TuberculosisinthePhilippines:10thingsyoushouldknow

MINDYOURBODYByWillieT.Ong,MD|UpdatedJanuary3,2012 12:00am
Tuberculosis(TB)isaninfectioncausedbybacteriathatusuallyaffectthelungs.Thesebacteria,
calledMycobacteriumtuberculosis,canbepassedontoanotherpersonthroughtinydroplets
spreadbycoughingandsneezing.Eventheaccidentalspreadofsalivathroughlaughing,singing,
andspittingcanpassontheTBbacteria.
InthePhilippines,TBisthenumbersixleadingcauseofdeath,with73Filipinosdyingeveryday
ofTB.Letuslookat10factsaboutTB:
1.Anestimated200,000to600,000FilipinoshaveactiveTB.Thisconditionmakestheperson
sickandcontagioustoothers.ActiveTBcanoccurinthefirstfewweeksafterinfectionwiththe
bacteria,oritcanoccurafewyearslater.SignsandsymptomsofactiveTBincludecough,
phlegm(sometimeswithblood),unexplainedweightloss,fatigue,afternoonfever,nightsweats,
chills,andlossofappetite.Seeyourdoctorifyouhavethesesymptoms.
2.ThedangerofTBisreal.Outof196countries,thePhilippineshasthedistinctionofbeing
includedinthetop22highburdentuberculosiscountriesintheworld.Thisreportisaccording
totheWorldHealthOrganizations(WHO),whichranksthePhilippinesatnumbernine
worldwide.Together,these22countries(includingthePhilippines)contribute80percentofthe
globalTBburden.TBisadiseaseofpovertyandthehighTBburdenisareflectionofour
economicstatus.Ontheotherhand,somepeopleconsiderbeingnumbernineasgoodnews
sincewecamefromnumbersevenworldwide!Infact,afterChina,thePhilippineshadthe
secondhighestnumberofTBcasesintheWHOWesternPacificRegionin2007.
3.EachpersonwithactiveTBcanspreadthediseaseto10otherFilipinoseachyear!Thisis
alarmingsincetherearebetween200,000and600,000FilipinoswithactiveTB.Multiplythisby
10,andjustimaginehowmuchTBisbeingspreadyearly.Hence,ifsomeoneinthehousehold
hasbeendiagnosedwithTB,alltheothermembersofthehouseholdshouldgettested(likea
chestxray)forTB,too.TheusualtreatmentcourseforTBisbetweensixandninemonthsof
continuousmedicines.Thegoodnews,however,isthatonceactiveTBistreatedwiththe
appropriatedrugs,thepersonisnolongercontagiousafterthreeweeks.Thatiswhythosewho
arebeingtreatedforTBareadvisedtorestduringthefirstmonth.
4.Anotheralarmingfact:Anestimated80percentofFilipinoshavelatentTB.Becauseofthe
hugeTBburdeninthecountry,mostofusalreadyhavethesocalledlatentTB.Yes,thatinall

likelihoodmeansyouandme.Inthiscondition,wealreadyhavetheTBinfectioninourbodies,
buttheTBisstillintheinactivestate.Hence,wefeelnosymptomsandwearenotcontagiousto
otherpeople.Somecountries,liketheUS,willtreatthosewithlatentTBwithmedicines.Butwe
canthelpitbecauseweareborninthePhilippines.Wejustneedtoobserveahealthylifestyle,
orelsetheTBinfectionmightgetreactivated.
5.Tuberculosiscanaffectotherorgansofthebody,suchasthekidneys,spineorbrain.
Symptomsdependontheorganaffected.TBofthespinecausesseverebackpain,whileTBof
thekidneyscancausebloodyurine.Hence,TBshouldbecheckedandtreatedasearlyas
possible.
6.TreatmentofTBmaynotchangeyourchestxrayresultsbacktonormal.Thus,manyFilipinos
cannotpassjobtestsforabroadbecauseofpastorpresentTBinfection.Studiesshowthatonce
treatmentforTBiscompleted,arepeatchestxraymayshowthefollowingresults:30percent
ofchestxrayswillreverttonormal(goodnews),30percentofchestxrayswillimprovebutwill
stillshowascar(stillcantpassjobtest),30percentofchestxrayswillremainthesame.This
justgoestoshowthattheTBburdeninthecountryisalsoaffectingtheemploymentofour
people.
7.TheBCGvaccineagainstTBisnot100percenteffective.AlthoughtheWHOrecommendsthat
BCGbegiventoallinfantsandyoungchildrenincountrieswithhighTBburden,thevaccinedoes
notalwaysprotectpeoplefromTB.Inaddition,theprotectiongivenbytheBCGdoesnotseem
tobeeffectiveasthepersonbecomesanadult.Still,theBCGappearstoprotecttheperson
fromamoreseriousTBdiseaseandshouldbeapartoftheimmunizationprogram.
8.Bewareofmultipledrugresistanttuberculosis(MDRTB).Anotherchallengeistheemergence
ofanewdrugresistantstrainofTBcalledMDRTB.Thisnewsuperbugprobablyarosebecause
TBpatientsdidnotadheretotheirdrugregimen,whichmeansthattheydidnttaketheir
medicinesreligiouslyfortheusualsixmonths.Becauseofthis,theTBbacteriadevelopeda
resistancetothefirstlinedrugslikeIsoniazidandRifampicin.MDRTBisdifficultandexpensive
totreat.Worldwide,in2008,therewereanestimated440,000newcasesofMDRTBand
150,000deathsfromMDRTB.Estimatesshowthat3.3percentofnewTBcasesarereallyMDR
TB.
9.HaveyouheardofXDRTB?IfhavingthemultidrugresistantTBisbadenough,scientistshave
discoveredathirdmoreterriblestrainofTB.Thesenastybacteriaarecalledextensivelydrug
resistantTBorXDRTB.ThismeansthatXDRTBisresistanteventothespecialdrugsdeveloped
forMDRTB.Beforewarned:TheWHOhasreportedthatXDRTBcaseshavebeenconfirmedin
58countries,includingthePhilippines.
10.Finally,somegoodnews.DespitethehighTBincidence,significantdevelopmentshavebeen

madeinincreasingcasedetectionandtreatmentinthecountry.In2007,thePhilippines
achievedaTBcasedetectionrateof75percent,exceedingtheWHOtargetof70percent.The
DirectlyObservedTherapyShortCourseorDOTSistheinternationallyrecommendedstrategy
forTBcontrol.DOTSsimplymeansaskingarelativeorahealthworkertodirectlyobservethe
patienttakingtheantiTBmedicinesdaily.ThePhilippinesDOTStreatmentsuccessisataround
88percent,whichishigherthantheWHOtargetof85percent.Fortunately,international
agencies,liketheGlobalFundandUSAID,arehelpingthecountrycombatTB.
Despitetheseaccomplishments,manyfactorsstillneedtobeaddressedsuchasreducingthe
stigmaofTBpatients,andincreasingthepublicsawarenessofthedisease,especiallytheneed
fortreatment.SomeinfectedTBpatientsstillrefusetreatmentandcontinuetoposeadangerto
peoplearoundthem.
Iappealtoourpolicymakers,healthworkers,andmediatofurtherstrengthenourcampaign
againstthisterriblescourge.