Sikkim has emerged as the next big concern on India’s already riddled tuberculosis map with 11 per cent of the new tuberculosis cases in the State found to be multi-drug-resistant (MDR), a figure almost on par with the country's TB capital, Mumbai. In the rest of India, multi-drug resistance in new TB cases is pegged at around 2 per cent.
The Sikkim government held a meeting with various health agencies last week and is drawing up a plan to tackle the concern. “Recently, we held a workshop to collate all the information that the State has and find out ways to tackle the MDR and overall TB cases. We are also better equipped with modern diagnostic machines,” Prem Das Rai, Member of Parliament from Sikkim told The Hindu .
What has surprised TB experts is the similarity emerging from two vastly different geographies: Mumbai, a port city known for its high-density slums and clustered living, and Sikkim, an idyllic state nestled in the Himalayan range.
While the reason for Sikkim’s high MDR burden is still being explored, the Indian Council of Medical Research’s (ICMR) institute in Dibrugarh (Assam) studied 120 MDR-TB strains of patients from Sikkim over the past year and identified 70 per cent of them as ‘Beijing strains’. “The study is not published yet and we do not have a definitive explanation, but Beijing strain is more common in the northeast, China and Tibet,” Dr. Soumya Swaminathan, director-general, ICMR told The Hindu . She said the strain is considered to be more virulent with a higher tendency to develop drug resistance.
Sikkim is a landlocked state bordered by Bhutan, Tibet and Nepal.
Mumbai, with a population of 1.3 crore, recorded over 27,000 TB cases last year of which 3,300 were MDR-TB cases. In comparison, Sikkim, with a population of 6.1 lakh, recorded less than 2,000 cases last year, of which over 200 cases were of MDR-TB. “In numbers, Mumbai has the highest MDR-TB burden, but in proportion, Sikkim’s burden is now almost on par. It is quite surprising. Sikkim is different from Mumbai. There is no overcrowding and the risk factors are different. We will undertake a full situational analysis and look at all risk factors,” said Dr. Swaminathan.
Union health officials also pointed to factors that make Sikkim an unlikely candidate for a high burden. “The state has high nutrition and education levels,” said Dr. Sunil Khaparde, Deputy Director General of the Central Tuberculosis Division. As per Census 2011, Sikkim’s literacy rate is 81.42 per cent. Dr". Khaparde said a molecular and an epidemiological study will be undertaken to study the reason.
TB experts said while Sikkim has been recording drug-resistant cases for some time, technology is now available to map it accurately.
“After the GeneXpert TB test was brought, it has improved our capacity to understand drug resistance,” said Nerges Mistry, director of Foundation for Medical Research, who attended the meeting at Gangtok last week.
