The number of people who are being infected with multi-drug-resistant TB (MDT-TB) has increased significantly; too few are being diagnosed and treated, says the World Health Organization (WHO). The campaign to reduce TB infections globally by half by 2015 could be undermined by MDT-TB.
On a good note, thanks to an aggressive global anti-tuberculosis campaign, 20 million people are alive today – those people would have died without treatment, says a WHO in a report issued this week, called the Global Tuberculosis Report 2012.
According to Dr. Mario Raviglione, Director of the WHO Stop TB Department, 51 million people with TB (tuberculosis) have been effectively treated and cared for over the last 17 years. 20 million of those would not have survived without that treatment, he added. “This milestone reflects the commitment of governments to transform the fight against TB.”
Dr. Raviglione warned that we are now at a crossroads – either we eliminate tuberculosis in our lifetime, or the disease evolves, becomes more and more resistant and harder to treat, and many millions more than expected will die.
Despite enormous progress, TB continues to be a major infectious global disease that kills an enormous number of people.
The authors of the report inform that:
- Even though the total number of infections worldwide has been falling since the middle of the last decade, there were 8.7 million reported new cases in 2011.
- 1.4 million people died from TB in 2011. Of those, 430,000 were HIV-positive.
- 13% of the new infections were also infected with HIV.
- TB is still a major killer of women. 1.4 million deaths occur each year from TB, and at least half of them are women.
- European and African regions are not on track to reduce the 1990 death numbers by half before the end of 2015. All of WHO’s six regions around the world, however, are seeing reduced TB rates.
Nearly all the 22 high-burden countries that account for more than 80% of global TB cases are seeing falling TB infection rates, as well as impressive reductions in mortality. The high-burden countries are Afghanistan, Bangladesh, Brazil, Cambodia, China, DR Congo, Ethiopia, India, Indonesia, Kenya, Mozambique, Myanmar, Nigeria, Pakistan, Philippines, Russian Federation, South Africa, Thailand, Uganda, Tanzania, Viet Nam, and Zimbabwe.
- There is persistently slow progress in multi-drug-resistant TB (MDR-TB). Only one fifth of patients infected with this TB type are currently being diagnosed globally.
In India and China, the countries with the largest number of MDR-TB cases, only one in every ten infected people is being diagnosed and treated.
The number of TB cases in Cambodia dropped by 45% from 2002 to 2011, a country which WHO mentioned as an example of exceptional progress. The report includes details on 204 countries and territories, covering all types of TB, as well as TB financing and R&D (research and development).
The report makes special mention of a diagnostic device that can test people for TB within just 100 minutes, including MDR-TB. Called the Xpert MTB/RIF, the fully automated device can diagnose TB and rifampicin-resistant disease (rifampicin is an antibiotic). It has been rolled out and is available in 67 low- and middle-income countries.
Between WHO’s endorsement of the test in December 2010 and the end of June 2012, over 1.1 million tests have been purchased in the 67 nations, with South Africa purchasing 37% of them.
Initially the test cost $16.86, it then dropped to $9.98, and is expected to fall in price even further.
WHO is excited about some new TB drugs – the first in over 4 decades – which should be available for use next year.
Innovative tools to prevent, detect and treat all different forms of TB are steadily making their way through the R&D pipeline.
New TB vaccines – the authors say that eleven new TB vaccines are progressing through the development stage. Experts are sure some of them will be available “further down the line, as well as a “point-of-care” diagnostic – both within the next ten years.
Between 2013 and 2015 there is:
- A $1.4 billion funding gap for research
- An additional $3 billion annual funding shortfall
The annual shortfall could have serious consequences for TB control, the authors warn.
Dr Katherine Floyd, who coordinated the report team, said:
“This gap threatens to hold back delivery of TB care to patients and weaken measures that prevent and control the spread of TB, with low-income countries at most risk.”
Ninety per cent of all external donor financing for tuberculosis comes from the Global Fund to Fight AIDS, TB and Malaria. WHO is urgently calling on all donor countries, agencies and organizations to help deal with this serious funding gap.
Globally, the burden of tuberculosis is highest in Africa and Asia. China and India account for nearly 4 in every 10 cases worldwide. South-East Asia and the Western Pacific regions account for approximately 60% of all cases.
Twenty-four per cent of all cases occur in the African region, which also has the highest death rates.
Globally, 3.7% of all new cases and 20% of cases that have already received treatment have MDR-TB. Nearly 60% of all MDR-TB cases occur in Russia, South Africa, India and China.
Nearly 80% of all cases of patients with HIV plus TB are in Africa.
TB in children – WHO estimates that there are 0.5 million cases of TB infection among children aged 15 years or less, of whom 64,000 died in 2011. The authors emphasize that estimating TB rates among children on a global scale is difficult.
Written by Christian Nordqvist