Tuberculosis--the continuing scourge of India

Epidemiological picture of tuberculosis in India is complex with wide variation in the annual risk of infection and prevalence of disease. The concentration of the disease among younger age groups makes tuberculosis a major socio-economic burden in India. The disability adjusted life years (DALYS) is estimated to be around 63 and 46 lakhs of years of life lost in men and women respectively. The burden is likely to increase with HIV epidemic with an increase of cases with dual infection, increase in morbidity and mortality due to tuberculosis. Management of drug resistant tuberculosis is a major hurdle in tuberculosis control and is a major step in cutting the chain of transmission to those with HIV infection, AIDS and immunodeficiency. Development of new therapeutic modalities to address this problem are also urgently required. Poor patient compliance has been the reason for failure of many control programmes. Operational research studies conducted by the TRC have resulted in elucidation of socio-behavioural aspects of patients which need further investigation for remedial measures. Studies to improve drug delivery and to measure the impact of health education and mass media on compliance are areas which need to be concentrated. Newer techniques such as DNA fingerprinting need to employed to improve knowledge of the patterns of transmission in communities. The impact of HIV infection on tuberculosis and the role of chemoprophylaxis in HIV infected individuals in high risk populations, children in close contact with newly diagnosed patients and HIV infected individuals need to be urgently explored. Improved methods for diagnosis of Mycobacterium tuberculosis infection must await considerable advance in the understanding of basic immunology, mycobacterial antigenic structure and host-parasitic interaction.