India in Race to Contain Untreatable Tuberculosis
By GEETA ANAND
Multi-drug-resistant tuberculosis has been a growing problem in India for years. Now an even more extreme strain of the deadly disease -- resistant to all of the drugs normally used to treat it -- is causing concern. WSJ's Natacha Butler reports from Mumbai.
MUMBAI—India's slow response to years of medical warnings now threatens to turn the country into an incubator for a mutant strain of tuberculosis that is proving resistant to all known treatments, raising alarms of a new global health hazard.
"We finally have ended up with a virtually untreatable strain" of tuberculosis in India, said Dr. Zarir Udwadia, one of the country's leading TB authorities.
In December, Dr. Udwadia reported in a medical journal that he had four tuberculosis patients resistant to all treatment. By January, he had a dozen cases, then 15.
A government backlash began immediately. Anonymous health-ministry officials denied the reports through media outlets. They accused Dr. Udwadia and his colleagues of starting a panic. A Mumbai city health official seized patient samples for verification in government labs.
In April, the government quietly confirmed the strain, according to internal Indian health-ministry documents reviewed by The Wall Street Journal.
Spread of the strain could return tuberculosis to the fatal plague that killed two-thirds of people afflicted, before modern treatments were developed in the 1940s, said Dr. Mario Raviglione, director of the Stop TB Department of the World Health Organization. The WHO is now assisting India to combat the strain.
Tuberculosis Strains Raise Concern in India
Chiara Goia for The Wall Street Journal
Ganga Jatolia, and her mother, Geeta, inside their small house in the Chembur neighborhood of Mumbai.
The number of known cases in India is small but geographically dispersed. Dr. Udwadia's patients are in Mumbai, at the P.D. Hinduja National Hospital & Medical Research Center. In the high-tech hub of Bangalore, St. John's National Academy of Health Sciences has seen six cases. And in New Delhi, the All India Institute of Medical Sciences has confirmed another two, said officials at the institutions.
"While this handful of cases is worrying, it's just the tip of the iceberg," said Dr. Soumya Swaminathan, of India's National Institute for Research in Tuberculosis. For treatments, Dr. Udwadia said, "We've got nothing."
Ashok Kumar, head of India's tuberculosis-control program, said the government was "seriously addressing" the widening drug-resistance problem. However, he refuted Dr. Udwadia's description of a "totally drug-resistant" TB strain—not because there is a treatment, but because the term isn't internationally recognized and a new cure could be discovered.
Dr. Kumar said Dr. Udwadia and his hospital should have reported the cases to local health authorities, instead of an international medical journal. Public concern about drug-resistant TB, he said, "is not a well-founded fear."
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Tuberculosis, a communicable, airborne disease that usually attacks the lungs, is mostly found in pockets of deep poverty around the world. Healthy, well-fed people are less likely to contract the disease when exposed.
India has the largest number of the world's cases—2.3 million of the nearly nine million people afflicted annually—and it is the country's most fatal infectious illness. Government authorities estimated about 100,000 of India's patients have drug-resistant strains, which researchers say can mutate into forms increasingly immune to more and more medicines.
For years, India was praised for having the world's most ambitious TB treatment program, with 640,000 people who dispense medicines and 13,000 centers for diagnosis.
But the program is strained. TB patients, for example, are treated by village nurses, who also supervise most other health programs, said Dr. Swaminathan. Nurses often don't have time to monitor TB patients, who must take medicines for months. Many patients quit early.
The government has promised to expand its treatment system by 2017, with the goal of quickly diagnosing and treating drug-resistant TB cases.
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