Lok Sabha Question No. 33 (UNSTARRED), answered on 2019-06-21
Subject: Multi-Drug-Resistant TB
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Umesh G. Jadhav, Feroze Varun Gandhi

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

## LOK SABHA UNSTARRED QUESTION NO. 33 TO BE ANSWERED ON 21 ST JUNE, 2019

## MULTI - DRUG - RESISTANT TB

## 33. DR. UMESH G. JADHAV: SHRI FEROZE VARUN GANDHI:

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

- (a) whether as per the World Health Organization TB report, 2018, India continues to ha maximum  TB  cases  in  the  world  and  accounts  for  nearly  27  per  cent  of  the  10  million pati ents in the world;
- (b) if so, the reaction of the Government thereto;
- (c) whether the number of patients suffering from Multi - Drug- Resistant TB in the country are among the highest in the world;
- (d) if so, the details thereof indicating the number of patients who have been cured and during the last three years, State/ UT - wis ; and
- (e) the further steps taken/being taken by the Government to combat antibiotic resistance as a phenomenon and pr event new cases of TB from emerging?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI ASHWINI KUMAR CHOUBEY)

- (a): The estimated incidence of Tuberculosis in India as per the Global TB report 2018 i per  lakh population  for  the  year  2017.  India  accounts  for  27.4  lakh  estimated  new  TB  ca annually, which is the highest in terms of absolute numbers. However, in terms of incide Tuberculosis per lakh population, India ranks 35th in the world.
- (b):   The Mi nistry has developed the National Strategic Plan (NSP) for Tuberculosis (20 -2025) with the goal of ending TB by 2025.

The details are indicated in reply to part (e).

- (c ):    As per Global TB report (2018), the estimated Multi Drug Resistant/ Rifampicin Resistant (MDR/ RR) TB patient was 5,58,000 globally and 1,35,000 in India, highest in the worl terms of number of cases. India stands at 22 nd among 30 high burden countries for MDR RR TB (Global TB report 2018) in terms of estimated number of cases pe r lakh population.

(d):     The number of patients cured of TB in the last three years State/ UT - wise is enclosed as Annexure 1. The number of deaths reported due to TB State/ UT - wise in the last three years is enclosed as Annexure 2.

(e):   The Ministry of Health and Family Welfare has taken various regulatory measures to cur the misuse of antibiotics. Details are as under -

- Antibiotics are included in Schedule H and H1 of the Drugs and Cosmetics Rule 1945  and  are  required  to  be  sold  by  retail  only  unde r  the  prescription  of  a Registered Medical Practitioner. Further in order to regulate  the  hum consumption of antibiotics to restrict the over the counter availability of antibiotics,  the  Drug  &  Cosmetics  Rules,  1945  have  since  been  amended  vide G azette  Notification  No  GSR  588  (E)  dated  30.08.2013  incorporating  a  new, namely, Schedule H1 under the Drugs & Cosmetics Rules containing 47 drugs which include antibiotic drugs, Anti TB drugs and certain habit -forming drugs. The drugs falling under Schedu le H1 are required to be sold in the country with the following conditions:
- o The  supply  of  a  drug  specified  in  Schedule  H1  shall  be  recorded  in separate register at the time of the supply giving the name and addres the  prescriber,  the  name  of  the patient,  the  name  of  the  drug  and  the quantity supplied and such records shall be maintained for three years be open for inspection.
- o The drug specified in Schedule H1 shall be labelled with the symbol R which shall be in red and conspicuously displaye d on the left top corner of the label, and shall also be labelled with the following words in a box

- Not to be sold by re Practitioner.'

a red border: 'SCHEDULE H1 DRUG - WARNING: -It  is  dangerous  to  take  this  preparation  except  in  accordance  with medical advice. tail without the prescription of a Registered Medical

- The Drugs and Cosmetics Rules were amended by the Ministry of Health and Family Welfare vide Gazette notification G.S.R. 28(E) dated 17.01.2012, to ma a  provision  that  the  container  of a  medicine  for  treatment  of  food  producing animals shall be labelled with the withdrawal period of the drug for the spec which it is intended to be used.
- The  Department  of  Animal  Husbandry,  Dairying  and  Fisheries  has  issued  a circular to all Director s/Commissioners (Animal Husbandry) of all state and UTs vide their letter no. 102 -74/2014 - Trade Dated on 03.06.2014 and directed for the judicious  use  of  antibiotics  and  hormones  for  the  treatment  of  ailing producing animals and at the same time use o f antibiotics and hormones in animal feed should also be stopped. Subsequently DCG (I) has also issued an advisory all States/UTs on 12.09.2014 that use of Antibiotics and Hormones in animal f should also be stopped.

The Ministry has developed the Na tional Strategic Plan (NSP) for Tuberculosis (2017 -2025) with the goal of ending TB by 2025.

## The key focus areas are:

- Early diagnosis of all the TB patients, prompt treatment with quality assured dru treatment regimens along with suitable patient s upport systems to promote adherence.
- Engaging with the patients seeking care in the private sector.
- Prevention  strategies  including  active  case  finding  and  contact  tracing  in  high vulnerable population
- Airborne infection control.
- Multi - sectoral re sponse for addressing social determinants.

## Annexure 1

|                           | Number of TB patients Cured   | Number of TB patients Cured   | Number of TB patients Cured   |
|---------------------------|-------------------------------|-------------------------------|-------------------------------|
| State                     | 2016                          | 2017                          | 2018                          |
| Andaman & Nicobar Islands | 147                           | 179                           | 178                           |
| Andhra Pradesh            | 32178                         | 49892                         | 33354                         |
| Arunachal Pradesh         | 901                           | 648                           | 837                           |
| Assam                     | 14593                         | 12095                         | 11434                         |
| Bihar                     | 28841                         | 21189                         | 19096                         |
| Chandigarh                | 1156                          | 1185                          | 1163                          |
| Chhattisgarh              | 12349                         | 11881                         | 13044                         |
| Dadra &Nagar Haveli       | 234                           | 210                           | 279                           |
| Daman &Diu                | 102                           | 123                           | 104                           |
| Delhi                     | 17157                         | 16543                         | 14105                         |
| Goa                       | 614                           | 601                           | 506                           |
| Gujarat                   | 45238                         | 47022                         | 43251                         |
| Haryana                   | 17945                         | 14464                         | 16573                         |
| Himachal Pradesh          | 6142                          | 5806                          | 6059                          |
| Jammu &Kashmir            | 4027                          | 3478                          | 2709                          |
| Jharkhand                 | 16190                         | 15872                         | 14226                         |
| Karnataka                 | 26600                         | 25648                         | 29307                         |
| Kerala                    | 10433                         | 8982                          | 9384                          |
| Lakshwadeep               | 22                            | 10                            | 29                            |
| Madhya Pradesh            | 43302                         | 41750                         | 43341                         |
| Maharashtra               | 48956                         | 42415                         | 43414                         |
| Manipur                   | 696                           | 603                           | 585                           |
| Meghalaya                 | 1673                          | 1198                          | 848                           |
| Mizoram                   | 589                           | 457                           | 384                           |
| Nagaland                  | 1068                          | 844                           | 778                           |
| Odisha                    | 20069                         | 16278                         | 20961                         |
| Puducherry                | 657                           | 672                           | 745                           |
| Punjab                    | 15782                         | 14654                         | 14726                         |
| Rajasthan                 | 39989                         | 39613                         | 37646                         |
| Sikkim                    | 475                           | 381                           | 294                           |
| Tamil Nadu                | 34404                         | 33188                         | 40293                         |
| Telangana                 | 18779                         | 20264                         | 19692                         |
| Tripura                   | 1362                          | 983                           | 864                           |
| Uttar Pradesh             | 112973                        | 81622                         | 76760                         |
| Uttarakhand               | 5852                          | 4761                          | 4659                          |
| West Bengal               | 43272                         | 40626                         | 41089                         |
| India                     | 6,24,767                      | 5,55,904                      |                               |

## Statewise deaths reported due to TB in India

| State                |   2014 |   2015 |   2016 |
|----------------------|--------|--------|--------|
| Andaman & Nicobar    |     38 |     17 |     21 |
| Andhra Pradesh       |   3089 |   2764 |   4537 |
| Arunachal Pradesh    |     68 |     74 |     39 |
| Assam                |   1759 |   1785 |   1588 |
| Bihar                |   1914 |   1800 |   1415 |
| Chandigarh           |     48 |     65 |     68 |
| Chhattisgarh         |   1350 |   1436 |   1596 |
| Dadar & Nagar Haveli |     18 |     18 |     15 |
| Daman & Diu          |      9 |     14 |     14 |
| Delhi                |   1281 |   1296 |   1370 |
| Goa                  |     52 |     45 |     49 |
| Gujarat              |   4312 |   4657 |   5087 |
| Haryana              |   1709 |   1700 |   1543 |
| Himachal Pradesh     |    537 |    539 |    547 |
| Jammu & Kashmir      |    292 |    316 |    342 |
| Jharkhand            |   1465 |   1192 |    994 |
| Karnataka            |   4348 |   4192 |   3958 |
| Kerala               |   1084 |    953 |    961 |
| Lakshadweep          |      2 |      1 |      1 |
| Madhya Pradesh       |   3574 |   3761 |   3816 |
| Maharashtra          |   7629 |   6904 |   6121 |
| Manipur              |     75 |     77 |     54 |
| Meghalaya            |    190 |    214 |    164 |
| Mizoram              |     87 |     93 |     56 |
| Nagaland             |     77 |     44 |     49 |
| Orissa               |   2451 |   2380 |   2162 |
| Pondicherry          |     64 |     55 |     63 |
| Punjab               |   1989 |   1786 |   1799 |
| Rajasthan            |   3428 |   3667 |   3877 |
| Sikkim               |    222 |     38 |     44 |
| Tamil Nadu           |   4095 |   4205 |   4118 |
| Telangana            |   2050 |   1926 |      0 |
| Tripura              |    141 |    162 |    113 |
| Uttar Pradesh        |   8736 |  10233 |   8256 |
| Uttarakhand          |    537 |    512 |    443 |
| West Bengal          |   4506 |   4376 |   4448 |
| TOTAL                |  63226 |  63297 |  59728 |