In most of the developed world, latent TB is an indication to start treatment. At least one in three Indians has latent TB. The person with latent TB is not contagious, has a normal chest X-ray and no clinical manifestations.
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Typically, latent TB is characterized by a positive reaction to a tuberculin skin test called Mantoux, or a positive blood test known as Interferon Gamma Release Assay. Latent TBĪnyone who is infected with TB but does not have the disease is classified as having latent TB. During my three years treating children with TB in an Indian hospital, three of my colleagues acquired the disease, including one that spread to the brain and another one with the resistant form. Health care workers who take care of patients with TB themselves often fall prey to the disease and become transmitters. There can be no compromise as far as the diligent use of N-95 masks is concerned. However, this directive is often not followed, possibly due to lack of funds, callous attitudes or even corruption. The Indian government has mandated TB hospitals to use these masks. However, the cost is likely minuscule if one looks at the loss of productivity of those with TB as well as the financial burden of their treatment.
They are disposable, cannot be reused and are more expensive than the surgical masks. Specialized training is required to use the masks correctly. N-95 masks, sometimes called respirators, are more effective at preventing TB than the ordinary surgical masks or no masks at all. At the least, a public conversation regarding this matter needs to start. A reasonable compromise would be to provide enough facilities so that isolated patients’ rights are minimally infringed upon. However, allowing contagious TB patients to move around in the community or travel freely will ensure that India will probably never put an end to TB. A governmental directive and concerted efforts to isolate a large number of patients will no doubt be met with resistance by advocacy groups, and for good reason. Isolation of patients until they are no longer contagious raises philosophical and ethical issues. Treating physicians recognize the importance of quarantine but are not able to recommend isolation due to the lack of a directive in the national TB policy. India does not have a quarantine policy, even for those who have the drug-resistant form and are highly contagious. The developed world isolates people who are suspected of having TB until they are proven to be not contagious.
Infectious diseases can be tamed only by development and proper implementation of preventive strategies. There are a few aspects that need immediate attention of the government if India is to win its war on TB. While development of effective disease treatment strategies is essential, there seems to be a lack of focus as far as very obvious and basic preventive measures are concerned. A TB patient at the Chest Disease Hospital in Srinagar, India.
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