Tubercublosis, a preventable and curable disease, is still one of the top infectious killers worldwide, causing the death of approximately 4,500 people daily. 

Throughout the years, several global efforts have tried to reduce the number of deaths from the disease and today the TB burden weighs heaviest on the poorest and most vulnerable people and countries thereby emphasising existing inequalities.

World Tuberculosis Day was marked on Sunday, the date marking the day Robert Koch, a German physician, discovered the bacterium causing TB in 1882. The theme chosen for this year’s World TB day was ‘It’s time’. 

This slogan urges governments, affected communities, civil organisations and healthcare providers to unite their forces and eradicate TB once and for all without leaving anyone behind.

‘The End TB strategy’, which has been proposed by the World Health Organisation, is based on five pillars by which governments must abide to effectively reduce the number of deaths and new TB cases by 95 and 90 per cent respectively by the year 2035. These are scale up access to prevention and treatment; promote an equitable, rights-based and patient-centred TB response; promote an end to stigma and discrimination; ensure sufficient and sustainable financing including for research; and build accountability.

According to the Tuberculosis Surveillance and Monitoring in Europe report published last year, 50 cases of TB were noted in Malta in 2016. Forty-eight of these cases involved foreigners, including irregular immigrants who come from countries where TB is endemic and foreign workers who come to Malta legally. 

Moreover, the TB diagnosed in foreign workers − whatever their origin − has been observed to be slightly more drug-resistant when compared to the other cases.

Brian Farrugia, a medical consultant at the Chest Clinic at St Luke’s Hospital said that, among the Maltese, “TB has essentially become a disease of the elderly”. 

When asked about whether Malta is keeping up with  the targets proposed by  the ‘End TB strategy’, Dr Farrugia said Malta has always  been compliant with WHO International guidelines.

He added that there is a culture of accountability in the departments managing and monitoring this disease in Malta. 

“The Department of Public Health and Disease Surveillance Unit, Chest Unit and Clinic, Infectious Disease and Prevention Control Unit Consultants and Paediatric Department, the Laboratory, Radiology and bronchoscopy services, Agency for the Welfare of Asylum Seekers (AWAS) and the Jesuit refugees services (JRS) are all in good communication with each other and work together with the aim of delivering the best possible care,” he said.

The treatment of TB in Malta involves a multi-disciplinary team approach

When irregular immigrants arrive in Malta they are screened for the infectious form of the disease via X-ray. The same goes for people working in the healthcare sector and catering industry. They are also screened for the latent or dormant disease by undertaking a blood test called the Quantiferon test.

“Thankfully, access to healthcare in Malta is good and  the treatment of TB in Malta involves a multi-disciplinary team approach” said Dr Farrugia.

“Front line doctors such as GPs, casualty doctors and nurses are trained to always maintain a high level of suspicion when it comes to the detection of TB. Pharmacy services are aware of what the projected requirements are and supply effective anti-TB drugs. And the laboratory services department has shown the greatest development in the last several years with regards to TB detection in Malta.” 

Sputum samples are examined microscopically and cultured on both liquid and solid culture media. A doctor can obtain a diagnosis within a day or two through a polymerase chain reaction (PCR) test.

Dr Farrugia also said that the diagnosis and treatment for TB have been given free of charge to those legally or irregularly in Malta since the year 2000. 

“This is done without any discrimination, in confidentiality and respect,” he noted.

Dr Farrugia also stated that a personal and trusting relationship is built between the patient and healthcare professionals. This is because people diagnosed with TB are seen regularly so that compliance to treatment can be strengthened and monitored. Treatment for TB generally involves a six-month course of drugs.

According to the doctor, there is obviously always room for improvement. He mentioned improving direct observation of drug taking; the possibility of purchasing and obtaining new anti-TB drugs if required such as Bedaquiline and Delamanid for drug resistance; widening the treatment of latent TB infection; continuing to increase more awareness among healthcare workers and the population; and keeping a watchful eye for changing epidemiology.

How may TB present itself?

TB can affect different organs in the body so it can present itself in many ways, but the lungs are affected in most cases. The most common symptoms are a persistent cough of more than three weeks (with or without sputum), unexplained weight loss and sudden profuse sweating, especially during the afternoon or at night. 

Many other diseases can also show up with these symptoms, so if they are new to you, speak to your GP.

Antonia Bonello is a medical student.