World TB day is observed on 24th of March every year. This year’s theme is “The Clock is Ticking”. This day is designed to raise public awareness about the TB epidemic, which is still the number one killer globally among infectious diseases. Tuberculosis is a curable and preventable disease. The global burden of the disease attributes to delay and poor diagnostic and inadequate treatments, which leads to the severity of the disease with an increase in mortality rate and the spike in transmission and development of drug resistance. TB does not spare any country in the world, even though it unreasonably impacts LMIC (lower- to middle-income countries). A total of 3% of global TB cases occur in the WHO European Region. In the US, about 13 million people live with latent TB.

Even as the world comes to grips with the mounting death toll due to the Covid-19 pandemic, the WHO released its 2020 Global Tuberculosis Report last week. The news is not good. Nearly 1.4 million people died from TB in 2019. Of the estimated 10 million people who developed TB that year, some 3 million were either not diagnosed, or were not officially reported to national authorities.

A six-month-long duration of TB treatment under the DOTS programme is fraught with issues like non-compliance by patients, mix up of drugs, etc., contributing to the emergence of multi-drug-resistant TB. Shortening the duration of treatment has been a priority area in the TB drug discovery research efforts. In a recent Phase 3 clinical trial (Study 31/A5349), a 4-month regimen is as efficacious as the 6-month regimen for treatment of drug-susceptible tuberculosis in patients. This landmark breakthrough is expected to strengthen the global efforts for the elimination of TB by 2030.

Vaccines have played a major role in our efforts to control many bacterial and viral infectious diseases. Smallpox is the classical example of a viral disease that has been eradicated primarily by using an effective vaccine.

Mycobacterium tuberculosis (Mtb) infection accounts for the highest number of human deaths in low- and middle-income countries of the world. Mtb is also the most common opportunistic infection accompanying HIV infection. The death rate for combined Mtb/HIV infection is almost three-fold higher when compared to Mtb infection of HIV-seronegative patients, and the increase is not due simply to depletion of CD4 T cells due to HIV. The increased risk of mortality is due to a syndemic interaction between the two pathogens that leads to advanced immunodeficiency, chronic immune activation, and increased disease dissemination. Because of the synergy, eradication of MTB is dependent on the eradication of HIV. Though HIV/AIDS is often described as incurable, the recent “shock-and-kill” strategy to eradicate HIV holds promise for the eradication of MTB. Coinfection also amplifies transmission of multidrug-resistant tuberculosis (MDRTB), which, besides requiring longer treatment, has a very low success rate. Pending effective vaccine development, there is a need to identify newer targets for the development of drugs to treat MDRTB & XDR-TB.

Tuberculosis in captive Asian elephants has been a subject of interest among the experts and practitioners for the past few decades. During COVID -19 pandemic, the zoos remained closed, and the caregivers had to spend extended hours in the enclosures to help the elephants get rid of boredom and depression. Such proximity enhanced the chance of TB transmission from elephants to human bodies. Hence, effective measures are needed for the early detection of TB infection in captive elephants to curb further transmission.