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Ideas to cover

 

  • Tuberculosis

  • Coronavirus

  • Zoonotic diseases

  • Anti-Microbial Resistance (AMR)

 

Tuberculosis

 

  • Why important for UPSC:

– One of the top 10 death causes worldwide

– India has highest TB burden in the world

  • 27% of global cases (WHO Global TB report 2019) • Communicable disease
  • Pathogen: Mycobacterium tuberculosis
  • Transmitted through:

– Coughing, sneezing and spitting

  • Typically affects lungs (pulmonary TB) , but can also affect other sites (extra-pulmonary TB)

 

Tuberculosis

 

  • TB Prevention:
  • Good hygiene practices
  •  Coughing etiquettes
  • Protection masks
  • TB Vaccine
  • Baccilus calmette-guerin(BCG) vaccine – live attenuated in which cattle TB bacteria is used. Helps prevent Meningitis TB/ Brain TB. Also imparts immunity against leprosy bacteria

– Mycobacterium lepare

  • Treatment -> antibiotics for 6 months

 

Tuberculosis

 

  • MDR and XDR TB

– Multi-Drug Resistant(MDR) TB

  • Bacteria that are resistant to at least 2 most effective anti TB drugs -> Isoniazid and rifampicin

– Extensively Drug Resistant (XDR) TB

  • Resistant to Isoniazid and rifampicin + any flouroquinolones + any of the 2ndline fo TB drugs -> Amikacin or Kanamycin or capreomycin
  • Treatment: 2 year treatment with special drugs
  • India has highest TB burden of MDR TB too: 27%

 

Tuberculosis

  • WHO End-TB strategy (post 2015)

– Update from WHO stop-TB strategy (2006-2015)

 

 

Tuberculosis

 

 

Tuberculosis

 

  • Part of SDG 3.3
  • Revised National TB Control Programme (RNTCP) initiated in 1993 as upgrade to NTP (1962)
  • National Strategic Plan for Tuberculosis Control 2012-2017

– TB Free India

– Aim of universal access to quality TB diagnosis and treatment for all TB patients in the community

 

Tuberculosis

 

  • Recently RNTCP launched NSPTC 2017-2025 for the control and elimination of TB in India by 2025.

– 4 strategic pillars (DTPB)

– Detect: find all drug sensitive TB cases (DS-TB) and drug resistant TB cases (DRTB)

  • Special emphasis on high risk pop (migrant workers, HIV patients, contacts. Etc.)
  • Mandatory notification of all TB cases

– Treat: Provision of free TB drugs in the form of daily fixed dose combinations (FDCs) for all TB cases is advised with the       support of directly observed treatment (DOT)

– Prevent: new emergence and reemergence in susceptible populations

– Build and strengthen enabling policies, empowered institutions, additional human resources with enhanced capacities,           and provide adequate financial resources.

 

Tuberculosis

 

  • NIKSHAY Portal

– case-based web-based TB surveillance system called “NIKSHAY” (https://nikshay.gov.in ) for both government and                  private health care facilities

  • Nikshya Poshak Yojana: Financial incentive of Rs.500/- per month provided for nutritional support to notified TB patient for duration for which the patient is on anti-TB treatment through DBT
  • Vaccination under Universal immunization programme, Indradhanush etc.

 

Coronavirus

 

  • Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as MERS-CoV and SARS-CoV.
  • These viruses consist of a core of genetic material surrounded by an envelope with protein spikes, which gives it an appearance of a crown (Latin: corona)
  • A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans
  • Zoonotic disease: transmitted between animals and people

 

Coronavirus

 

  • Novel Coronavirus (COVID-19 or 2019-nCOV)

– First reported from Wuhan(China)

– Reportedly carried by Bat

  • Most viruses are carried by Bats. Why?

– WHO declared it Public health emergency of international concern (PHEIC)

  • Symptoms:

– fever, tiredness, and dry cough. Some patients may have aches and pains, nasal congestion, runny nose, sore throat or          diarrhea. These symptoms are usually mild and begin gradually

 

Coronavirus

 

  • Spread:

– person to person through small droplets from the nose or mouth which are spread when a person with COVID-19                 coughs or exhales

– These droplets land on objects and surfaces around the person. Other people then catch COVID-19 by touching these           objects or surfaces, then touching their eyes, nose or mouth

– Virus may be present in faeces in certain cases

  • Treatment

– no specific vaccination or anti viral drug available yet

 

Zoonotic Diseases

 

  • infectious diseases that can naturally be transmitted/spread between animals (usually vertebrates) and humans
  • Can be bacteria, virus, fungi etc.
  • 1959 WHO definition of zoonoses: those diseases and infections which are naturally transmitted between vertebrate animals and humans.
  • World Zoonoses Day – July 6

 

Zoonotic Diseases

 

  • Classification:

– Based on agent:

  •  Bacterial
  • Viral
  • Fungal • Etc.

– Reservoir host:

  • Anthropozoonoses – lower vertebrates to man e.g. rabies, plague, anthrax etc.
  • Zooanthroponoses – man to lower vertebrates e.g. human TB in cattle and parrots
  • Amphixenoses – maintained in both and can transmit in either direction e.g. salmonellosis

 

Zoonotic Diseases

 

  • Classification:

– Mode of transmission:

  • Direct zoonoses: by direct contact or fomites or mechanical carrier e.g. rabies
  • Cyclozoonoses: more than one vertebrate host species, but no invertebrate host for the completion of the life cycle of the agent
  • Metazoonoses: requires a vertebrate and invertebrate for completing life cycle
  • Saprozoonoses: vertebrate host and a non-animal developmental site like soil, plant material, pigeon dropping etc. for the development of the infectious agent

 

Zoonotic Diseases

 

  • Zoonoses as an emerging threat: WHO in 2015 WHO highlighted that 75 per cent of new diseases that have affected humans over the last decade have been caused by pathogens originating from an animal or from products of animal origin

– Animals act as reservoirs of host of unknown or relatively less known pathogens

– Human-animal proximity caused by increasing population, deforestaion etc.

– Climate change -> human and animal migrations causing new avenues of such transfers

– Climate change -> emergence of mutated pathogens and new vectors

– AMR caused by animal industry

– Fast spread because of global movements

 

Zoonotic Diseases

 

  • Threats:

– Frequent occurrences of novel dangerous diseases like 2019-ncov (development dimension)

– Can be harnessed for biological weapons if not studied properly (security dimension)

– Economic losses

  • Less trade, tourism
  • Disruption of global supply chains

 

Zoonotic Diseases

 

  • Suggestions:

– One health approach

– Research and innovation to better understand such transmissions

– Human capital development in respective fields

– Regulation of animal husbandry with focus on animal health and its impact on humans

– Stricter control and restrictions on other wildlife trades and transfers

– Community awareness programmes for incultation of good hygiene practices

 

Anti-Microbial Resistance (AMR)

 

  • Anti-Microbials: used against disease causing pathogens as a form of treatment.
  • Repeated exposures -> pathogen evolves and develops resistive mechanisms against actions of the antimicrobials
  • AMR/AR -> is the ability of a microbe to resist the effects of medication that could successfully treat the microbe

 

Anti-Microbial Resistance (AMR)

 

  • Overuse and Misuse of antimicrobials • Not completing AM courses
  • Cultural Events such as mass bathing: e.g. Kumbh mela
  • Excess use of certain antibiotics in animals • Pharmaceutical industry pollution
  • Poor hygiene and sanitation, particularly in healthcare establishments

 

Anti-Microbial Resistance (AMR)

 

  • Negative impact:

– Previously treatable diseases become untreatable which can lead reemergence of controlled diseases such as polio, smallpox, measles etc.

– AMR increases duration of treatment

– increasing healthcare costs

– Rise of new epidemics and pandemics

– Threat to overall development and sustainability

 

AMR – Efforts

 

  • WHO “global action plan on antimicrobial resistance”:

– Improve awareness and understanding of AMR

– Strengthen knowledge through surveillance and research

– Reduce incidence of infection

– Optimize use of antimicrobial agents

– Increase investment in new medicines, diagnostic tools, vaccines, and other interventions

  • CARB-X -> Combating Antimicrobial Resistant Bacteria Biopharmaceutical Accelerator -> a global partnership to research on AMR and new antimicrobials

 

AMR – Efforts

 

  • National Health Policy 2017

– accepts the issue of AMR and calls for effective action

– Calls for One health approach

  • MoHFW – AMR as one of the top 10 priorities for ministry’s collaboration with WHO
  • NCDC’s “AMR Containment Programme” • National Action plan for AMR 2017-2021
  • National Policy for Containment of Antimicrobial Resistance 2011
  • Schedule H-1 drug under Drug and Cosmetic rules to regulate the sale of AMs in country
  • Red Line Campaign discourage OTC sales of prescription only antibiotics
  • FSSAI banned the use of use of antibiotics and similar substances in fisheries
  • ICMR’s “National Anti-Microbial Resistance Research and Surveillance Network (AMRRSN)” to enable compilation of National Data of AMR at different levels of Health Care