Rate Of Global TB Levelling Off Says WHO

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Main Category: Tuberculosis
Also Included In: HIV / AIDS;  Aid / Disasters;  Public Health
Article Date: 23 Mar 2007 - 0:00 PDT

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Infection rates of the global epidemic of TB, the second biggest infectious killer worldwide, could be levelling off says the World Health Organization (WHO).

The global epidemic of tuberculosis (TB) the airborne lung disease that is a leading cause of death from infectious diseases worldwide, second only to HIV/AIDS, kills 1.6 million people a year.

In a report released this week, timed to coincide with World TB Day tomorrow, Saturday 24th March, the WHO says that the worldwide TB epidemic has levelled off for the first time since 1993 when it was declared a public health emergency.

The Global Tuberculosis Control Report, officially released yesterday, says the TB incidence rate peaked in 2004 and held steady in 2005.

However, the increase in extensively drug-resistant TB (XDR-TB) and HIV/AIDS as well as other escalating obstacles are a considerable barrier to controlling the TB epidemic, says the report.

United Nations Secretary-General Ban Ki-moon said, "We are currently seeing both the fruits of global action to control TB and the lethal nature of the disease's ongoing burden."

He praised the effort of governments and agencies, "Almost 60 per cent of TB cases worldwide are now detected, and out of those, the vast majority are cured. Over the past decade, 26 million patients have been placed on effective TB treatment thanks to the efforts of governments and a wide range of partners".

"But the disease still kills 4400 people every day," he added.

The report explains that although the rate of incidence of TB appears to have levelled off in 2004 - 2005, the actual numbers of people becoming infected is rising because the world's population is rising. However, compared to the rate of population growth, the rate of growth of new TB cases is slightly lower.

The total number of TB cases worldwide went up by 69,000 from 8,718,000 in 2004 to 8,787,000 in 2005, a rise of under 1 per cent. 12 per cent, that is 195,000 of the 1.6 million people who died of TB in 2005 had HIV.

The biggest barrier to progress in overcoming the TB epidemic the report says is the uneven access to diagnosis and treatment within the countries affected.

WHO Director-General, Dr Margaret Chan, said, "We need to tackle this problem as part of the larger challenge of increasing access to primary health care services".

She stressed the importance that, "All people, no matter who they are or where they live, should have access to TB diagnosis and treatment as part of a package of general health services that bring multiple health benefits".

The report mentioned five other major barriers to progress in tackling the global TB epidemic.

(1) HIV/TB

The major cause of death for people with HIV/AIDS is TB, and HIV is the main reason targets for TB control fail where HIV prevalence is high. In Sub-Saharan Africa HIV/AIDS is fuelling the TB epidemic in a dramatic way, the report says.

The key to reducing the burden of TB for people living with HIV is for TB and HIV programmes to collaborate.

(2) HIV among TB Patients

While HIV testing for TB patients is rising in Africa, few people with HIV are screened for TB.

Executive Director of UNAIDS, Dr Peter Piot, said, "In the last year, we have seen unprecedented collaboration between the TB and HIV communities, but much more is needed if we are to achieve our goal of universal access to quality TB and HIV prevention, diagnostic, treatment and care services".

(3) Extensively Drug-resistant TB (XDR-TB)

The spread of XDR-TB could reverse the gains made recently.

Director of the WHO Stop TB Department, Dr Mario Raviglione, said they have a clear plan on how to control XDR-TB, "But countries are moving far too slowly on implementing this plan".

He said funding was an important part of the strategy. It will take an extra 650 million US dollars to implement control of XDR-TB and multi-drug-resistant TB (MDR-TB) globally in 2007 alone.

"Beyond that, because of the threat of XDR-TB, research to identify new diagnostics, drugs and vaccines is more vital than ever," he added.

(4) Overall Funding Gap

Although monetary support for tackling TB has risen considerably since 2002, and currently sits at 2 billion US dollars, another 1.1 billion is needed for 2007, to meet the 2006 - 2015 Global Plan to Stop TB.

The total required to meet the 10 year Plan is 56 billion US dollars, half from countries where TB is endemic and half from donor countries. At the moment there is a commitment gap of 31 billion.

(5) Lack of Facilities and Infrastructure

The report also says that lack of infrastructure and capacity, such as insufficient laboratory facilities and acute staff shortages contributes significantly to the the problems of tackling TB in the countries most affected.

The hope is that the 2015 target for decreasing TB worldwide set as the Millennium Development Goal will be met earlier if the current plateau hails the start of a downward trend. However, progress needs to be much faster to sustain this hope in the face of the considerable barriers.

In the Global Plan to Stop TB, the target is to halve the 1990 figure for incidence and deaths due to TB by 2015.

The Americas, South-East Asia and the Western Pacific are on track to meet their 2015 Global Plan targets, while Africa, the Eastern Mediterranean and Europea regions are not.

Multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) have developed because first and second line drugs to treat the less virulent forms of TB have been misused or mismanaged.

TB is normally treated with four standard first line drugs. If they are not administered correctly, or if the treatment plan is disrupted, then multidrug- resistant TB (MDR-TB) strains emerege which take longer to treat with second-line drugs. These are more expensive and have more side-effects.

And so the problem escalates. When treatment for MDR-TB is incorrectly administered or treatment interrupted, then this increases the chances the virus will evolve to the more resistant form, extensively drug-resistant TB (XDR-TB), which is resistant to both first and second line drugs. Treatment for XDR-TB is limited and death is invariably inevitable.

Both MDR-TB and XDR-TB can be spread from person to person.

The Global Plan to Stop TB (2006-2015), launched by the Stop TB Partnership in January 2006, is a roadmap for treating 50 million people for TB. It also aims to enrol 3 million people with TB and HIV on antiretroviral therapy over the next 10 years, which would save 14 million lives.

Tomorrow, Saturday 24th March is World TB Day.

Click here for WHO Stop TB Department website.

Click here for TB Alert - the UK's National Tuberculosis Charity

Written by: Catharine Paddock
Writer: Medical News Today
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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