Tuberculosis cases increase by 40% in capital

The chief of infectious diseases at Health Authority-Abu Dhabi attributed the upward trend to better detection methods.

Cases of tuberculosis in the capital have increased by more than 40 per cent, according to new figures from the Health Authority-Abu Dhabi.

Doctors reported 894 active cases of tuberculosis last year compared with 625 in 2010 and 272 in 2009.

Of the those cases, 708 were pulmonary tuberculosis, with expatriates accounting for more than 90 per cent of all cases. The upward trend is continuing, with 183 pulmonary TB infections reported so far this year compared with 143 in the first quarter of last year.

Dr Farida Al Hosani, the section head of communicable diseases at Haad, attributed the rise to better detection methods.

"Before 2010, a culture was not taken for every case," she said. "With improved quality of screening we are now able to catch more cases."

However, experts say the strict regulations could also play a role.

"Having a law that deports those with TB can actually be counterproductive," said Dr Lucica Ditiu, executive secretary of the Stop TB partnership. "Not only does it add to the stigma, but it makes people afraid to be diagnosed, making them wait longer and spread the disease."

Officials at the Health Authority-Abu Dhabi (Haad) say they have taken stringent measures to combat the disease. This includes implementing the World Health Organization's treatment standards last May, said Dr Al Hosani.

"This provides detailed guidelines for health-care professionals on how to deal with tuberculosis, including specifying the facilities that patients need to be admitted to, whether public or private," she said. "Medical treatment needs to be closely supervised."

When an active form of the disease is first diagnosed, patients are quarantined at any of the Seha hospitals in Abu Dhabi. All cases are immediately reported to the Ministry of Interior.

Once patients are no longer infectious, usually between the first two weeks and two months of treatment, their sponsors must sign an agreement form ensuring the patient receives adequate treatment before they can be discharged. Haad also requires an agreement by the patient's family or friends to support the patient during treatment.

To effectively monitor this, Haad introduced an electronic tracking record for TB cases through a notification system. Haad is looking at introducing the Polymerse Chain Reaction method as a standard screening procedure. It uses DNA-based technology allowing doctors to identify if a person is TB-positive in as little as two hours.

Once the sputum is taken, two tests are done - a smear and a culture. Results for the smear tests take one day, while for the culture tests it takes up to six weeks. But the new PCR technology can minimize the six-week wait to two hours.

If the smear tests are positive, patients will be placed in quarantine until the culture tests are confirmed.

What happens after a positive test

After a patient receives a diagnosis of pulmonary TB, he is treated with a six-month to one-year course of drugs. After this, the patient is considered cured.

Within the first two weeks to two months, however, a patient becomes non-infectious. It is at this point that expatriate patients are usually sent back to their home countries, said Dr Mirza Al Sayegh, a consultant physician with the Dubai Health Authority and head of the Emirates Respiratory Society.

“This way we ensure the patient cannot spread the disease to others when he is on the plane,” he said.

The fault with this, experts said, is that there is no guarantee that patients will continue treatment. This can result in a relapse, or worse, a drug-resistant form of the disease, said Dr Lucica Ditiu, executive secretary of the Stop TB partnership.

In addition to the health danger, drug-resistant forms of TB have financial implications. Treating tuberculosis costs US$25 (Dh92) for a six-month course of drugs. Drug-resistant forms of the infection, however, can cost between $3,000 and $3,500 for the necessary two-year treatment course, said Dr Ditiu, adding that combatting the disease is not the responsibility of the health authorities alone.

“The first and most important thing is admitting there is a problem,” she said. “Combatting TB requires high levels of awareness as well as fiscal power. What we’ve seen work is linking the issue to a powerful personality who is willing to say we have a problem and let’s work together to fight it.”