Lok Sabha Question No. 638 (UNSTARRED), answered on 2016-11-18
Subject: Cases of TB and MDRTB
Ministry: HEALTH AND FAMILY WELFARE
Asked by: RANGASWAMY DHRUVANARAYANA, M. UDHAYAKUMAR, ANURAG SINGH THAKUR, RAYAPATI SAMBASIVA RAO, BALASUBRAMANIAM SENGUTTUVAN, SAKUNTALA LAGURI

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 638 TO BE ANSWERED ON 18 TH NOVEMBER, 2016

## CASES OF TB AND MDRT B

## 638. SHRI R. DHRUVA NARAYANA:

ADV. M. UDHAYAKUMAR:

SHRI ANURAG SINGH THAKUR:

SHRI RAYAPATI SAMBASIVA RAO:

SHRI B. SENGUTTUVAN:

SHRIMATI SAKUNTALA LAGURI:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a)  the  number  of  cases  of  Tuberculosis (TB)  and  Multi - Drug  Resistant  TB (MDRTB)  and attributable deaths reported in the country during each of the last three years and the current year, State/UT - wise;
- (b)  the  steps  taken/proposed  to  be  taken by  th Government  for  identification, detection  and treatment of TB/MDRTB/XDR - TB  cases along wit h the funds allocated and utilised therefor during the said period, State/UT - wise;
- (c) whether the Government has received a donation of 300 doses of Bedaquiline medicines to treat TB patients, if so, the details thereof;
- (d) whether the Government has s etcertain eligibility criteria for Bedaquiline TB Drug, if so, the details thereof; and
- (e) the present status of TB research, vaccines, diagnostics and drugs?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE

(SHRI FAGGAN SINGH KULASTE)

- (a): The details of the number of Tuberculosis (TB) and Multi - Drug Res stant TB (MDRTB) and attributable deaths reported in the country during the last three years and the cur State/UT wise is annexed (Annexure -I,II,III,IV).
- (b ): Under the Revised National Tuberculosis Control Programme (RNTCP) prevention and control  of  Tuberculosis /Multi  Drug  Resistant  Tuberculosis is  addressed  in  a  comprehensive manner.The strategy is multi - pronged and includes, inter alia, the following
- strengtheni ng  and  improving quality  of  basic  DOTS  services  including  introducing  daily regimen for drug sensitive Tuberculosis.
- addressing TB HIV co - infection, other co - morbidities and MDR - TB
- engaging with care providers both in the public and the private sector
- targeted intervention in the vulnerable population and strengthening urban TB control
- integrating newer molecular diagnostics for TB  in the health system for early diagn MDR TB
- expansion of Programmatic Management of Drug Resistant Tuberculosis  ( PMDT) services and introduction of new drug Bedaquiline.
- aligning the Tuberculosis Units with Block Units under National Health Mission (NHM) rationalizing  the  available  resources  and  integration  of  TB  services  in  the  genera system
- leveraging o f Information Communication Technology for TB notification and strengthening of monitoring.

The details of funds allocated and utilized during the said pe riod are placed as Annexure - V.

(c ): The Government has received a commitment for donation of 600 courses of Bedaquiline. O these, 300 courses of Bedaquiline, have been received, till date. These drug courses ar administered to the respective patients of Delhi, Tamil Nadu, Assam, Mumb ai and Gujarat in the following six institutes:

1. National Institute of Tuberculosis and Respiratory Diseases, New Delhi
2. Rajan Babu Instititute of Pulmonary Tuberculosis, Delhi
3. 3.Government Hospital for Thoracic Medicine, Tambaram, Chennai
4. 4.GuwahatiMedical college and Hospital, Guwahati
5. KEM Hospital, Mumbai
6. B.J. Medical College and Hospital, Ahmedabad

(d):Apart  from  applicable  inclusion  and  exclusion  criteria,  the  following  are  the  eli criteria for Bedaquiline under RNTCP -

The  drug  is to  be  prescribed  to  adults  aged  above  18  Years  belonging  to  the  following  s -groups:

- Patients having pulmonary Multi Drug Resistant (MDR)/ Rifampicin resistant TB havin documented resistance to any fluoroquinolone group of drugs
- Patients  having pulmonary  Multi  Drug  Resistant/  Rifampicin  resistant  TB  having documented resistance to all second line injectable anti TB drugs
- Extensively Drug Resistant  (XDR)TB with: -Resistance to all Fluoroquinolone group of drugs and all second line injectable anti TB drugs
- -Resistance to all Fluoroquinolone group of drugs and any second line injectable TB drugs
- -Resistance to all second line injectable anti TB drugs and any Fluoroquinolone g of drugs
- -Resistance  to  any  second  line  injectable  anti  TB  drugs  a nd  any  Fluoroquinolone group of drugs
- -Treatment  failures  of  MDR - TB  plus  Fluoroquinolones/Second  Line  Injectable resistance
- -Treatment Failures of XDR - TB

(e):I ndian C ouncil  of M edicalR esearch  (ICMR) in  collaboration  with  D epartment  of Biotechnology  (DBT) and Ministry  of  Health  &  Family  Welfare  has  initiated  validation  of simple, affordable indigenous Indian technologies for diagnosis of TB and MDR-TB. Clinical trials  on  shortening  the  treatment  duration  and  for  testing  regimen  for  drug  resistant in teraction between diabetes and TB are ongoing. A nimal studies have been undertaken to find out the efficacy of the TB vaccine candidates. Several new TB vaccine candidates arein clinical phase - I/II and some are in advanced stages of evaluation.

## Annexure-I

| S No   | State/UTs   | 2013   | 2014   | 2015   | Upto June   |
|--------|-------------|--------|--------|--------|-------------|

|    |                      |         |         |         |   2016 |
|----|----------------------|---------|---------|---------|--------|
| 1  | Andaman & Nicobar    | 738     |     756 |     584 |    260 |
| 2  | Andhra Pradesh       | 103707  |   88638 |   61758 |  32854 |
| 3  | Arunachal Pradesh    | 2500    |    2691 |    2748 |   1379 |
| 4  | Assam                | 35624   |   38317 |   38014 |  19015 |
| 5  | Bihar                | 67020   |   67991 |   64928 |  34191 |
| 6  | Chandigarh           | 2890    |    2869 |    3143 |   1656 |
| 7  | Chhattisgarh         | 25889   |   28864 |   29950 |  15807 |
| 8  | Dadar & Nagar Haveli | 411     |     450 |     487 |    278 |
| 9  | Daman & Diu          | 742     |     279 |     284 |    187 |
| 10 | Delhi                | 50727   |   54037 |   55260 |  33190 |
| 11 | Goa                  | 1778    |    1660 |    1599 |    813 |
| 12 | Gujarat              | 74086   |   77395 |   82585 |  45014 |
| 13 | Haryana              | 38104   |   39498 |   40913 |  22312 |
| 14 | Himachal Pradesh     | 13691   |   14441 |   14333 |   7622 |
| 15 | Jammu & Kashmir      | 11038   |   10243 |    9873 |   5469 |
| 16 | Jharkhand            | 34941   |   35907 |   34792 |  18829 |
| 17 | Karnataka            | 61446   |   61328 |   59932 |  31043 |
| 18 | Kerala               | 24204   |   23439 |   22785 |  10929 |
| 19 | Lakshadweep          | 23      |      27 |      40 |     24 |
| 20 | Madhya Pradesh       | 92420   |  100034 |  103108 |  55032 |
| 21 | Maharashtra          | 137237  |  135465 |  130874 |  63939 |
| 22 | Manipur              | 2329    |    2198 |    1881 |    910 |
| 23 | Meghalaya            | 5002    |    4944 |    4674 |   2215 |
| 24 | Mizoram              | 2005    |    1993 |    2088 |   1140 |
| 25 | Nagaland             | 3339    |    3298 |    3316 |   1757 |
| 26 | Orissa               | 45269   |   45777 |   45814 |  24582 |
| 27 | Pondicherry          | 1458    |    1409 |    1288 |    736 |
| 28 | Punjab               | 37258   |   38152 |   38625 |  20952 |
| 29 | Rajasthan            | 94698   |   94908 |   90296 |  47685 |
| 30 | Sikkim               | 1637    |    1630 |    1400 |    822 |
| 31 | Tamil Nadu           | 80407   |   84570 |   80543 |  41822 |
| 32 | Telangana            | -       |   18655 |   39498 |  20211 |
| 33 | Tripura              | 2540    |    2507 |    7394 |   1223 |
| 34 | Uttar Pradesh        | 256733  |  255364 |  246589 | 139550 |
| 35 | Uttarakhand          | 13700   |   14429 |   14317 |   7637 |
| 36 | West Bengal          | 90423   |   89819 |   87468 |  46283 |
|    | TOTAL                | 1416014 | 1443942 | 1423181 | 757368 |

State/UT wise TB deaths reported in the last three years and current year

| State             | 2012   | 2013   |   2014 |   Upto June 2015 |
|-------------------|--------|--------|--------|------------------|
| Andaman & Nicobar | 34     | 18     |     38 |               12 |
| Andhra Pradesh    | 5439   | 5169   |   3089 |             1407 |
| Arunachal Pradesh | 65     | 67     |     68 |               44 |
| Assam             | 1648   | 1678   |   1759 |              863 |
| Bihar             | 2125   | 2139   |   1914 |              994 |
| Chandigarh        | 82     | 65     |     48 |               35 |
| Chhatisgarh       | 1085   | 782    |   1350 |              767 |
| D & N Haveli      | 12     | 15     |     18 |                7 |
| Daman & Diu       | 7      | 8      |      9 |                6 |
| Delhi             | 1241   | 1316   |   1281 |              702 |
| Goa               | 75     | 76     |     52 |               18 |
| Gujarat           | 3808   | 4094   |   4312 |             2349 |
| Haryana           | 1649   | 1628   |   1709 |              900 |
| Himachal Pradesh  | 521    | 518    |    537 |              141 |
| Jammu & Kashmir   | 337    | 303    |    292 |              159 |
| Jharkhand         | 1341   | 1332   |   1465 |              637 |
| Karnataka         | 4542   | 4356   |   4348 |             2093 |
| Kerala            | 1205   | 1158   |   1084 |              478 |
| Lakshadweep       | 1      | 1      |      2 |                1 |
| Madhya Pradesh    | 2966   | 3174   |   3574 |             1881 |
| Maharashtra       | 7687   | 7716   |   7629 |             3494 |
| Manipur           | 72     | 73     |     75 |               36 |
| Meghalaya         | 213    | 202    |    190 |              112 |
| Mizoram           | 79     | 77     |     87 |               56 |
| Nagaland          | 91     | 201    |     77 |               32 |
| Orissa            | 2405   | 2332   |   2451 |             1230 |
| Puducherry        | 78     | 66     |     64 |               30 |
| Punjab            | 1925   | 1678   |   1989 |              988 |
| Rajasthan         | 3592   | 3599   |   3428 |             1882 |
| Sikkim            | 82     | 47     |    222 |               17 |
| Tamil Nadu        | 3865   | 4005   |   4095 |             1987 |
| Telangana         | -      | -      |   2050 |             1008 |
| Tripura           | 150    | 106    |    141 |               81 |
| Uttar Pradesh     | 7866   | 7946   |   8736 |             5049 |
| Uttarakhand       | 552    | 500    |    537 |              262 |
| West Bengal       | 5047   | 5184   |   4506 |             2261 |
| Total             | 61887  | 61629  |  63226 |            32019 |

Under RNTCP, TB Patient who died during the course of treatment regardless of cause is declared as 'Died'

#Treatment outcomes of patients registered as drug sensitive TB under RNTCP are reported 13-15 months after initiation of treatment, hence data upto 2015 has been provided upto March 2015.

## Annexure III

## MDR cases initiated on treatment under RNTCP (2013- 2016)

| State             |   2013 |   2014 |   2015 |   2016 (till June) |
|-------------------|--------|--------|--------|--------------------|
| Andaman & Nicobar |     21 |     39 |     46 |                 27 |
| Andhra Pradesh    |    905 |    719 |    645 |                429 |
| Arunachal Pradesh |    172 |    206 |    171 |                127 |
| Assam             |    388 |    360 |    424 |                164 |
| Bihar             |    554 |    973 |   1320 |                840 |
| Chandigarh        |     43 |     44 |     36 |                 33 |
| Chhattisgarh      |    125 |    141 |    183 |                 93 |
| Delhi             |   1278 |   1572 |   1561 |                920 |
| Goa               |     42 |     37 |     43 |                 22 |
| Gujarat           |   1660 |   1971 |   1860 |               1186 |
| Haryana           |    505 |    561 |    659 |                321 |
| Himachal Pradesh  |    248 |    236 |    192 |                112 |
| Jammu & Kashmir   |    130 |     97 |     97 |                 55 |
| Jharkhand         |    257 |    225 |    206 |                182 |
| Karnataka         |    717 |    731 |    936 |                694 |
| Kerala            |    220 |    198 |    179 |                 98 |
| Madhya Pradesh    |    814 |   1116 |   1276 |                596 |
| Maharashtra       |   4687 |   5072 |   5878 |               3340 |
| Manipur           |     56 |     38 |     35 |                 33 |
| Meghalaya         |    134 |    204 |    189 |                114 |
| Mizoram           |     29 |     47 |     47 |                 18 |
| Nagaland          |     76 |     75 |     63 |                 26 |
| Orissa            |    203 |    244 |    262 |                122 |
| Puducherry        |     18 |     28 |     13 |                 10 |
| Punjab            |    465 |    436 |    446 |                285 |
| Rajasthan         |   1805 |   1663 |   1727 |               1011 |
| Sikkim            |    226 |    242 |    203 |                141 |
| Tamil Nadu        |   1287 |   1155 |   1031 |                599 |
| Telangana         |    720 |    770 |    729 |                311 |
| Tripura           |     10 |     14 |     16 |                  9 |
| Uttar Pradesh     |   1859 |   2798 |   4765 |               2962 |
| Uttarakhand       |    177 |    281 |    303 |                123 |
| West Bengal       |   1288 |   1798 |   1563 |               1085 |
| Grand Total       |  21119 |  24091 |  27104 |              16088 |

## MDR cases died andreported under RNTCP (2013 - 2015)

| State             | 2010   | 2011   |   2012 |   2013 |
|-------------------|--------|--------|--------|--------|
| Andaman & Nicobar |        | 0      |      2 |      9 |
| Andhra Pradesh    | 17     | 47     |    169 |    221 |
| Arunachal Pradesh |        | 0      |     11 |     13 |
| Assam             |        | 0      |     31 |     83 |
| Bihar             |        |        |     25 |    125 |
| Chandigarh        |        | 0      |     10 |      5 |
| Chhattisgarh      |        | 0      |      5 |     29 |
| Delhi             | 58     | 110    |    285 |    222 |
| Goa               |        | 1      |      6 |      8 |
| Gujarat           | 168    | 190    |    416 |    353 |
| Haryana           | 16     | 20     |     34 |    145 |
| Himachal Pradesh  |        | 13     |     18 |     47 |
| Jammu & Kashmir   |        | 0      |     17 |     23 |
| Jharkhand         | 0      | 7      |     25 |     43 |
| Karnataka         |        | 15     |     19 |    195 |
| Kerala            | 18     | 17     |     46 |     36 |
| Madhya Pradesh    |        | 8      |     80 |    189 |
| Maharashtra       | 49     | 102    |    775 |    965 |
| Manipur           |        | 0      |      5 |      5 |
| Meghalaya         |        | 0      |     18 |     22 |
| Mizoram           |        | 0      |      6 |      4 |
| Nagaland          |        | 0      |      6 |     10 |
| Orissa            | 3      | 8      |     19 |     32 |
| Puducherry        |        | 2      |      6 |      5 |
| Punjab            |        | 0      |     49 |    110 |
| Rajasthan         | 46     | 69     |    468 |    411 |
| Sikkim            |        | 1      |      4 |     33 |
| Tamil Nadu        | 38     | 38     |    171 |    295 |
| Telangana         | 28     | 60     |    116 |    183 |
| Tripura           |        | 1      |      1 |      9 |
| Uttar Pradesh     |        | 14     |     28 |    462 |
| Uttarakhand       |        | 4      |     19 |     23 |
| West Bengal       | 42     | 38     |    139 |    216 |
| Grand Total       | 483    | 765    |   3029 |   4531 |

Under RNTCP, MDR-TB Patients who died during the course of treatment regardless of cause is declared as 'Died'. Data is till 31st December  2013 (as treatment outcomes of drug resistant TB patients registered under RNTCP are reported 31-33 months after initiation of treatment), Data of Lakshadweep is reported along with Kerala, whereas Data of Daman, Diu and Dadra & Nagar Haweli is reported along with Gujarat.

## Annexure IV

## Revised National TB Control Programme

## State wise Allocation and Utilisation (cash and kind)

(Rs. In lakhs)

| Sl.No.   | Name of the State UT   | 2013- 14   | 2013- 14    | 2014- 15   | 2014- 15    | 2015- 16   | 2015- 16    | 2016- 17*   | 2016- 17*   |
|----------|------------------------|------------|-------------|------------|-------------|------------|-------------|-------------|-------------|
| Sl.No.   | Name of the State UT   | Allocation | Expenditure | Allocation | Expenditure | Allocation | Expenditure | Allocation  | Expenditure |
| 1        | Andhra Pradesh         | 4907.34    | 3947.42     | 2861.96    | 2411.67     | 2200.34    | 2315.49     | 2194.68     | 1740.21     |
| 2        | Andaman & Nicobar      | 87.15      | 75.23       | 87.15      | 69.8        | 90.90      | 90.9        | 90.90       | 69.06       |
| 3        | Arunachal Pradesh      | 565.36     | 418.48      | 565.36     | 577.51      | 552.32     | 552.32      | 564.48      | 415.44      |
| 4        | Assam                  | 4303.74    | 1535.01     | 4303.74    | 2500.55     | 2527.13    | 2527.13     | 2776.33     | 1137.18     |
| 5        | Bihar                  | 4094.59    | 1013.72     | 4094.59    | 2089.95     | 2963.81    | 2464.15     | 2962.00     | 2253.07     |
| 6        | Chandigarh             | 154.54     | 134.74      | 154.54     | 191.71      | 156.14     | 156.14      | 156.14      | 83.07       |
| 7        | Chattisgarh            | 1440.60    | 912.66      | 1440.6     | 1620.95     | 1401.08    | 1152.24     | 1398.15     | 653.60      |
| 8        | D & N Haveli           | 68.05      | 52.68       | 68.05      | 44.55       | 72.03      | 64.3        | 72.03       | 51.45       |
| 9        | Daman & Diu            | 43.47      | 25.83       | 43.47      | 12.62       | 45.98      | 45.98       | 45.98       | 32.66       |
| 10       | Delhi                  | 1820.02    | 1426.7      | 1820.02    | 1844.34     | 1705.12    | 1705.12     | 1018.43     | 791.26      |
| 11       | Goa                    | 116.34     | 103.08      | 116.34     | 134.56      | 127.78     | 72.77       | 127.61      | 11.10       |
| 12       | Gujarat                | 4857.52    | 5845.89     | 4857.52    | 3623.03     | 3298.04    | 3423.41     | 3282.10     | 2404.91     |
| 13       | Haryana                | 1292.26    | 604.37      | 1292.26    | 1125.74     | 1207.93    | 1261.1      | 1204.96     | 953.15      |
| 14       | Himachal Pradesh       | 581.22     | 548.08      | 581.22     | 819.6       | 837.57     | 852.38      | 833.82      | 534.46      |
| 15       | Jammu & Kashmir        | 943.43     | 680.01      | 943.43     | 720.57      | 1038.26    | 829.1       | 1036.78     | 744.78      |
| 16       | Jharkhand              | 1783.56    | 1001.41     | 1783.56    | 855.1       | 1512.16    | 1216.61     | 1511.23     | 61.80       |
| 17       | Karnataka              | 3195.23    | 1789.59     | 3195.23    | 3084.58     | 3186.19    | 2011.15     | 3177.65     | 2255.14     |
| 18       | Kerala                 | 1440.91    | 1807.19     | 1440.91    | 1246.72     | 1395.33    | 1365.74     | 1393.01     | 1008.78     |
| 19       | Lakshadweep            | 35.39      | 19.91       | 35.39      | 23.16       | 37.95      | 37.95       | 37.95       | 0.00        |
| 20       | Madhya Pradesh         | 3081.84    | 2105.28     | 3081.84    | 2483.31     | 2880.71    | 3031.22     | 2878.14     | 2201.53     |
| 21       | Maharashtra            | 6657.74    | 6708.83     | 6657.74    | 9688.05     | 8085.75    | 8438.54     | 8059.40     | 6483.16     |
| 22       | Manipur                | 657.22     | 277.82      | 657.22     | 446.82      | 524.57     | 524.57      | 548.31      | 331.31      |
| 23       | Meghalaya              | 550.67     | 288.08      | 550.67     | 685.85      | 427.62     | 427.62      | 453.95      | 278.94      |
| 24       | Mizoram                | 414.39     | 304.09      | 414.39     | 386.57      | 392.75     | 392.75      | 402.29      | 271.08      |
| 25       | Nagaland               | 596.41     | 253.26      | 596.41     | 377.66      | 460.49     | 460.49      | 477.38      | 310.26      |
| 26       | Orissa                 | 2141.81    | 1205.67     | 2141.81    | 2031.3      | 1991.54    | 1664.56     | 1986.79     | 925.65      |
| 27       | Puducherry             | 183.56     | 177.96      | 183.56     | 148.63      | 187.88     | 204.88      | 110.57      | 85.00       |
| 28       | Punjab                 | 1207.19    | 1239.71     | 1207.19    | 1414.16     | 1273.22    | 1332.87     | 1270.01     | 985.60      |
| 29       | Rajasthan              | 3653.38    | 2404.08     | 3653.38    | 2956.61     | 2792.23    | 2934.77     | 2781.23     | 2268.95     |
| 30       | Sikkim                 | 242.98     | 181.61      | 242.98     | 488.26      | 426.92     | 426.92      | 474.88      | 68.12       |
| 31       | Tamilnadu              | 3131.84    | 2519.66     | 3131.84    | 3622.28     | 3367.31    | 3515.37     | 3353.00     | 1788.36     |
| 32       | Tripura                | 583.71     | 184.02      | 583.71     | 138.76      | 290.20     | 290.2       | 300.38      | 124.50      |
| 33       | Uttar Pradesh          | 7631.54    | 4982.92     | 7631.54    | 7856.69     | 7350.90    | 10455.95    | 7337.90     | 5557.34     |
| 34       | Uttrakhand             | 661.14     | 537.47      | 661.14     | 826.36      | 651.62     | 672.4       | 650.44      | 507.49      |
| 35       | West Bengal            | 3834.82    | 2685.07     | 3834.82    | 3191.68     | 3187.70    | 3383.41     | 3183.10     | 2464.18     |
| 36       | Telangana              |            |             | 2045.38    | 1795.27     | 1672.53    | 1429.96     | 1667.00     | 298.14      |
| Total    | Total                  | 66960.96   | 47997.53    | 66960.96   | 61534.97    | 60320.00   | 61730.46    | 59819.00    | 40150.73    |