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Highest Recorded Rates of Drug-Resistant Tuberculosis Reported: More than 110,000 deaths worldwide in 2006 attributed to deadly disease


USIS Washington File - March 5, 2008

Washington -- Drug-resistant forms of the airborne infectious disease tuberculosis (TB) are spreading around the world, raising concern among health leaders and prompting a global response to these emerging and often lethal contagions.

The response includes a new World Health Organization (WHO) report, Anti-Tuberculosis Drug Resistance in the World, based on data collected between 2002 and 2006 on 90,000 TB patients in 81 nations.

The report -- which presents findings from the largest survey to date on the scale of drug resistance in TB -- targets multidrug-resistant (MDR) TB, which is resistant to at least two of the best (first-line) anti-TB drugs, isoniazid and rifampicin.

"What is disturbing to me and all those involved," Dr. Mario Raviglione, director of the WHO Stop TB Department, told the House Foreign Affairs Subcommittee on Africa and Global Health February 27, "is that we are now seeing the highest rates of MDR-TB ever recorded in the history of TB control." MULTIDRUG RESISTANCE Those with MDR-TB must be treated with more expensive, less effective second-line drugs for 18 to 24 months. If they do not complete this course or are treated with the wrong drugs, they can develop extensively drug-resistant (XDR) TB, an often deadly type of MDR-TB that is resistant to first- and second-line drugs.

WHO estimates that nearly 500,000 MDR-TB cases occurred worldwide in 2006, with more than 110,000 deaths. According to the study, which for the first time includes an analysis of extensively drug-resistant TB, the virtually untreatable XDR-TB has been recorded in 46 countries.

The highest rates of MDR-TB among new cases were reported from Azerbaijan (22.3 percent), Eastern Europe's Moldova (19.4 percent), Ukraine (16 percent) and Russia's Tomsk Oblast (15 percent).

The report also found a link between HIV infection and MDR-TB. Surveys in Latvia and Ukraine found nearly twice the level of MDR-TB among TB patients living with HIV than among those who were not infected with the virus.

In 2006, WHO launched the Stop TB Strategy, the core of which is a TB-control approach called DOTS (directly observed therapy-short course), created in 1995. It includes political commitment with sustained financing, case detection through quality-assured bacteriology, standardized treatment with supervision and patient support, an effective drug supply and management system, and a monitoring and evaluation system.

More than 22 million patients have been treated under DOTS-based services and an expanded strategy recognizes key challenges of TB/HIV and MDR-TB.

URGENT ACTION In the United States, the Centers for Disease Control and Prevention (CDC)/National Institutes of Health (NIH), the U.S. Agency for International Development (USAID), and the President's Emergency Plan for AIDS Relief (PEPFAR) support WHO TB-control efforts, and the U.S. government helped develop the WHO Global MDR-XDR TB Plan.

CDC works closely with other agencies to prevent TB globally, CDC Director Julie Gerberding told the House panel, "and [Health and Human Services/]CDC also supports WHO and the Stop TB Partnership on a number of important activities, including providing technical assistance to the Global Drug Facility, which works to supply quality medications for TB programs." Complementary research efforts of CDC and NIH play a key role in the development of new drugs and new regimens for drug-resistant TB, she added.

At USAID, Kent Hill, assistant administrator for global health, said, the core of work on TB is focused on developing the capacity of countries affected by TB to put in place effective programs to combat and control TB.

"Between 2006 and 2007," he added, "USAID provided nearly $600 million for TB programs worldwide, including about $166 million directed specifically to Africa, This is in addition to funding for TB/HIV provided under PEPFAR. USAID supports TB programs in 37 countries," focusing on 19 countries with a high burden of TB, MDR-TB or TB/HIV.

FUNDING GAP In its effort to help fight TB, PEPFAR increased funding for HIV/TB five-fold, U.S. Global AIDS Coordinator Dr. Mark Dybul said, from $26 million to $131 million, from fiscal years 2005 to 2007, and $150 million is planned for fiscal 2008.

"Whether it is drug resistant or not, TB is an airborne, potentially deadly disease," Dybul said. "Because its effect on the immune system makes HIV-infected people more susceptible to infection, HIV is the greatest risk factor for developing tuberculosis." "Urgent action is needed to build strong TB control programs with mainstreamed MDR-TB treatment elements and rapid scale up of HIV/TB interventions," Raviglione said. "Strengthened laboratories for TB diagnosis and surveillance are essential, along with infection control and more health providers and communities prepared and motivated to ensure effective and safe treatment for patients." WHO estimates that $4.8 billion is needed for overall TB control in low- and middle-income countries in 2008, with $1 billion for MDR-TB and XDR-TB. There is a finance gap of $2.5 billion, including a $500 million gap for MDR-TB and XDR-TB combined.

More information about the Stop TB Strategy is available on the WHO Web site.

Additional information about tuberculosis is available at the CDC Web site.


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Information in this article was accurate in March 5, 2008. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.