ABSTRACT
The Central TB Division (CTD), Government of India, initiated a systematic drug resistance surveillance (DRS), as per the global guidelines, among new TB patients reporting to health facilities under RNTCP. The data obtained from two districts of the eastern part of the country conducted by National TB Institute (NTI) are presented in this study. Objective: To measure the levels and pattern of resistance to anti-tuberculosis drugs among “newly diagnosed” sputum smear positive pulmonary tuberculosis cases in two identified districts, namely, Hoogli of West Bengal and Mayurbhanj of Orissa. Results: Of the total 693 smear positive specimens subjected for culture from both the districts, 545 (78.6%) were culture positive for M. tuberculosis, 62 (8.9%) were culture negative and 86 (12.4%) were contaminated. Culture negativity and contamination rates were 7.9% & 9.9% from Mayurbhanj district and 10% and 14.9% respectively from Hoogli district. The resistance to any drug was 5.4% in Mayurbhanj and 16.7% in Hoogli district. The resistance level to all the four primary drugs ranged from 0.4% to 3.9% in Mayurbhanj and 1.9% to 13.7% in Hoogli district. MDR was 0.7% (95% CI: 0.0% - 1.7%) and 3.0% (95% CI: 1 % - 5.1 %) in Mayurbhanj and Hoogli districts respectively. Conclusion: The study demonstrates that the levels of H, R and MDR in these two districts are within the expected levels, when compared with other studies conducted in India as per global DRS guidelines. However, in order to document success of RNTCP in reducing the levels of MDR TB, particularly in younger population, it is now necessary to conduct DRS in much larger population.
ABSTRACT
A case-control study was conducted to estimate the protective effect of BCG vaccination against tuberculosis among children. The children with suspicion of tuberculosis (TB) attending two hospitals in Bangalore city were registered into the study and subjected to detailed clinical examination and investigations. The presence of BCG scar was taken as evidence of vaccination. Modified Stegen-Jones scoring method was adopted for diagnosing TB. The hospital children with score of 7 were considered as TB cases. Children residing in the neighbourhood of cases were similarly investigated and those scoring 4 were labeled as controls. A total of 118 age-sex matched case-control pairs were identified and final analysis was confined to 113 cases and 109 controls after excluding children with doubtful BCG scar. A low protective effect of BCG vaccination at 31% (not significant, statistically) was observed against TB - all forms combined, among children vaccinated as under Universal Immunization Programme. Though the protective efficacy against extra-pulmonary TB was observed to be higher than for pulmonary TB, it was also not significant, statistically. It will be appropriate to conduct further studies on protection rendered by BCG vaccination against tuberculous meningitis and other severe forms of TB. Besides, the quality of vaccination programme including cold chain maintenance also needs to be evaluated.