TB still persists in J&K

Srinagar, Dec 16: Despite significant progress in recent years, tuberculosis (TB) continues to infect thousands in J&K.

The perception that TB has been eradicated is far from the truth, as recent data and expert insights reveal significant gaps in detection, treatment, and awareness.

The Nikshay portal of the Union Ministry of Health provides a stark reminder of TB’s persistent burden. Between January and December 2024, J&K reported 11,613 TB cases.

While this marks a decline compared to the 14,644 cases reported during the same period in 2023, the decrease may not necessarily indicate progress.

Experts warn that underreporting and undiagnosed cases might mask the actual burden of the disease.

Zooming in on Kashmir alone, 2894 cases have been detected this year, compared to 2956 in 2023 and 3376 in 2022.

However, five districts – four in south Kashmir and Budgam - have been declared TB-free under the National Tuberculosis Elimination Programme (NTEP).

A senior doctor working at a Kashmir Medical College said that TB-free does not mean a region or district has no TB cases.

“It means the number of cases has seen a marked decline,” he said. “While these achievements are commendable, they may create a misleading impression that TB is no longer a concern.”

A pulmonologist closely involved with TB intervention strategies here shared a sobering observation: “The quantum of tests has decreased, so not as many TB cases are reported as exist in the community. Additionally, the number of patients requiring hospitalisation for TB has increased in the past couple of years.”

This trend signals late detection and poor adherence to treatment, leading to severe complications.

State TB Officer Dr Adfar Yaseen told Greater Kashmir that the quantum of testing had increased and J&K was carrying out extensive molecular testing of samples.

“We want to intensify finding the subclinical cases to prevent their progression to disease,” she said.

Dr Adfar said that efforts were on to ensure “not a single case is missed” to break the chain of transmission.

“Mandatory TB notification is critical,” she said. “Without comprehensive reporting, resource allocation and intervention planning suffer.”

Noted pulmonologist and former Director SKIMS Soura, Prof Parvaiz A Koul believes that TB has been dealt with to a large extent in Kashmir.

“If one area in the country could be TB-free it could be Kashmir. There is a lot of variance in TB presentation in Kashmir. The data are hugely different from the rest of the country,” he said.

Dr Koul said Kashmir has sporadic Multi-drug Resistant TB and HIV TB association needs to be spoken, given the number of IV drug abusers Kashmir is recording.

“And many of them are HIV positive, so we have a new problem,” he said. “Extrapulmonary TB is also common but overall, TB diagnostics has improved with the use of Xpert, Line probe assays and sequencing. We need to have sequencing platforms available in addition to strong implementation of NTEP.”

Globally, TB remains a leading cause of death, with 1.6 million fatalities recorded in 2021.

India accounts for nearly 26 percent of the global TB burden, making it critical to address gaps in testing, reporting, and treatment adherence.

J&K’s current TB numbers, though seemingly on the decline, may not reflect the true picture.

The gaps in data reporting and community awareness amplify the risk of undiagnosed and untreated cases.

Advanced diagnostic tools like GeneXpert have revolutionized TB detection, yet their reach is limited, especially in remote areas of Kashmir.

Coupled with the underreporting of cases by private healthcare providers, the true extent of TB remains uncertain.

The Government of India’s 100-day TB eradication campaign, including three districts in J&K, seeks to intensify case finding, promote testing, and encourage treatment adherence.

While the campaign presents an opportunity, its long-term impact depends on sustained efforts and community involvement.

“Declining cases must not breed complacency. We need to see beyond the figures,” a senior pulmonologist said.

TB disproportionately affects marginalized groups, including the poor, malnourished, and immunocompromised.

The stigma surrounding TB often discourages people from seeking timely care, exacerbating the disease’s impact.

Multidrug-resistant TB (MDR-TB) presents an additional challenge. Late detection and poor adherence to treatment regimens often lead to drug resistance, requiring longer and more expensive treatment protocols.