Drug-resistant tuberculosis now at record levels
In some areas of the world, one in four people with tuberculosis (TB) becomes ill with a form of the disease that can no longer be treated with standard drugs regimens, a World Health Organisation (WHO) report says. In the new WHO's Multidrug and Extensively Drug-Resistant Tuberculosis: 2010 Global Report on Surveillance and Response, it is estimated that 440,000 people had MDR-TB worldwide in 2008 and that a third of them died. In sheer numbers, Asia bears the brunt of the epidemic. Almost 50% of MDR-TB cases worldwide are estimated to occur in China and India. Encouraging signs Tuberculosis programmes face tremendous challenges in reducing MDR-TB rates. But there are encouraging signs that even in the presence of severe epidemics, governments and partners can turn around MDR-TB by strengthening efforts to control the disease and implementing WHO recommendations. Slow progress
Progress remains slow in most other countries. Worldwide, of those patients receiving treatment, 60% were reported as cured. However, only an estimated 7% of all MDR-TB patients are diagnosed. This points to the urgent need for improvements in laboratory facilities, access to rapid diagnosis and treatment with more effective drugs and regimens shorter than the current two years. WHO is engaged in a five year project to strengthen TB laboratories with rapid tests in nearly 30 countries. This will ensure more people benefit early from life-saving treatments. It is also working closely with the Global Fund to Fight AIDS, Tuberculosis and Malaria and the international community on increasing access to treatment. Resistant form of TB
Multidrug-resistant TB (MDR-TB) is caused by bacteria that are resistant to at least isoniazid and rifampicin, the most effective anti-TB drugs. MDR-TB results from either primary infection with resistant bacteria or may develop in the course of a patient's treatment. Extensively drug-resistant TB (XDR-TB) is a form of TB caused by bacteria that are resistant to isoniazid and rifampicin (i.e. MDR-TB) as well as any fluoroquinolone and any of the second-line anti-TB injectable drugs (amikacin, kanamycin or capreomycin). The cost of treating TB
These forms of TB do not respond to the standard six-month treatment with first-line anti-TB drugs and can take up to two years or more to treat with drugs that are less potent, more toxic and much more expensive, from 50 to 200 times higher. While a course of standard TB drugs cost approximately US$ 20, MDR-TB drugs can cost up to US$ 5,000 and XDR-TB treatment is far more expensive. In 2008, there were an estimated 9.4 million new TB cases, and 1.8 million TB deaths. 440,000 MDR-TB cases are estimated to have emerged in the same year with 150,000 MDR-TB deaths. No official estimates have been made on the number of XDR-TB cases, but there may be around 25,000 a year with most cases fatal. Since XDR-TB was first defined in 2006, a total of 58 countries have reported at least one case of XDR-TB. Strengthening laboratories
There is an urgent need to expand and accelerate in countries access to new, rapid technologies that can diagnose MDR-TB in two days rather than traditional methods which can take up to four months. EXPAND TB is a five year project targeting 27 countries, launched in 2008 and implemented by WHO, the Foundation for Innovative New Diagnostics (FIND), the Stop TB Partnership's Global Drug Facility (GDF) and the Global Laboratory Initiative (GLI) with financial support from UNITAID. Countries and case studies
Six countries are featured throughout the report in special focus sections. Bangladesh is one of the very few developing countries in which continuous surveillance among previously treated TB cases is being carried out in selected areas. Risk factors: HIV and MDR-TB
The report highlights several reasons why drug-resistant TB may be associated with HIV. However, more research is needed to determine whether there is an overlap between the MDR-TB and HIV epidemics worldwide. Reporting on MDR-TB globally
Despite the growing understanding of the magnitude and trends in drug-resistant TB, major gaps remain in geographical areas covered. Since 1994, only 59% of all countries globally have been able to collect high quality representative data on drug resistance. There is an urgent need to obtain information, particularly from Africa and those high MDR-TB burden countries where data have never been reported: Bangladesh, Belarus, Kyrgyzstan, Pakistan and Nigeria. Moreover, countries need to expand the scope of their surveys to cover entire populations, repeat surveys are needed to better understand trends in drug resistance and countries need to move towards adopting systematic continuous surveillance. ................................................. Source: World Health Organisation
For all latest news, follow The Daily Star's Google News channel.
Comments