JUST because a certain disease is inactive doesn’t mean its bearer is safe. Understanding it, in fact, is like dealing with a hidden enemy, as those infected do not manifest the symptoms of an active illness and cannot transmit this to another host. It could be a public-health menace waiting to explode, inasmuch as 30 million Filipinos out of the more than 100 million total Philippine population may harbor the inactive form of tuberculosis, known as latent tuberculosis (TB) infection.

With 2 billion people infected world wide and one dying every 25 seconds, TB is a global public-health concern. “Latent TB infection is one of the major contributors to the pool of active TB disease cases and should be regarded as a major public health problem,” warned Aamir Khan, an epidemiologist and executive director of Interactive Research and Development based in Karachi, Pakistan.

Speaking before participants of this year’s annual convention of the Philippine Coalition Against Tuberculosis (PhilCAT), Khan explained that expanding access to testing and caring for people with latent TB infection would help countries like the Philippines catalyze prevention and contribute to ending the epidemic.





“People who are infected with TB but are not sick make up a reservoir of potential future cases of TB, and it is estimated that roughly 10 percent of them will eventually have active disease, 5 percent within the first two years after infection,” he said in a speech at the PhilCAT event held at Crowne Plaza Manila Galleria, last August 16 to17.

The chance of someone developing active TB disease later in life increases significantly, especially if a person becomes sick with other diseases that weaken the immune system. Consider, for instance, when someone contracts HIV — the virus that causes AIDS — or develops chronic kidney disease.

Medical experts say patients with active TB experience such symptoms as coughing, which lasts three or more weeks, coughing up blood, shortness of breath, fever, chills, night sweats and unintentional weight loss.

Reinvigorated program

Stressing the importance of saving the lives of those with latent TB infection and reducing their suffering, Khan said, “There should be a reinvigorated program that could make sure this group of individuals obtain the treatment they need, to prevent latent TB infection developing into active TB disease.”

Aside from prioritizing people living with HIV and children under the age of five who have been in contact with people who have TB, this group of individuals should also be included: HIV-negative children aged 5 years and older, adolescents and adults who are in contact with TB patients, including those with multidrug-resistant TB.

Shorter treatment regimens may breed better compliance by patients with latent TB infection, Khan said, citing a successful campaign done in Karachi. A weekly dose of rifapentine and isoniazid over three months, for instance, was offered as an alternative to the usual six months of isoniazid as preventive treatment. Another regimen is a daily does of rifampicin plus isoniazid for three months.

“These shorter regimens helped our patients adhere to their treatment and complete it,” Khan revealed, telling his audience he looks forward to implementing similar guidelines in the Philippines. A number of opportunities may be derived from such guidelines, he said, including simpler, shorter, preventive TB regimens, which will help reinvigorate TB prevention for high burden countries like the Philippines.

This year, PhilCAT is moving to strengthen a campaign to identify those who have latent TB infection and give them prompt treatment. The organization’s founding chair, Camilo Roa, explained that while not all with latent TB infection would develop the active form of disease, about 5 percent of them — or 1.5 million Filipinos — would within the next two years, if they do not receive adequate treatment.

“Identifying and providing these individuals with preventive therapy may hold the key to curbing the number of Filipinos suffering from the active form of TB,” he said.