TB in the Philippines: “It’s Time”

CEBU, Philippines — There was a time when TB was a big scare in the Philippines. Then, with vigorous government effort, people thought that the disease was effectively contained. But it only looked “contained” on the surface; TB actually continued to lurk among the population.

Last year, in September, during the first-ever UN high-level meeting on TB in New York Department of Health Secretary Dr. Francisco Duque III had committed to finding and treating 2.5 million people with TB in the Philippines by the year 2022. The commitment meant that, yes, TB was still very much around in the country – and in fact, it is still a leading killer worldwide.

About one million Filipinos have active TB disease, the third highest prevalence rate in the world after South Africa and Lesotho. TB is the number one killer among all infectious diseases. Every day more than 70 people die from TB in the Philippines, which is really sad because TB is a highly curable disease.

The most familiar symptom of active TB is a bad cough that produces blood-tinged phlegm, and lasts for three weeks or longer. The cough is usually accompanied by chest pain, fatigue, loss of appetite, weight loss, fever, chills, and night sweating.

TB is the more common term for tuberculosis, an airborne contagious disease that can be fatal if left untreated. The name is derived from the “tubercle,” a TB bacteria-containing lesion that is walled off by white blood cells following the immune response to TB infection. It has been called a “disease of the poor” because it is more prevalent in developing countries where poverty and malnutrition are a problem.

Ingrid Koo, PhD, in an article at www.verywell.com, explains that TB is spread when an infected person coughs. She cites that the risk for TB infection is highest among people who stay in closed environments with an infected person, for long periods of time. The disease is noted to be more common among people in crowded housing, as well as those with weakened immune system due to malnutrition.

Yet despite its label as a “disease of the poor,” the well-off countries are not totally spared from it – TB remains a problem in their hospitals, prisons, and homeless shelters, where crowded conditions prevail. Also, some developed countries have experienced a re-emergence of the disease due to people traveling to and from other countries where TB is rampant.

This year’s World Tuberculosis Day theme is: “It’s time.” It is a call for countries to do their share to end TB from the planet by the year 2030. Yet, the Philippines is among the few countries where the number of people with TB continues to increase every year.

World Health Organization (WHO) representative in the Philippines Dr. Gundo Aurel Weiler believes that fighting TB in the Philippines requires going beyond the health sector. That it requires systematic screening for TB among all high risk groups, especially in vulnerable communities.  That it requires the private and public sectors to closely collaborate and work together, and for concerted action by all sectors and all healthcare providers.

According to the national strategic plan of the Department of Health, about 6 to 9 percent of Filipinos need to undergo chest X-ray screening annually. Similarly, 2 to 3 percent of the general population needs to undergo testing with rapid molecular diagnostics annually. Adequate quantities of the required diagnostics and drugs have to be mobilized to ensure uninterrupted supply of these.

Approximately 90 percent of infected people develop latent TB, in which the infection is neither symptomatic nor contagious. Many people with latent TB never develop active TB; however, active TB is serious and can be fatal as a result of tissue destruction that leads to rupture of blood vessels and hemorrhage or uncontrolled bleeding. TB is fatal in up to 50 percent of patients who do not receive proper treatment.

There is no vaccine to prevent TB. While a TB vaccine, known as the Bacille Calmette-Guerin or BCG vaccine, is given at birth in most developing countries, it has been shown to reduce the rate of TB meningitis and miliary TB only in the first year of life. Its effect in adults is limited. So it is not realistic for one to take the vaccine and expect to see good protection.

Health authorities advise that when traveling to areas where TB is prevalent, one sahll avoid exposure to crowded environments, such as hospitals, prisons, or homeless shelters. Or better yet, wear appropriate face masks for protection.

Secretary Duque has appealed to everyone to lend full support to the Department of Health in its fight against TB. For his part, WHO’s Dr. Weiler rallies all Filipinos:  “Everyone must join the race to end TB by 2030. The clock is ticking… It’s time to ensure that no one dies of TB anymore.”