A30-year-old Indian woman infected with the dreaded multidrug-resistant tuberculosis (MDR TB) travelled from New Delhi to Chicago in December and sparked an international public health nightmare.
The US Centers for Disease Control (CDC), the federal government's apex infection-control organisation, is busy trying to trace the 44 passengers who sat around the woman and test them for possible infection. The woman travelled on American Airlines Flight 293 last month, was admitted to hospital for coughing up blood, fever and for chest pain. The CDC said the facts of the case indicated "a potential for transmission of drug-resistant TB infection to others."
In the globalised world, increased air travel has made it easier for viruses and bacteria to cross borders and cause outbreaks in new populations. Last year, a TB-infected lawyer from Atlanta created a similar scare by flying to and from Europe, an Indian tourist infected 200 people in northern Italy with chikungunya and caused Europe's first outbreak, even as Myanmar reported 11 polio cases after being free of the disease for seven years.
"A health crisis in one country can impact lives and trade in another so the world has to work together to control and contain disease," says a World Health Organisation (WHO) expert. The WHO introduced revised International Health Regulations last year that give countries clear guidelines for reporting disease outbreaks so that timely containment could be made.
The ascent of newer and more deadly viruses - such as H5N1 that causes avian flu - has pushed tuberculosis away from list of frightening diseases. The infection may be curable but it still highly prevalent in India. Lifestyle factors such as stress and bad diets are pushing the body's immunity down and causing full-blown infection even among the affluent young, who traditionally did not suffer from TB.
Stress, sleepless nights, smoking and crash diets have pushed up tuberculosis (TB) infection among the urban 18-35 year olds, who now account for 60 per cent of TB infections in several upscale clinics and hospitals. The disease shows a clear gender bias, with two in three patients with TB being young women.
According to the WHO, about one in three people in India have latent TB, which means that they are infected but do not have the symptoms because of robust immunity. In a healthy immune system, macrophages - type of white blood that destroys foreign material - help wall off TB bacteria, but the body cannot mount an effective defence if the immunity is low.
A number of factors can weaken the immune system. "Diseases such as AIDS, diabetes or cancers suppress immunity, as do drugs such as corticosteroids, arthritis medications or anti-cancer drugs. Smoking as a tuberculosis risk factor has also been emphasised in medical literature in the past five years and some studies show it can double the risk," says Dr J.N. Pande, senior consultant medicine at Sitaram Bhartia Institute, and the former head of medicine at the All India Institute of Medical Sciences.
Unfortunately, the urban lifestyles make the job easy for the TB bacterium. Among women, dieting is a major factor that triggers infection, along with jobs with long and erratic timings, such as those at BPOs, the hotel sector and airlines. "People with symptoms are highly contagious and should stay away from work to ensure they don't infect others," says Pande.
What is worrying is that many patients these days do not display the classic symptoms of TB, such as a racking cough accompanied by sputum. In most cases, the symptoms are weight loss, loss of appetite and low-grade fever are the only symptoms and doctors have to rely on X-says for diagnosis. "In the absence of chronic cough an sputum positivity, anyone with weight loss and low-grade fever that lasts for over a month should get screened for TB," says Pande.
The US Centers for Disease Control (CDC), the federal government's apex infection-control organisation, is busy trying to trace the 44 passengers who sat around the woman and test them for possible infection. The woman travelled on American Airlines Flight 293 last month, was admitted to hospital for coughing up blood, fever and for chest pain. The CDC said the facts of the case indicated "a potential for transmission of drug-resistant TB infection to others."
In the globalised world, increased air travel has made it easier for viruses and bacteria to cross borders and cause outbreaks in new populations. Last year, a TB-infected lawyer from Atlanta created a similar scare by flying to and from Europe, an Indian tourist infected 200 people in northern Italy with chikungunya and caused Europe's first outbreak, even as Myanmar reported 11 polio cases after being free of the disease for seven years.
"A health crisis in one country can impact lives and trade in another so the world has to work together to control and contain disease," says a World Health Organisation (WHO) expert. The WHO introduced revised International Health Regulations last year that give countries clear guidelines for reporting disease outbreaks so that timely containment could be made.
The ascent of newer and more deadly viruses - such as H5N1 that causes avian flu - has pushed tuberculosis away from list of frightening diseases. The infection may be curable but it still highly prevalent in India. Lifestyle factors such as stress and bad diets are pushing the body's immunity down and causing full-blown infection even among the affluent young, who traditionally did not suffer from TB.
Stress, sleepless nights, smoking and crash diets have pushed up tuberculosis (TB) infection among the urban 18-35 year olds, who now account for 60 per cent of TB infections in several upscale clinics and hospitals. The disease shows a clear gender bias, with two in three patients with TB being young women.
According to the WHO, about one in three people in India have latent TB, which means that they are infected but do not have the symptoms because of robust immunity. In a healthy immune system, macrophages - type of white blood that destroys foreign material - help wall off TB bacteria, but the body cannot mount an effective defence if the immunity is low.
A number of factors can weaken the immune system. "Diseases such as AIDS, diabetes or cancers suppress immunity, as do drugs such as corticosteroids, arthritis medications or anti-cancer drugs. Smoking as a tuberculosis risk factor has also been emphasised in medical literature in the past five years and some studies show it can double the risk," says Dr J.N. Pande, senior consultant medicine at Sitaram Bhartia Institute, and the former head of medicine at the All India Institute of Medical Sciences.
Unfortunately, the urban lifestyles make the job easy for the TB bacterium. Among women, dieting is a major factor that triggers infection, along with jobs with long and erratic timings, such as those at BPOs, the hotel sector and airlines. "People with symptoms are highly contagious and should stay away from work to ensure they don't infect others," says Pande.
What is worrying is that many patients these days do not display the classic symptoms of TB, such as a racking cough accompanied by sputum. In most cases, the symptoms are weight loss, loss of appetite and low-grade fever are the only symptoms and doctors have to rely on X-says for diagnosis. "In the absence of chronic cough an sputum positivity, anyone with weight loss and low-grade fever that lasts for over a month should get screened for TB," says Pande.