by Yogan Pillay & Foster Mohale
Every year on 24th March the global community commemorates World Tuberculosis (TB) Day. It was on this day in 1882 that Robert Koch told the world that a bacillus called mycobacterium tuberculosis causes tuberculosis or TB for short.
This year’s World TB Day theme is “Yes! We can end TB”.
How is South Africa doing in combatting TB? While we have seen some improvement, TB is still a very big problem for the country. Every year, it is estimated that around 290 000 people contract TB and 54 000 people die from TB. This puts South Africa as one of the countries with the highest rates of TB in the world. This picture is further complicated by HIV as people living with HIV are more likely to also have TB – as their immune systems are compromised.
There are other risk factors for acquiring TB as well. These include: malnutrition; alcohol use; smoking; and diabetes.
However, we can end TB because TB can be diagnosed and treated in six months and is curable. It is therefore very important for those with symptoms of TB (coughing for 2 weeks, night sweats, bodily aches, weight loss) to visit their nearest public clinic and get tested, and if positive to get treatment. Early presentation to a clinic and treatment will also be good for those we are close to – family members, work colleagues and people we travel with in busses, taxis and trains. This is because TB is airborne and can be transmitted from one person to the next. A person with untreated TB can infect up to 15 others!
One of the challenges with TB, like COVID-19, is that some people with the disease do not have any symptoms. This means that they will unknowingly transmit the disease to others. One approach is for anyone who has been in contact with a person that has been diagnosed with TB to get a test. In countries in Europe, they were able to eliminate TB by screening and testing everyone annually. We need to consider doing this in South Africa and other high burden countries as well if we are to eliminate TB. This will require us to do mass screening and testing. With artificial intelligence (AI) reading chest X-rays and an affordable TB test to confirm the diagnosis, mass screening and testing will be feasible and affordable in many countries.
While TB is a very old disease – it was found in Egyptian mummies – except for children – we don’t have a vaccine that works for young people and adults. Even the vaccine for children which is called BCG, is not very effective and is more than 100 years old. However, there is some good news. There are a few vaccines that are currently being studied – one of which is called M72 which is currently in clinical trials in a few countries, including South Africa. If these clinical trials find that this vaccine works, we may have a TB vaccine for adolescents and adults by 2028/9.
In the absence of a new vaccine, what can be done?
A recently published study called ‘RATIONS’ done in India found that the provision of food to malnourished TB patients and members of their households can reduce deaths in people with TB and also reduce transmission to members of their households. Because of these results, some people are now referring to food as a ‘vaccine’. Given the levels of malnutrition and TB in South Africa, provision of food by government should be considered in addition to the temporary disability grant that some people with TB are eligible for whilst they are on treatment.
As we commemorate World TB Day on Sunday 24 March 2024, let us remember those that have passed on from TB and those who are currently affected. Equally, let us remember that TB treatment is free and that TB is curable! Yes! We can end TB in South Africa.
Prof Yogan Pillay (University of Stellenbosch) & Foster Mohale (National Department of Health Spokesperson)
