Tuberculosis is the second greatest killer due to single infectious agent worldwide, with a reported 1.3 million people dying from the disease in 2012 and 8.6 million falling ill.
The World Health Organization (WHO) have recently announced a plan in which tuberculosis (TB) will be eliminated from 33 countries and territories where there are less than 100 cases per million population, including the US.
Specifically, they outline a preliminary phase where the goal is to have fewer than 10 new TB cases per million people per year in the target countries by 2035. After this target has been achieved, the aim will be to reach full elimination by 2050: less than 1 case per million per year.
The countries and territories targeted by the WHO include 20 European countries and 7 North American countries.
One-third of world's population infected
TB is an infectious disease caused by bacteria. It is spread from person to person by the germs being sent through the air by carriers coughing, sneezing or spitting.
Around one-third of the world's population has been infected with TB bacteria, but are not ill with the disease and are unable to transmit it to others. There is a 10% likelihood that people infected with the bacteria go on to develop the disease, though this risk is higher in people with compromised immune systems.
Around one-third of people with HIV worldwide are also infected with TB bacteria. People who have both HIV and TB bacteria are 30 times more likely to develop the TB disease than people without HIV. About 20% of deaths among people with HIV are as a result of TB.
Importantly, TB is both curable and preventable. Without proper treatment, around two-thirds of people who develop the disease will die.
The Centers for Disease Control and Prevention (CDC) report that in 2010, there were 11,182 cases of TB in the United States; a rate of 3.6 cases per 100,000 people.
Framework for TB elimination
The framework was developed with experts from countries with low rates of TB, using the recent WHO global TB strategy as a foundation. The new framework and its implementation were discussed in a meeting of representatives of the low TB-burden countries, co-hosted by the WHO and the European Respiratory Society (ERS) and held in Italy; one of the 33 countries addressed by the framework.
There is a focus on approaches that have already proven to be successful in treating TB, and eight interventions are highlighted specifically by the framework:
- Ensure funding and stewardship for planning and services of high quality
- Address most vulnerable and hard-to-reach groups
- Address special needs of migrants; cross-border issues
- Undertake screening for active TB and latent TB infection in high-risk groups and provide appropriate treatment; manage outbreaks
- Optimize multi-drug resistant TB prevention and care
- Ensure continued surveillance and program monitoring and evaluation
- Invest in research and new tools
- Support global TB control.
Many of those most vulnerable to TB are hard-to-reach groups of people who have problems accessing health services. They include people who are poor and homeless, migrants, drug users or incarcerated.
WHO Assistant Director-General Dr. Hiroki Nakatani says that low TB-burden countries are already able to drive down TB cases by 2035. "Universal health coverage, which ensures everyone has access to the health services they need without suffering financial hardship as a result, is the bedrock. The key is to target smart TB interventions towards the people who need them most."
Dr. Mario Raviglione, Director of WHO's Global TB Program, states "countries with a low incidence of TB are uniquely positioned to reach historically low levels of TB. They can serve as global trailblazers."
Will this framework have an impact on the developing world? In 2012, the WHO reported that 60% of new TB cases globally occurred in Asia, and that sub-Saharan Africa had the greatest proportion of new cases per population with more than 255 cases per 100,000 people.
With the framework predominantly targeting countries in Europe and North America, what will these efforts mean for those most affected by TB?
In a news release, the European Lung Foundation (ELF) say that, in order to eliminate the disease in low-burden countries, it will be vital to scale up TB prevention in care in high-incidence countries, with concerted action and tight collaboration between countries with high and low TB burdens essential.