Where we stand in the battle

TB remains a threat to the health and well-being of people around the world. Among infectious diseases, TB remains the second leading killer of adults in the world, with more than two million TB-related deaths each year.

Until TB is controlled, World TB Day will not be a celebration.

But it is a valuable opportunity to educate the public about the devastation TB can spread and how it can be stopped.

The theme chosen for World TB Day on March 24, 2004, is "Every Breath Counts -- Stop TB Now".

There is an inseparable link between the act of breathing and life itself. Indeed, breath, and breathing, are central to every human act and expression. Breath, and the act of breathing, are also closely associated with tuberculosis, an infectious disease that spreads through the air. People are infected when they inhale micro-droplets containing bacilli that infectious TB patients expel by coughing or sneezing.

Although a person with infectious TB, as shown experimentally, is capable of infecting between 10 and 15 people in one year, more than 100 million out of the 220 million people in Indonesia are already infected with the TB bacillus.

Not all of these infected people are sick and they do not necessarily have the disease. A country-wide health survey in 2001 showed that 583,000 people suffer from TB, while 286,000 among them are sources of TB infection, excreting live TB bacilli. Left untreated, 140,000 sufferers will die within two years.

Indonesia ranks third in the world in number of TB cases, behind India, with the largest TB burden of 800,000 infectious cases, and China with approximately 650,000 cases. Worldwide, the incidence of TB will rise to 10.6 million cases by the year 2020, accompanied by immense problems with the dreadful TB/HIV co- infection and multi-drug resistant (MDR) TB.

Acquiring epidemic proportions, WHO declared "TB a global emergency" in 1993. To combat TB in Indonesia, the minister of health declared "war on TB" on Nov. 4, 1998, which was followed up by the proclamation of Gerdunas TB (Concerted National Action to Stop TB) on March 24, 1999.

This national action requires all government hospitals and public health centers to cooperate with their non-governmental counterparts and private doctors to combat TB based on the DOTS strategy.

The tragedy of HIV/TB co-infection is that a healthy person infected with TB may get the disease if their immune system becomes weakened. This can be caused by a superimposed HIV infection. A rise in HIV infections in a community will result in a rise of the number of (infectious) TB patients in that community.

Whereas superimposed HIV infection in a patient already with TB will result in the early development of AIDS (double trouble). Superimposed HIV will also result in the emergence of mycobacterial resistance to anti-TB medicines and, eventually, lead toward incurable multi-drug resistant TB (triple trouble).

One of the major challenges in TB control is to ensure TB patients get a full course of uninterrupted treatment with the correct drug dosages.

In 2002, the World Health Organization introduced so-called fixed-dose combination (FDC) drugs for use in national TB programs.

Overall, there are five types of fixed-dose combinations. Those used in Indonesia are the so-called 4FDC tablets (containing isoniazid, rifampicin, pyrazinamide and ethambutol) for the initial, daily, intensive phase of two months, and 2FDC tablets (containing isoniazid and rifampicin) for the continuing intermittent phase (three times per week for four months).

Last year, Central Java, Yogyakarta, East Java and South Sulawesi, as part of a pilot project, started to use these FDC tablets in their TB control programs.

Credit has to be given to the WHO, because for the first time in the history of TB chemotherapy, these tablets contain meticulously accurate dosages of anti-TB drugs that can comfortably be used for any patient with a body weight of 27 kilograms to over 70 kilograms, under routine program conditions.

Prior to the introduction of FDC tablets, a patient would have to swallow eight different shaped, sized and colored tablets in a single dose, while risking serious overdoses of the drugs if a patient's weight was less than 40 kilograms.

Now, depending on weight, a patient only takes two to a maximum of four FDC tablets per day.

The use of FDC tablets may effectively prevent the false dosing of drugs, increase compliance and ultimately prevent the emergence of resistant TB.