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24% of global missed TB cases in India: WHO -Kounteya Sinha
-The Times of India

LONDON: One in every four missed cases of tuberculosis (TB) globally is in India.The World Health Organisation has found that India tops the list of the world's missed TB cases. Almost 24% of the world's missed TB cases are from India, according to the Global TB Report 2014 released on Thursday.

Ten countries accounted for 74% (2.4 million) of the estimated "missed" cases globally in 2013.

The number of missed cases is defined as the difference between the estimated number of incident cases and notified (new and relapse) cases in 2013.

Of the nine million incident cases of TB estimated to have occurred in 2013, only 5.7 million were both detected and notified to national TB programmes (NTPs) or national surveillance systems giving a case detection rate of 64%.

WHO says that this leaves a gap of approximately 3.3 million people with TB who were "missed", either because they were not diagnosed or because they were diagnosed but not reported. WHO said "Improvements in case detection in India would have a global impact, given the size of the TB burden in the countries and the sizeable gap between notified cases and estimated incidence.

A recent study in India suggests that about 50% of detected cases are not reported to the NTP, a finding confirmed in a recent prevalence survey in Gujarat (unpublished data)".

Meanwhile, WHO revised its estimate of how many people have TB by almost 5,00,000. In 2013, some 9 million people had developed TB around the world, up from 8.6 million in 2012.

About 1.5 million people had died in 2013 from TB, including 3,60,000 people who had been HIV positive, the WHO said in its global report. In 2012, there had been 1.3 million tuberculosis deaths.

The WHO said its report underlined that a "staggering number of lives are being lost to a curable disease and confirms that TB is the second biggest killer disease from a single infectious agent".

"One of the biggest issues facing organizations tackling the disease was the number of undiagnosed cases. The fact that three million people are missing out on treatment every year explains why there are still so many avoidable deaths from tuberculosis," said TB Alert chief executive Mike Mandelbaum.

Most people who developed TB in 2013 were in South East Asia and the Western Pacific.

India accounted for 24% of cases alone while China saw 11% of total cases.

An estimated 37 million lives have been saved through effective diagnosis and treatment of TB since 2000.

Dr Mario Raviglione, director of the Global TB Programme, WHO said: "Insufficient funding is hampering efforts to combat the global epidemic. An estimated $8 billion is needed each year for a full response, but there is currently an annual shortfall of $2 billion, which must be addressed. The multi-drug resistant TB (MDR-TB) crisis continues, with an estimated 4,80,000 new cases in 2013. Worldwide, about 3.5% of all people who developed TB in 2013 had this form of the disease, which is much harder to treat and has significantly poorer cure rates".

Since 2009, with more laboratories rolling out rapid tests, there has been a tripling of MDR-TB cases being diagnosed.

In 2013, 1,36,000 MDR-TB cases were detected and 97,000 people started treatment. Although the number of patients treated has increased three-fold since 2009, at least 39,000 patients, diagnosed with this form of TB, were not being treated last year and globally only 48% of patients were cured.

Another key challenge identified by WHO is the co-epidemic of TB and HIV. An estimated 1.1 million (13%) of the 9 million people who developed TB in 2013 were HIV-positive, with 4 out of 5 cases and deaths occurring in the African Region. While the number of TB deaths among HIV-positive people has been falling for almost a decade, from 5,40,000 in 2004 to 3,60,000 in 2013, antiretroviral treatment, preventive therapy and other key interventions still need to be further scaled-up.

Of the estimated 9 million people who developed TB in 2013, more than half (56%) were in the South-East Asia.

About 60% of TB cases and deaths occur among men, but the burden of disease among women is also high. In 2013, an estimated 5,10,000 women died as a result of TB, more than one third of whom were HIV-positive. There were 80,000 deaths from TB among HIV-negative children in the same year.