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TDR-TB: What’s all the hype?

Also published on Global Voices is an international community of bloggers who report on blogs and citizen media from around the world.
The Indian media and blogosphere have been locked in fierce battle over two words: “extensively,” and “totally.” If you’ve been following Indian news at all, you know that I’m talking about the global health community’s tuberculosis debate.
India’s media sphere exploded last week with reports from Mumbai of a tuberculosis strain completely resistant to all known treatment. The Indian newspapers coined it “totally drug-resistant tuberculosis” or TDR-TB. But just a few days later the World Health Organization released a statement refuting the term TDR-TB, saying that it has no clearly definition for TDR-TB, and that the TB emerging in Mumbai, India is merely another strain of extremely drug-resistant TB (XDR-TB). They’re now calling it XXDR-TB, or “extensively drug-resistant TB.”

A blogger for, Bharati Ghanashyam, summed up the outrage that erupted in the global health blogosphere following the WHO’s statement, “Call it any name but banish it.”

The blogosphere and headlines erupted with experts and Indian citizens wondering why the Government of India and the big players in TB treatment were arguing over what to call it, rather than what to do about it.

Journalists Against TB, a group of six Indian authors who formed a blog to advocate for TB issues in India, posted on their blog:

“And now it’s TDR-TB! Why are we not able to get our act together?”

Ghanashyam commented that the TDR-TB fiasco arose on the heels of the news that India had been declared polio-free for an entire year. His question: how could India achieve such a milestone but drop the ball so badly with TB? He then noted that there was “considerable debate, denial and discussion on whether this new form can be termed TDR-TB. As per a report in the Indian Express, “The doctors from Hinduja have unnecessarily raised a panic alarm. The term TDR is not recognized by the WHO or the Revised National Tuberculosis Control Programme (RNTCP). As of now, they are only slotted as XDR-TB cases,” said an official from the Directorate of Health Services.”

Does it really matter what we call it? “Call it any name but banish it,” Ghanashyam wrote.

Twitter user TBVI_EU agreed: “It makes little difference what we call different forms of TB. What matters is people are dying,” he tweeted on Jan. 19.

Blogger Alanna Shaikh, an expert in health consulting, got some attention from the development community for her blog post on End the Neglect: “Blogging on Behalf of the Global Network for Neglected Tropical Diseases,” and calling the new form “TDR-TB.”

“TDR-TB is exactly what it sounds like. Doctors have not yet been able to identify a treatment for this TB that will work,” she wrote. “This is a bad, bad development for global health.”

To put the debate into context, the story broke early last week, Jan. 17, when the Times of India reported that 12 people were quarantined in Mumbai with a “killer” form of tuberculosis. The entire global health community began talking about the dire threat that “TDR-TB” posed to the general population. A few days later, the World Health Organization released a statement saying that the term “totally drug-resistant TB (TDR-TB),” used in media reports to describe eight cases of tuberculosis in Mumbai, was, in fact, an incorrect use of the term.

The WHO officially does not endorse a definition for “total drug resistance.” The WHO claims on their website,, that there is no way to determine whether strains of TB that appear resistant to drugs in the laboratory, are actually resistant to the drugs in the patient. This may seem counter-intuitive since the 12 patients suffering from a particularly virulent form of tuberculosis in Mumbai have obviously show they are not susceptible to the available drugs, the WHO is simply attempting to state that it lacks a standardized test to determine just how effective different combinations of the drugs are in the laboratory vs. treating real patients.

Incidentally, India’s Ministry of Health issued a report on Jan. 20 stating that nine out of the 12 reported patients were stable on their current treatment while three had died, confirming that the strain is susceptible to some antibiotic treatment.

One thing remains certain, the #tuberculosis Twitter stream and TB online advocacy community are adamant that tuberculosis needs to remain a high-priority for donor governments and international donor organizations like the Global Fund and the United Nations.

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