance spreading around the world at an alarming rate and has given rise to incurable strains of the bacterial infection — known as totally drug-resistant TB — which cannot be treated with any known medicines.

“Earlier and faster diagnosis of all forms of TB is vital,” said WHO director general Margaret Chan as the U.N. health agency published new TB data on Thursday. “It improves the chances of people getting the right treatment and being cured, and it helps stop spread of drug-resistant disease.”

Last year the WHO called for multidrug-resistant tuberculosis (MDR-TB) to be recognized as a public health crisis. It says the contagious, deadly superbug forms of the disease carry “grave consequences for those affected.”

Treating even regular TB is a long process. Patients need to take a cocktail of antibiotics for six months and many fail to complete the treatment.

This in turn has fuelled the emergence of drug-resistant TB — a man-made problem that has grown in the past decade because people sick with regular TB were either being given the wrong medicines or wrong doses or did not complete their treatment.

Diagnosis gap

Experts say one of the major hurdles to tackling drug-resistant strains effectively is that so many patients who have contracted them do not know it and so continue with the wrong treatments or are not treated at all.

Some of the poorest and most ill-equipped countries have only one central laboratory, which often has limited capacity to diagnose MDR-TB. In other cases, patient samples have to be sent to other countries for testing.

Traditional diagnostic tests can take more than two months to get results, leaving a dangerous gap in which the patient is not getting the right treatment and is putting others at risk of catching the contagious disease.

The WHO says up to 2 million people worldwide may be infected with drug-resistant TB by 2015.

Newer, speedier diagnostic tests have been developed in recent years, but the problem has been getting the technology and know-how to the countries where they are needed most.

However, Chan cited encouraging signs from an international project known as EXPAND-TB (Expanding Access to New Diagnostics for TB), financed by UNITAID, which has helped to triple the number of MDR-TB cases diagnosed in participating countries.

In 2009, UNITAID backed the EXPAND project with $87 million US to new TB diagnostic technologies in 27 low- and middle-income countries, which together account for around 40 per cent of the global MDR-TB burden.

“The gap in access to TB diagnostics and care is far from filled, but it is narrowing,” said Mario Raviglione, director of WHO’s global TB program. “Increased capacity and reduced prices mean that we can reach more people.”

Source: cbc news

India still home to quarter of global TB cases

Despite having a strong public sector programme to contain the disease, tuberculosis still remains a cause of concern for India, which has nearly a quarter of the global burden of TB, health experts said.

Experts said measures which can help strengthen the fight against the disease include involvement of the private sector, more political commitment to create awareness and containing risk factors like malnutrition.

“TB is still a cause for concern. It is the sheer numbers in India and the associated problems like poverty which are responsible for this,” Soumya Swaminathan, director, National Institute for Research in Tuberculosis, an organization under the health ministry, told IANS.

According to the World Health Organization (WHO), there are 2.2 million tuberculosis patients in India, which makes it the world’s highest TB-burden country. TB killed 1.3 million people worldwide in 2012 and India alone accounted for 26 percent of the total cases.

She said that China and Brazil have done better in controlling TB in their respective countries and India needs to do more.

“In eight years, India has made tremendous progress as far as containing TB. But it needs to do much more,” she added.

But R. S. Gupta, deputy director general (TB) in the health and family welfare ministry, said: “Treatment success rates have been above 85 percent for several years in the country.”

Gupta told IANS that the overall quality of TB services, including human resources and systems for financial management are being strengthened.

To achieve the National Tuberculosis Programme’s (NTP) ambitious goal of universal health care access for all people with TB by 2017, financial commitments must be maintained by all partners, including international agencies, he said.

The state-run tuberculosis control initiative of the government, NTP provides free of cost, quality anti-tubercular drugs across the country. More than 1.5 million people avail the facility at 13,000 centres.

Gupta said that the private sector should be involved more as most patients are being treated in private clinics.

Agreed Swaminathan, who said that the government needs to work in tandem with the private sector.

“Standard procedures need to be followed for notification of the disease and diagnosis, especially by private practioners,” Swaminathan told IANS.

In 2012, India declared TB to be a notifiable disease. It means that with immediate effect all private doctors, caregivers and clinics treating a TB patient had to report every case to the government.

According to a recent WHO report, India has achieved the Millenium Development Goal (MDG) target for TB which says that the incidence of the disease should be falling. It is on track to reach the 2015 targets for reductions in TB prevalence and mortality.

But it added that India accounts for 31 percent of the estimated 2.9 million missed TB cases — people who were either not diagnosed or diagnosed but not reported to NTP.

It is estimated that about 40 percent of the Indian population is infected with TB bacteria, the vast majority of whom have latent rather than active TB.

Listing the other steps needed, Swaminathan said: “Getting more political commitment and activism from civil society to create awareness about TB like it was done in the case of HIV/AIDS would be a great help.”

India also needs to contain the risk factors associated with the disease. The biggest among them is malnutrition, which makes people more susceptible to the development of active TB. Tuberculosis patients have lower Body Mass Index (BMI), muscle mass and subcutaneous stores of fat.

“Malnutrition is the biggest risk factor and it has been overlooked,” she said, adding that the “disease needs to be fought on a common platform by all stakeholders.”

Source: Zee News

 

Poor diagnosis driving global multidrug-resistant TB, WHO warns

Half a million people fell sick with dangerous superbug strains of tuberculosis (TB) in 2012, but fewer than one in four were diagnosed, putting the rest at risk of dying due to the wrong medicines or no treatment at all.

Latest data from the World Health Organisation (WHO), which says drug-resistant TB is a “global health security risk”, showed a third of the estimated 9 million people who contract TB in any form each year do not get the care they need.

This has led to drug resistance spreading around the world at an alarming rate and has given rise to incurable strains of the bacterial infection – known as totally drug-resistant TB – which cannot be treated with any known medicines.

“Earlier and faster diagnosis of all forms of TB is vital,” said WHO director general Margaret Chan as the U.N. health agency published new TB data on Thursday. “It improves the chances of people getting the right treatment and being cured, and it helps stop spread of drug-resistant disease.”

Last year the WHO called for multidrug-resistant tuberculosis (MDR-TB) to be recognized as a public health crisis. It says the contagious, deadly superbug forms of the disease carry “grave consequences for those affected”.

Treating even regular TB is a long process. Patients need to take a cocktail of antibiotics for six months and many fail to complete the treatment.

This in turn has fuelled the emergence of drug-resistant TB – a man-made problem that has grown in the past decade because people sick with regular TB were either being given the wrong medicines or wrong doses or did not complete their treatment.

HURDLES

Experts say one of the major hurdles to tackling drug-resistant strains effectively is that so many patients who have contracted them do not know it and so continue with the wrong treatments or are not treated at all.

Some of the poorest and most ill-equipped countries have only one central laboratory, which often has limited capacity to diagnose MDR-TB. In other cases, patient samples have to be sent to other countries for testing.

Traditional diagnostic tests can take more than two months to get results, leaving a dangerous gap in which the patient is not getting the right treatment and is putting others at risk of catching the contagious disease.

The WHO says up to 2 million people worldwide may be infected with drug-resistant TB by 2015.

Newer, speedier diagnostic tests have been developed in recent years, but the problem has been getting the technology and know-how to the countries where they are needed most.

However, Chan cited encouraging signs from an international project known as EXPAND-TB (Expanding Access to New Diagnostics for TB), financed by UNITAID, which has helped to triple the number of MDR-TB cases diagnosed in participating countries.

In 2009, UNITAID backed the EXPAND project with $87 million to new TB diagnostic technologies in 27 low- and middle-income countries, which together account for around 40 percent of the global MDR-TB burden.

“The gap in access to TB diagnostics and care is far from filled, but it is narrowing,” said Mario Raviglione, director of WHO’s global TB program. “Increased capacity and reduced prices mean that we can reach more people.”

UNITAID was launched in 2006 by the governments of Britain, Brazil, Chile, France and Norway to give sustainable funding for the fight against HIV/AIDS, malaria and tuberculosis. About 70 percent of its funds come from a levy on airline tickets.

Source: Reuters

China ‘has halved its TB problem,’ survey data suggests

China has more than halved its tuberculosis (TB) prevalence, with rates falling from 170 to 59 per 100,000 population, figures suggest.

The Lancet report says the success is due to a huge expansion of a community-based disease control programme. The World Health Organization says other countries could use a similar approach.

China is a major contributor to the global TB pandemic, accounting for more than one-tenth of cases worldwide. The Lancet report reveals what progress China has made on reducing this burden, based on a 20-year-long analysis of national survey data.

Between 1990 and 2000, levels of TB were reduced in provinces where the WHO-recommended directly observed treatment, short-course (DOTS) programme – rapid detection and cure of infectious tuberculosis patients living in the community – was adopted.

By 2010, TB prevalence in China fell by 57%, tripling the reduction of the previous decade.

The increase of known TB cases treated using DOTS rose from 15% in 2000 to 66% in 2010.

Lead researcher Dr Yu Wang, from the Chinese Centre for Disease Control and Prevention in Beijing, said: “One of the key global TB targets set by the Stop TB Partnership aims to reduce tuberculosis prevalence by 50% between 1990 and 2015.

“This study in China is the first to show the feasibility of achieving such a target, and China achieved this five years earlier than the target date.”

The 2014 World Health Assembly will look at eliminating TB and setting ambitious new targets which could include a 50% reduction in tuberculosis prevalence between 2015 and 2025.

Giovanni Battista Migliori from WHO said: “The results from China show the feasibility of achieving such a target by aggressively scaling up the basic programmatic elements of tuberculosis control both within and outside the public sector.”

He said other countries could learn from China’s example.

TB remains a big issue in many countries, including India, Russia and many African nations. Better diagnostic tools and treatments are still needed.

Aaron Oxley of Stop TB UK said: “China has shown what is possible to achieve when attention and resources are brought to the fight against TB. But nearly 4,000 people still die from TB every day, and 3 million cases go undiagnosed each year. We still have a long way to go.”

Source: BBC news

New antibiotic discovered for multi-resistant tuberculosis

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Researchers from EPFL (Swiss Federal Institute of Technology in Lausanne) and the AN Bach Institute in Moscow have discovered a new and extremely promising antibiotic for tuberculosis, especially effective against multi-resistant strains of the disease, which are on the rise in Eastern Europe. The drug, developed as a European FP7 project, has proven very effective against the disease.

In an article published in EMBO Molecular Medicine, the researchers show that, when combined with other drugs, the new antibiotic, called ‘PBTZ169’, can take down even the most resistant strains of tuberculosis bacteria.

Following the publication, the researchers formed the IM4TB Foundation on their campus. Supported by EPFL, the foundation aims to bring the new treatment to the market. This unusual step was taken because traditionally, technology transfer from academia to the pharmaceutical industry doesn’t work well with tuberculosis: development costs are too high and the affected countries are often barely able to maintain their own healthcare infrastructures.

With the IM4TB Foundation, EPFL intends to pick up the slack in the limitations of the industrial model. “The development of antibiotics is increasingly expensive and the countries most affected by tuberculosis are still emergent,” says Benoit Lechartier, co-author of the PBTZ169 study. “The recent closure of the AstraZeneca research centre in India illustrates the extent to which it is difficult for the pharmaceutical industry to invest in infectious diseases.”

Human trials in 2015

Located on the EPFL campus, the IM4TB Foundation plans to move onto human trials within a year, in collaboration with the University of Lausanne Hospitals (CHUV).

PBTZ169 shows much promise. It attacks the bacterium’s strong point – the cell wall, which forms an impenetrable shield against antibiotics and the patient’s immune system. “Our molecule makes the bacterium literally burst open,” explains Stewart Cole, director of the study and head of EPFL’s Global Health Institute.

A cheap but formidable weapon against resistant strains

The researchers showed that PBTZ169 is extremely effective in tri-therapy, where it is combined with a standard drug, pyrazinamide, and a more recent one, bedaquiline – and both these drugs have already been approved by the EU and the FDA for multi-resistant strains. “This could be the winning strategy,” says Cole. “These molecules attack different targets in the bacterium. By combining them, we drastically reduce the risk that it will mutate into more resistant forms.”

As a treatment, PBTZ169 has many advantages. It is not expensive to produce, since it is relatively easy to synthesize. Initial tests have shown good compatibility with other anti-tuberculosis treatments and it is expected to be equally compatible with antiretrovirals used to treat AIDS, as HIV-positive individuals are particularly vulnerable to tuberculosis, and cases of cross-infection are on the rise.

This molecule is the culmination of many years of research. The preliminary versions were formidable in the laboratory, where they decimated bacteria in culture. However, their effectiveness in vivo was limited. New technologies like structural biology enabled researchers to redesign the molecule so that it could be more rapidly absorbed. “Thus we were able to improve its pharmacodynamics,” explains Cole. “Tuberculosis is often wrongly considered a disease of the past, but in order to fight it, we needed to employ 21st century technologies.”

More than 1.5 million deaths per year

Tuberculosis still kills more than 1.5 million people every year. It is uncommon in Europe, although certain countries such as the Ukraine are experiencing a resurgence of patients infected with multi-resistant strains. The EU is leading a programme that aims to eliminate the disease. The research team at EPFL that developed PBTZ169 received funding from the Seventh Framework Programme (FP7) of the European Commission, in the framework of an international collaboration.

Source: India Medical Times

Promising class of antibiotics discovered for drug-resistant TB

St Jude Children’s Research Hospital scientists have discovered a promising new class of antibiotics that could aid efforts to overcome drug-resistance in tuberculosis (TB). The drugs increased survival of mice infected with TB and were effective against drug-resistant strains of TB. St Jude led the international research effort, results of which appear in the journal Nature Medicine.

The antibiotics, called spectinamides, were created by changing the chemical structure of an existing antibiotic, spectinomycin, which does not work against TB.

In multiple trials of mice with both active and chronic TB infections, researchers report that one version of the new drug—an analogue known as 1599—was as good as or better than current TB drugs at reducing levels of the bacteria in the lungs of mice. In addition, 1599 caused no serious side effects.

“This study demonstrates how classic antibiotics derived from natural products can be redesigned to create semi-synthetic compounds to overcome drug resistance,” said corresponding author Richard Lee, a member of the St Jude Department of Chemical Biology and Therapeutics. “I hope the result will be drugs that are more effective against tuberculosis and offer a faster route to a cure with fewer side effects.”

TB remains a leading cause of global illness and death. The latest data from the World Health Organization estimates that TB kills 1.3 million persons annually and sickens 8.6 million worldwide. Current treatment requires months of multi-drug therapy to eradicate the slow-growing bacterium, which can lie dormant for years without causing symptoms and results in hard to treat chronic or latent infections. The rise of multi-drug resistant TB, including strains reportedly resistant to all available medications, has further complicated treatment.

This new class of antibiotics works against TB by disrupting the function of a part of the cell known as the ribosome, which is responsible for protein synthesis. To do that, the spectinamides bind to a particular site on ribosomes that is not shared by other TB drugs. That allows the drug to be used in combination with other medications.

For this study, researchers used an approach called structure-based design to re-engineer how spectinomycin binds to the ribosome. To guide their design efforts, scientists used a 3-D model that provided an atomic-level view of spectinomycin bound to the tuberculosis ribosome. The study reinforces the potential of structure-based design as a tool for designing other new agents to block mechanisms TB and other bacteria use to resist current antibiotics, Lee said.

The research reports on the first 20 of the more than 120 spectinomycin derivatives that have resulted from the effort. The list includes 1599 and two other analogues tested against TB in mice.

The three analogues not only bound the ribosome tightly, but they were more successful at avoiding a TB resistance mechanism called efflux. The TB bacteria use efflux pumps as a strategy to remove drugs and other threats from the cell before they can work against the bacteria. Efflux pumps, however, did not protect TB against spectinamides.

The drugs were also effective against multi-drug-resistant strains of TB growing in the laboratory. The strains had been isolated from patients with the disease.

Researchers also found no evidence that 1599 or the two other analogues tested interfered with normal functioning of human cells. Preliminary safety testing on cells grown in the laboratory showed the drugs were not toxic to mammalian cells because they only inhibit the bacterial ribosomes and not mammalian ribosomes.

Work is underway now in mice combining 1599 with new or existing TB drugs. The goal is to identify multi-drug therapy to try in a clinical trial of patients with drug-resistant TB.

Source: India medical Times

New device may put DNA testing in doctors’ hands

handheld-genetic-test

It can take days for doctors to determine if a patient infected with malaria carries a drug-resistant version of the disease. The same is true of tuberculosis.

But a new testing device could reduce that time lag to 15 minutes, potentially helping to ensure that patients are correctly treated right away, says the company developing this device.

United Kingdom company QuantuMDX now has a working prototype for a device intended to quickly test a sample of blood, sputum (saliva mixed with mucus) or even tumor cells for genetic markers that provide information to guide a doctor’s decisions on how to treat a patient.

“We want to put a full diagnostic test into the palms of health professionals’ hands,” said Elaine Warburton, chief executive officer of QuantuMDX and the companys cofounder.

The prototype is about the size of an iPad 5, or 6.6 by 9.4 inches (17 by 24 centimeters), but thicker. In about six months, Warburton said she anticipates the device will be reduced to about the size of an iPad mini, 5.3 by 7.9 in. (13 by 200 cm).

The device, currently known as Q-POC (pronounced Q-pock), is still a long way from being used in the clinic. The company still has work to do on the cartridges for use with the handheld prototype, and it needs to run clinical trials testing the device, followed by regulatory approval from bodies such as FDA, Warburton told LiveScience in an email.

Earlier this month at the Consumer Electronics Show in Las Vegas, Jonathan O’Halloran, inventor of the technology and the company’s cofounder, announced plans to launch a crowdfunding campaign. The campaign is expected to begin on Feb. 12 on the site Indigogo.com, to support further development of the Q-POC. The company is also interested in suggestions for a new name and design for the device, Warburton said.

If all goes well, QuantuMDX anticipates commercially launching the device and malaria test cartridge in Africa in 2015, she said.

Source: Fox news

59 test positive for TB after Las Vegas outbreak

Las Vegas public health officials say dozens of people linked to a tuberculosis outbreak at a neonatal unit have tested positive for the disease.

The Southern Nevada Health District reported on Monday that of the 977 people tested, 59 showed indications of the disease, though all but two of the cases are latent — meaning patients don’t show symptoms and aren’t contagious.

Dr. Joe Iser, chief medical officer at the health district, said the report demonstrates the importance of catching tuberculosis early.

“We want physicians to really think about making the diagnosis and quarantining, and then calling us,” he said. “This has been very expensive for us in terms of time and effort and dollars.”

A state report released last month found that Summerlin Hospital Medical Center failed to recognize and take precautions to diagnose the infected woman’s contagious lung disease when she gave birth in May to premature twin daughters, and allowed the woman to continue visiting her babies after she was discharged.

One of 25-year-old Vanessa White’s babies died in June. White died in July at a Los Angeles hospital and was diagnosed with tuberculosis through an autopsy. Her other baby died of tuberculosis on Aug. 1 at Summerlin Hospital.

Iser said officials cannot know for sure that all 59 cases are directly linked to the Las Vegas hospital. Several of those tested are immigrants from countries where tuberculosis is more prevalent, and could have been exposed earlier in their lives, he said.

The health district is encouraging all 59 people to accept treatment.

TB is spread through the air when a sick person coughs, sneezes or speaks. Symptoms include coughing, chest pain, fever and fatigue. The disease usually attacks the lungs, but can affect other organs and can be fatal if not properly treated.

The Centers for Disease Control and Prevention counted 569 TB deaths in the U.S. in 2010, the most recent year for which data is available. The number of U.S. TB cases has been on a steady decline since a resurgence in 1992, and in 2012, reached the lowest level since national reporting began in 1953.

The Nevada Bureau of Health Care Quality and Compliance investigated the case, and determined that the Las Vegas hospital wasn’t taking proper precautions to contain infections.

In November, eight employees, former patients and visitors filed a negligence lawsuit seeking damages from the hospital. Family members of the young mother who died of the illness have said they also plan to sue.

In the fall, investigators found that 26 people, including the mother’s family members and hospital staff, had been infected.

Health officials then tested hundreds of babies, family members and staff who had passed through the neonatal intensive care unit. They contacted the parents of about 140 babies who were at the unit between mid-May and mid-August, and set up a temporary clinic to test them.

Health officials are expected to release a final report next summer.

They will continue to test the infants who passed through the hospital in the coming months, to ensure the babies don’t develop any signs of the disease.

“I try to think, what if it was my son or daughter, my newborn infant, what would I want to be done?” Iser said.

Source: Miami Herald

‘Nuances of childhood TB are never taught in medical schools’

If diagnosing tuberculosis in children, particularly those aged under five years, is fraught with problems, health-care workers at different levels who are unaware of the latest advancements in childhood TB diagnosis and treatment make it even worse.

“Tuberculosis is a part of the training programme when doctors go through a M.D course. So a basic training is provided,” Dr. Soumya Swaminathan, Director of National Institute for Research in Tuberculosis (NIRT), Chennai said. “But we are talking about in-depth training on the recent advances in TB diagnostics and treatment. They [doctors] are not aware of these.”

There is a lack of awareness in India despite the National Revised Tuberculosis Control Programme (RNTCP) and the Indian Academy of Paediatricians (IAP) working together to develop the diagnosis and treatment guidelines.

This brings to the fore the compelling need for ongoing training in childhood TB. “Constant upgradation of knowledge is what is needed,” she said. “Private practitioners are generally not well informed compared with government doctors. So there is a need to reach out to private practitioners and train them.”

“Unfortunately, even in high TB burden countries, many paediatricians know little about TB and do not diagnose it in a timely fashion. TB is often poorly taught in medical schools and the nuances of childhood TB are virtually never taught,” Dr. Jeffrey R. Starke, Professor of Paediatrics, Baylor College of Medicine, Houston, Texas said in an email to this Correspondent. “As a result, paediatricians do not consider TB diagnosis and a child is not referred to the NTP [national tuberculosis programme] where TB-specific care is provided.”

The need for an engagement with health-care providers of different specialisations and at different levels cannot be overemphasised. “The engagement of all who provide care to children (including paediatricians and other clinicians) is crucial,” the 2006 WHO report on Guidance for National Tuberculosis Programmes on the Management of Tuberculosis in Children notes.

The recently released WHO’s Roadmap for Childhood Tuberculosis report emphasises the same point. “There is an urgent need for greater awareness of and increased screening for TB in children, particularly by services that serve children… Children with TB often present at primary- and secondary-care settings where there is a lack of guidance on how to address the challenges of diagnosing and managing childhood TB,” the Roadmap states.

The Roadmap has identified the need to engage four health-care programmes including maternal and child health services and private health-care sector.

“Overall, training of medical and nursing health workers on childhood TB seems to be variable, but often poor. It is quite good in South Africa, because TB is so common and so it [training] is a part of pre-service curriculum,” Prof. Steve Graham said in an email to this Correspondent. “In so-called developed countries, the general public and the health services lack knowledge of childhood TB because it is so uncommon.”

Prof. Graham is from the University of Melbourne and Murdoch Children’s Research Institute, Australia, and also The Union, France. He was the Chair of the Childhood TB subgroup of the Stop TB Partnership that led the Roadmap.

According to Prof. Graham, the awareness level of the latest developments in childhood TB should trickle down to the lowest level in the health-care system to increase the number of children who would get diagnosed and treated for TB on time. This includes “any health worker who cares for an adult case of TB or any health worker at a primary- and secondary-care level that diagnoses TB in children.”

Source: the hindu