Prof (Dr) Sunil Raina

Traditional TB control relies on identifying & testing individuals, but stigma, delayed care-seeking, & gaps in surveillance allow transmission to continue — especially in crowded indoor spaces

The Challenge
Tuberculosis (TB) remains one of the world’s deadliest infectious diseases, with over 10 million cases and 1.3 million deathsannually. Drug-resistant TB is an escalating biosecurity risk @organicbotanic.bsky.social @brownecfm.bsky.social @microlabdoc.bsky.social

#TB
Finding Solutions
Instead of asking “who is sick?” our solution asks “is transmission happening here?”—shifting the focus from individuals to locations where airborne spread occurs
@elhopkins.bsky.social @njbbari3.bsky.social @drinfosec.bsky.social
unpolitics.global/pubs/project...

The COVID-19 pandemic transformed this scientist into a research-integrity sleuth Lonni Besançon has faced online abuse, threats and legal challenges. But he remains proud of his service to science and society.

Need more like him to help differentiate between Science & Propaganda
www.nature.com/articles/d41...

‘Sleeping’ cancer cells in the lungs can be roused by COVID and flu Inflammation from the respiratory infections seems to be the culprit, study in mice finds.

#Covid is immune altering/damaging/dysregulating-Didn’t we know this before
Hidden in the lungs of some breast cancer survivors r tumour cells that can remain dormant for decades- until they one day trigger a relapse
@organicbotanic.bsky.social @elhopkins.bsky.social
www.nature.com/articles/d41...

Legionnaires’ disease cluster in New York City rises to 83 infections and 3 deaths NYC health officials are investigating a cluster of Legionnaires' disease cases, possibly linked to contaminated cooling towers, causing serious lung infection.

Remember Weakened Immune System is a risk factor for Legionnaires disease
& there is no doubt that as individuals & as a “collective” we r living in an immune deficient state
@organicbotanic.bsky.social @elhopkins.bsky.social @njbbari3.bsky.social
www.local3news.com/local-news/e...

#TB
Why solutions fail- Because people believe knowledge is uniformly distributed & confuse results obtained while dealing with variables as finite & unchangeable @organicbotanic.bsky.social @elhopkins.bsky.social @njbbari3.bsky.social

#TB
It has for centuries been a health & Social issue only
But now it is an environmental issue as well & with #MDRTB & #XDRTB, we can only imagine where it can go @organicbotanic.bsky.social @brownecfm.bsky.social @drinfosec.bsky.social @elhopkins.bsky.social @njbbari3.bsky.social

Seven suspected tuberculosis cases at Tacoma ICE processing facility The KING 5 Investigators discovered seven suspected cases of TB at the Northwest ICE Processing Center, confirmed by the Washington State Department of Health.

#TB
I have said this before - we r dealing with a “ limited understanding of TB”
TB will continue to have the most severe & long term impact on not just our health but our socio-cultural evolution as well
@organicbotanic.bsky.social @elhopkins.bsky.social
www.king5.com/article/news...

#Metformin
And this is how the obituary of a cheap & safe drug is written
url:https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2836528?utm_source=bluesky&utm_campaign=content-shareicons&utm_content=article_engagement&utm_medium=social&utm_term=080525 @organicbotanic.bsky.social

#Credit

Social Determinants of Health and Risk for Long COVID in the U.S. RECOVER-Adult Cohort | Annals of Internal Medicine Background: Social determinants of health (SDoH) contribute to disparities in SARS-CoV-2 infection, but their associations with long COVID are unknown. Objective: To determine associations between SDo...

#LongCovid
Vulnerable suffer more irrespective of the disease
Participants with social risk factors at the time of SARS-CoV-2 infection had greater risk for subsequent long COVID than those without
@organicbotanic.bsky.social @elhopkins.bsky.social
www.acpjournals.org/doi/10.7326/...

#Polio
Not over
Pakistan: 3 WPV1 & 1 +ve environmental sample
Côte d’Ivoire: 1 cVDPV & 2-+ve environmental sample
Ethiopia: 1 cVDPV2
Nigeria: 5 cVDPV2
Papua New Guinea: 6 cVDPV & 2 +ve environmental samples
Yemen: 43 cVDPV2
@organicbotanic.bsky.social
polioeradication.org/about-polio/...

#TB
Imagine having a cheap point-of-care self-administered tests for tuberculosis (TB) available with us which is sensitive enough to be useful (like we have for DM) @organicbotanic.bsky.social @elhopkins.bsky.social @njbbari3.bsky.social

#TB
#TBTPT
Why pause - we might be reaching a situation where our extreme efforts r pushing the disease spectrum towards #MDR & #XDR Tb
TB treatment has almost 100% good outcomes
MDR has around 50%
& for XDR still worse @organicbotanic.bsky.social @elhopkins.bsky.social @njbbari3.bsky.social

#TB
#MDRTB
#XDRTB
Probably we need to pause & reflect, why despite extreme efforts we r not able to make a significant change in TB situation & also pause interventions that have not been tested in real life situation- I fear we may aggravate the situation to no return @organicbotanic.bsky.social

O obably why, there is difference in symptomatology, presentation & response to treatment across population groups
Genetic diversity (which used to be region specific) & easily identifiable has become more complex with the way populations continue to mix & match @organicbotanic.bsky.social

#Tuberculosis
Mycobacterium tuberculosis (MTB) exhibits significant genetic diversity in India,with various lineages & spoligotypes circulating throughout the country- different lineages exhibit different drug resistance profiles & transmission patterns @elhopkins.bsky.social @njbbari3.bsky.social

#Tuberculosis
#CertificationIsNotElimination
Applying 20th century public health logic to TB is illogical
TB is not Smallpox & definitely not Polio
TB is an airborne infection with huge stigma travelling freely in highly mobile world @organicbotanic.bsky.social @elhopkins.bsky.social

#Tuberculosis
#CertificationIsNotElimination
Imagine a situation, if TB is certified “Eliminated” & yet we continue to have a substantial pool of infected individual &
Add to it TB is an airborne infection @organicbotanic.bsky.social @elhopkins.bsky.social @njbbari3.bsky.social

#CertificationIsNotElimination
#TB
#Leprosy
India met the WHO criteria for leprosy elimination (< than 1 case per 10,000 population) at the national level in 2005
Cut to 2024: India reported a total of 107,851 new leprosy cases & importantly complicated cases @organicbotanic.bsky.social

India met the World Health Organization's criteria for leprosy elimination (less than 1 case per 10,000 population) at the national level in 2005
Cut to 2025: India hosts 66% of leprosy patients

#Tuberculosis
The estimated pool of TB infection in community (upon which current strategies r based) is much smaller than the actual pool
We continue to miss a lot of active cases @organicbotanic.bsky.social @brownecfm.bsky.social @drinfosec.bsky.social @microlabdoc.bsky.social

#Tuberculosis
TB is a complex situation
Solutions grounded in linear relationship will prove counterproductive-
Probably why we r witnessing a large percentage of TB cases reported now belonging to non-vulnerable groups @organicbotanic.bsky.social @elhopkins.bsky.social @microlabdoc.bsky.social

#Tuberculosis
Anyone who says that TB can be eliminated by using current strategies by 2030, is either plan lying or has not been on the ground
A word of caution: Certification is not elimination & remember Leprosy @elhopkins.bsky.social @brownecfm.bsky.social @microlabdoc.bsky.social

A disease that carries Stigma, at least in LMIC, taking it to the community is the most difficult part- easy said than done

What makes Science Great- Funding or Intent
I believe without curiosity, science is not science

A day full of rains today, an evening filled with beauty & nature - a view from my window at 7:10 pm

#Pigeons
Day 5

Epidemiology & prevention strategies r not required
Including aspects like “why health” or “ how health” in the school curriculum from 6th class onwards will help
We talk about pollution (air or water) in isolation & don’t contextualise these to disease or health currently @drinfosec.bsky.social