Kerala has started an ambitious plan to eliminate tuberculosis — if it succeeds, it will be the first state in the country to do so.
WHO defines TB elimination as an incidence rate of 1 or less case per million population per year.
Included in the Kerala plan is vulnerability mapping of populations across the state. About 25 lakh individuals have already been identified for TB surveillance. The state is now preparing to treat all those with latent TB infection with preventive medication — 12 doses of Rifapentin and Isoniazid — to prevent them from becoming active TB cases.
A latent TB infection means presence of the bacteria in the body without any symptoms of the disease. It is only when a person becomes an “active” TB case that he/she spreads the disease. Dealing with latent TB infection is one of the accepted international strategies for TB reduction as controlling new infections automatically shrinks the pool from which new infections emerge.
However. the endemicity of TB in India means that the Tuberculin skin test, which is the preferred choice the world over, needs to be adjusted for the Indian population. The preventive TB medication was recently approved by the Drug Controller General of India.
“Kerala is on track to eliminate TB. We are almost reaching the end of the pool that can be managed with conventional techniques. We have completed the survey of the vulnerable population and are ready to test and treat for latent TB infection. We are waiting for the central government’s nod to start preventive medication,” said Kerala Health Secretary Rajeev Sadanandan.
Kerala recently showcased its TB plan to WHO Deputy Director General of Programmes Dr Soumya Swaminathan, a TB expert and former secretary of health research with the central government, during her visit to the state. She was impressed. “They have completed the vulnerability mapping where they have identified people most at risk such as smokers, alcoholics, people living in poverty. The private sector there is very involved as well, except for a slight gap in Nikshay (the online TB monitoring and treatment app). For India though, the current rate is obviously not good enough and we will have to bend it quite sharply to achieve the target. Looking for high-risk groups is key,” she told