Forms of tuberculosis (TB) that resist drugs are spreading in Europe at alarming rates, says the World Health Organization
(WHO). A new report from the organization says Multidrug-Resistant Tuberculosis is a disease that could cause a pandemic in
Western Europe and kill thousands of people if health authorities fail to tackle it properly.
Zsuzsanna Jakab, WHO's Regional Director for Europe told the press that:
"TB is an old disease that never went away, and now it is evolving with a vengeance".
Jakab is attending the sixty-first session of the WHO Regional Committee for Europe, being held in Baku, Azerbaijan this week. The 53 countries that make up WHO's European region are expected to endorse an ambitious action plan to fight resistant forms of TB.
Jakab said complacency has allowed the disease to resurge and it must be tackled now to avoid huge human and economic costs.
TB is an infectious disease caused by Mycobacterium tuberculosis bacteria that gives rise to over 9 million new cases worldwide every year and nearly 2 million deaths. It is the leading cause of death among curable infectious diseases.
WHO declared TB a global emergency in 1993.
One in three people in the world is infected with dormant TB bacteria, but it is only when the bacteria become active that they fall ill with the disease. Bacteria become active as a result of anything that can reduce the person's immunity, such as advancing age, HIV, and some medical conditions.
TB mostly affects the lungs (pulmonary), but it can also affect other parts of the body (extra-pulmonary). Only the pulmonary form of TB is infectious, and it spreads through coughing sprays of infectious droplets. People usually only become infected after prolonged contact with an infected person.
TB is not an easy disease to cure but it is curable. Treatment comprises a course of four standard, or first-line, anti-TB drugs and must continue for at least six months.
However, the cause for the current alarm is the rising number of cases of drug-resistant TB, or MDR-TB (multi-drug resistant TB), which develops when the first-line drugs are misused or mismanaged.
MDR-TB takes longer to treat with second-line drugs, which are more expensive and have more side-effects.
That is not the end of the story: for when second-line drugs are also misused or mismanaged in the treatment of MDR-TB, this leads to XDR-TB (extensively drug-resistant TB), and there are very few options for treating this form. The concern is that the resistant forms will rise to pandemic proportions unless TB control is managed properly.
The death rate for TB is about 7%: this can rise to 50% for the resistant forms, according to WHO figures that also show cases of MDR-TB and XDR-TB are spreading at the rate of around 440,000 new cases a year worldwide.
These resistant forms of TB are much harder and costlier to treat. It can take two years or more, and cost up to 16,000 US dollars in drugs alone per patient. If the patient needs isolation care in a hospital, then the cost is in the hundreds of thousands.
More than 80,000 of these annual cases of resistant TB occur in WHO's European region, which covers 53 European and Central Asian countries.
The highest burden is in eastern Europe and Central Asia, such as in Russia, Ukraine and Azerbaijan, but rates of TB and resistant TB are rising in western Europe as well.
For instance there are 3,500 cases of TB in London every year (2% of which are MDR-TB), the highest TB rate of any capital city in western Europe. The rate of MDR-TB in London doubled between 2005 and 2009.
WHO's action plan for tackling TB aims to increase awareness, diagnosis and access to treatment. Experts believe it has the potential to save billions of dollars and 120,000 lives by 2015. Much of the cost savings will be from preventing cases of resistant forms of TB.
The European targets, to be achieved by the end of 2015, are to:
- Decrease by 20% the proportion of MDR-TB cases among previously treated patients,
- Diagnose at least 85% of estimated MDR-TB cases, and
- Successfully treat at least 75% of patients notified as having MDR-TB.
"The Global Fund to Fight AIDS, Tuberculosis and Malaria has indicated that it strongly backs the action plan and is ready to provide financial support, where the affected countries step up their own financial commitment."
Click here for more information on the sixty-first session of the WHO Regional Committee for Europe and the new plan.
Written by Catharine Paddock PhD