Number of cases is only 10,267, not 63,000

The government on Tuesday contested the WHO figures that put the number of Multi-Drug Resistant Tuberculosis (MDR-TB) cases in India at 63,000, saying there were only 10,267.

As many as 38,287 suspected cases were examined till the end of 2011 and of them, 10,267 have been diagnosed with MDR-TB and 6,994 put on treatment, according to TB India-2012 — the annual status report of the Revised National TB Control Programme (RNCTP) brought out by the Health Ministry.

MDR-TB prevalence

The World Health Organisation, in its report released on the eve of World TB Day, said India had an estimated 63,000 cases of notified MDR-TB in 2010, the highest in South East Asia. It also put the MDR-TB prevalence estimates at 2.3 per cent among new cases and 12-17 per cent among re-treatment cases. However, due to the size of the population and the number of TB cases reported annually, India ranks second among the 27 MDR-TB high-burden countries worldwide after China.

Periodical exercise

But the RNCTP report points out that most studies on drug resistant TB in India were undertaken using non-standardised methodologies with bias and small samples usually from tertiary level care facilities. To obtain a more precise estimate of MDR-TB burden, the RNTCP carried out drug resistance surveillance (DRS) in accordance with global guidelines in selected States — Gujarat, Maharashtra, Andhra Pradesh — which indicated that the prevalence of MDR-TB was low, less than 3 per cent among new cases and 12-17 per cent in re-treatment cases. To substantiate the findings, two more DRS surveys are being carried out in western Uttar Pradesh and Tamil Nadu and two more are planned in Rajasthan and Madhya Pradesh. The surveys will be undertaken to periodically monitor and study the trend of MDR prevalence.

On Extensive Drug Resistant TB (XDR-TB), a subset of MDR-TB with resistance to second line drugs and injectable drugs, the report says the extent and magnitude of this problem is yet to be determined. No separate DRS surveys have been undertaken to estimate the burden of XDR-TB in the country. However, DRS surveys in Gujarat and Andhra Pradesh reported 14 XDR-TB cases and 112 XDR-TB patients were diagnosed at the National Reference Laboratories as reported by the States from 2008 to September 2011.

Global annual incidence

Though India is the second most populous country, it has more new TB cases annually than any other. In 2009, out of the estimated global annual incidence of 9.4 million cases, two million were estimated to have occurred in India. It is estimated about 40 per cent of the Indian population is infected with TB bacillus.