Epidemiology of tuberculosis: current status in India.

India is classified along with the sub-Saharan African countries to be among those with a high burden and the least prospects of a favourable time trend of the disease as of now (Group IV countries). The average prevalence of all forms of tuberculosis in India is estimated to be 5.05 per thousand, prevalence of smear-positive cases 2.27 per thousand and average annual incidence of smear-positive cases at 84 per 1,00,000 annually. The credibility and use of the estimates are discussed in detail. Reports on recent studies on the time trend of the disease from some areas in India, e.g., Chingleput in Tamil Nadu are discussed. They confirm the slow downward trend over a fairly long period of observation, as in the rural areas around Bangalore. It also outlines the serious escalation of disease burden in a tribal population group in Car Nicobar over a period 1986-2002, and highlights the nature and extent of the emerging threats. Some epidemiologists forecast a rise of 20 per cent in incidence in the next 20 yr, for India, with a cumulative rise of 46 million cases of tuberculosis during that period, largely as a consequence of HIV epidemic. The Governmental efforts at intervention through Revised National Tuberculosis Control Programme (RNTCP) and at monitoring the epidemiology of intervention through organising routine reporting are highlighted, and data are presented and evaluated on these. RNTCP needs to be used as an effective instrument to bring a change in epidemiological situation, through fast expansion and achievement of global target. The present review describes the global tuberculosis situation, and views it in the context of the goal of the antituberculosis intervention activities. It presents the epidemiological situation in India, comments on the current trend and discusses the efforts taken towards making projections on the likely burden of disease in India over time.