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India Gazette
09-07-2025
- Health
- India Gazette
ICMR-NIE introduce alert feature to reduce TB deaths in Tamil Nadu
By Shalini Bhardwaj Chennai (Tamil Nadu) [India], July 9 (ANI): More than half of all tuberculosis (TB) deaths occur within the first two months of treatment. In response, the Indian Council of Medical Research-National Institute of Epidemiology (ICMR-NIE) has introduced a new alert feature designed to immediately notify frontline healthcare workers when a patient is identified as severely ill following a TB diagnosis. The predictive model is expected to reduce the average time from diagnosis to hospital admission for severely ill patients with tuberculosis. The ICMR-NIE has recently launched a predictive model that helps the state reduce TB deaths. The predictive model was developed using data from 57,803 adults diagnosed with TB from public health facilities. 'In 2023, of 57,803 adults with TB diagnosed from public facilities, 57,070 (99%) were triaged and 6864 (12%) were triage-positive (eligible for referral). Of 6864 eligible, 6105(89%) were referred, comprehensively assessed and confirmed as severely ill at nodal inpatient facilities. Of 6105 confirmed, 5926 (98%) were admitted for inpatient care and 5413 (92%) were successfully discharged for ambulatory directly observed treatment. The median admission duration was seven days,' the study noted. The new feature introduced by the ICMR-NIE would merge with the existing TB SeWA (Secere TB Web Application), which was launched in 2022 and integrated into the state's TN-KET (Tamil Nadu Kasanoi Erappila Thittam). According to experts from ICMR-NIE, 'This new feature will be useful to Alert front-line staff on how to recognise severely ill TB patients to avoid delay in treatment.' They further added, 'The Majority of TB deaths are being reported early (within 2 months), India TB program's information management system (Nikshay) dependent death prediction models are not feasible for prospective use as few variables are captured at diagnosis. Utilising routinely captured triage variables for severe illness in TB SeWA that are available under TN-KET at diagnosis (body mass index, pedal oedema, respiratory rate, oxygen saturation, and ability to stand without support), robust models for prospective use were developed.' (ANI)
The Print
08-07-2025
- Health
- The Print
Bringing dramatic drop in TB deaths, how TN set an example for rest of India with one-of-a-kind model
While TB-related death simply refers to a death among a person with TB within 12 months of notification (diagnosis), early TB death refers to deaths that happen within two months, often within the first few weeks of the notification. It is estimated that around 70 percent of TB deaths in the state are early TB deaths. An analysis by the agencies implementing the Tamil Nadu Kasanoi Erappila Thittam (TN-KET, which means TB death-free project) has shown that within six months of the launch of the initiative in April 2022, overall TB-related deaths have come down by nearly 10 percent while early TB fatalities reduced by nearly 20 percent. Chennai: A first-of-its-kind statewide differentiated tuberculosis (TB) care initiative in Tamil Nadu has significantly brought down TB deaths in the state, prompting researchers to pitch it as a model that can be replicated across the country. These results from TN-KET hold significance for India which continues to report the highest burden of TB and TB-related mortalities globally despite making significant strides in curbing the burden of the bacterial disease over the last several years. India is considered a TB endemic country, a highly infectious disease caused by a bacteria called Bacillus Mycobacterium Tuberculosis, which is spread when people who are sick with TB expel the pathogen into the air, mostly by coughing. Spearheaded by the Tamil Nadu State TB Cell and Indian Council of Medical Research-National Institute of Epidemiology (ICMR-NIE), the TN-KET initiative involves triaging (preliminary assessment) adults with TB at diagnosis, and those identified as severely ill based on specified indicators are prioritised immediately for referral, comprehensive assessment, and inpatient care. 'The key aim is to gauge or predict the patients who are likely to die due to the infectious disease while first identifying the disease in them and immediately offer them hospitalised care to treat the severe symptoms they have,' said ICMR-NIE director Dr Manoj Murhekar. The initiative, also supported by the World Health Organisation (WHO) India and the ICMR National Institute for Research in TB (ICMR-NIRT), has been implemented in all 38 districts of Tamil Nadu, except for Chennai. 'This initiative has shown that it is possible to bring down TB-related deaths remarkably by following some scientifically designed tools and methods. Severe illness can be quickly identified through triaging and they can be promptly admitted after diagnosis,' Dr Hemant Deepak Shewade, a senior medical scientist with ICMR-NIE who is associated with the initiative, told ThePrint. While the impact of the project in the first year has been analysed, the analysis of the second year (2023-24) is still underway but the early indications from routine monitoring of TN-KET suggest that it is even better than the previous results, Shewade said. 'We feel that scaling the model across India will be beneficial in bringing down the number of people dying every year due to the disease,' he added. The senior scientist, however, cautioned that such an initiative could only bring down TB-related deaths by up to 30 percent, and measures like detecting all TB incidents, early detection, comorbidity management, universal health coverage, among others, were crucial to further reduce TB deaths in the country. Dr Asha Frederick, Tamil Nadu's State TB Officer, said that district TB officers and Nodal physicians have played a key role in the implementation of the initiative. 'We recommend that these triage variables are captured elsewhere including other Indian states and high TB burden countries to guide patient management,' Dr Frederick said. On the future plans for the TN-KET, the state has started identifying other severe comorbidities like uncontrolled Diabetes (requiring insulin) among people with TB. 'If this goes well, we plan to cover other severe comorbidities like severe addiction to alcohol and tobacco,' Frederick added. According to the World TB report 2024 by the WHO, there were an estimated 28 lakh incident people with TB in 2023, 26 percent of global TB burden. Also, the country had an estimated 3.1 lakh TB deaths that year which was 29 percent of all TB mortalities globally. Tamil Nadu is among the states with high TB burden in the country. Also Read: Lancet report highlights gaps in immunisation—no routine vaccine for 14.4 lakh Indian kids in 2023 How the strategy works As part of the project, health workers triage every new TB-diagnosed adult (all above 15 years) for very severe undernutrition, respiratory distress or poor physical condition on five variables—body mass index (BMI), pedal oedema (swelling of feet and ankles), respiratory rate, oxygen saturation, and ability to stand without support. This is carried out as a health system initiative in routine operational settings by existing health workforce. Whether or not a patient is severely ill is confirmed by entering the details into a software application TB SeWA (Severe TB Web Application). All those identified as severely ill are then prioritised for in-patient care by nodal physicians in nodal inpatient care facilities of the districts, using TN-KET case record form and in-patient care guides specifically developed for such patients. A study published on the early implementation of the project and its feasibility underlined that 80-90 percent of severely ill patients (as per triage tool) are getting detected and admitted within one day of diagnosis. The admission of severely ill patients (triage-positive) has improved over the years: 67 percent in 2022, 86 percent in 2023 and 91 percent in 2024. The median admission duration was five days in 2022 and this has improved to seven days in 2023 and 2024. Over the years, the focus has been to ensure quality comprehensive assessment and inpatient care during the admission of the severely ill patients with focus on therapeutic nutrition for very severely undernourished patients as half of those eligible for admission have very severe undernutrition. Between April 2022 and June 2023, as per details shared by ICMR-NIE scientists, 66,765 of 72,404 notified adults were triaged, and 7,950 were triage-positive (identified as severely sick due to TB). Among these, 5,870 (or 74 percent) patents were referred and admitted. The analysis later showed 21 percent decline in early TB death rate and 11 percent reduction in overall TB death rate during treatment. By improving the admission among triage-positive patients, there is scope to further reduce TB death rate, the researchers noted, adding that once the goal of 30 percent mortality rate reduction among notified TB patients using this strategy is achieved, they will consider adding follow up triaging for all patients at two months for further reduction in mortality rate. As per the Sustainable Development Goals (SDG), India has to eliminate TB by 2030. (Edited by Ajeet Tiwari) Also Read: COVID-19 vaccines linked to cardiac-related deaths? Siddaramaiah, Biocon founder Shaw spar on X
The Hindu
30-05-2025
- Health
- The Hindu
8 per cent infectious disease outbreaks during 2018-2023 spread from animals to humans, study says
Zoonotic outbreaks consistently peaked during June, July, and August, researchers from the Indian Council of Medical Research-National Institute of Epidemiology, Chennai said. Typically, about seven zoonotic outbreaks -- also sometimes called 'spillover events' -- occurred in a month, and such instances significantly increased over the years, specifically, post-pandemic, the study published in The Lancet Regional Health Southeast Asia journal found. Study highlights The team analysed a total of 6,948 outbreaks reported under the Integrated Disease Surveillance Program (IDSP) to identify trends. Of these, 583 (8.3 per cent) were zoonotic -- Japanese encephalitis was found to account for 29.5 per cent of zoonotic outbreaks, followed by leptospirosis (18.7 per cent) and scrub typhus (13.9 per cent). Region-wise, the northeast part of the country contributed 35.8 per cent of zoonotic disease outbreaks, followed by the southern (31.7 per cent) and western regions (15.4 per cent), the researchers found. They added that late reporting of disease outbreaks has declined over the years -- 52.6 per cent in 2019, 40.9 per cent in 2021, and 5.2 per cent in 2023. Overall, a third of the outbreaks during the study period were reported late, the team said. "Of the 6948 outbreaks reported in IDSP, 583 (8.3 per cent) were zoonotic, with a median of seven monthly zoonotic outbreaks. Outbreaks significantly increased over the years," the authors wrote. Further research required The researchers said that while outbreaks of measles, chickenpox, and dengue have been individually analysed, zoonotic events from the national-level infectious disease surveillance system have not been comprehensively examined. A lack of analysis of geographical patterns and documentation of reporting delays hindered evidence-based decision-making and targeted interventions, the team said. "Critical gaps in weekly outbreak reports were identified, particularly the lack of follow-up documentation. To address these gaps, we recommend strengthening disease-specific surveillance systems in hotspot regions," the authors concluded.
Time of India
30-05-2025
- Health
- Time of India
8 per cent infectious disease outbreaks during 2018-2023 spread from animals to humans, study says
New Delhi: Over eight per cent of outbreaks reported under India's infectious disease surveillance system between 2018 and 2023 were zoonotic -- spread from animals to humans, such as the COVID-19 pandemic, according to an analysis. Zoonotic outbreaks consistently peaked during June, July, and August, researchers from the Indian Council of Medical Research-National Institute of Epidemiology, Chennai said. Typically, about seven zoonotic outbreaks -- also sometimes called 'spillover events' -- occurred in a month, and such instances significantly increased over the years, specifically, post-pandemic, the study published in The Lancet Regional Health Southeast Asia journal found. The team analysed a total of 6,948 outbreaks reported under the Integrated Disease Surveillance Program (IDSP) to identify trends. Of these, 583 (8.3 per cent) were zoonotic -- Japanese encephalitis was found to account for 29.5 per cent of zoonotic outbreaks, followed by leptospirosis (18.7 per cent) and scrub typhus (13.9 per cent). Region-wise, the northeast part of the country contributed 35.8 per cent of zoonotic disease outbreaks, followed by the southern (31.7 per cent) and western regions (15.4 per cent), the researchers found. They added that late reporting of disease outbreaks has declined over the years -- 52.6 per cent in 2019, 40.9 per cent in 2021, and 5.2 per cent in 2023. Overall, a third of the outbreaks during the study period were reported late, the team said. "Of the 6948 outbreaks reported in IDSP, 583 (8.3 per cent) were zoonotic, with a median of seven monthly zoonotic outbreaks. Outbreaks significantly increased over the years," the authors wrote. The researchers said that while outbreaks of measles, chickenpox, and dengue have been individually analysed, zoonotic events from the national-level infectious disease surveillance system have not been comprehensively examined. A lack of analysis of geographical patterns and documentation of reporting delays hindered evidence-based decision-making and targeted interventions, the team said. "Critical gaps in weekly outbreak reports were identified, particularly the lack of follow-up documentation. To address these gaps, we recommend strengthening disease-specific surveillance systems in hotspot regions," the authors concluded. PTI
Hindustan Times
29-05-2025
- Health
- Hindustan Times
2023 Tamil Nadu outbreak of neurological infection traced to contaminated saline at clinic: Study
New Delhi, A genetic study has traced a 2023 outbreak of a neurological infection in Tamil Nadu to contaminated saline water used at a dental clinic, findings of which were published in The Lancet Regional Health Southeast Asia journal. Twenty-one probable cases of neuromelioidosis a neurological infection caused by bacterium Burkholderia pseudomallei between July 2022 and April 2023 were identified across four districts in the northern part of the state. Seventeen of the 21 cases came from a single district, of which 10 reported undertaking treatment at a dental clinic. The cluster of cases were found to have higher and quicker deaths, compared to the other 11 sporadic cases from environmental sources. Researchers from Christian Medical College, Vellore, Indian Council of Medical Research-National Institute of Epidemiology, Chennai, and other institutes attributed the cluster to invasive dental procedures injecting of a local anaesthetic and repeated irrigation with saline performed under suboptimal infection prevention and control conditions. Whole genome sequencing of 209 isolates, obtained from tissue, blood, and cerebrospinal fluid samples of the affected, revealed 'ST1553' strain of the bacterium B pseudomallei as being associated with the neurological infection outbreak. Along with suggesting a new process by which neuromelioidosis can be contracted, the findings highlighted the importance of molecular methods of analysis in identifying the strain of the bacterium circulating in southeast Asia. Rigorous infection prevention and control practices across healthcare facilities, particularly those performing invasive procedures, need to be enforced, the authors said. "We confirmed a large cluster of neuromelioidosis from south India, likely representing sporadic cases from environmental sources and cases linked to an iatrogenic source at a dental clinic," the authors wrote. "Rapid and high case fatality among dental cases supports the direct trans-neural spread of B pseudomallei to the brainstem following inoculation via contaminated saline," they wrote.
