USIS Washington File - March 24, 2008
Washington -- The pace of progress in the intense battle between
global public health officials and Mycobacterium tuberculosis --
the cause of an airborne infectious disease epidemic that killed
1.7 million people in 2006 -- slowed during that year, according
to the World Health Organization (WHO).
Global Tuberculosis Control 2008, released March 17, describes a
decline in tuberculosis (TB) diagnosis, a slight rise in global
cases since 2005, the highest levels ever recorded for
multidrug-resistant TB and a lethal combination of TB and
HIV/AIDS that is fueling the TB epidemic in parts of the world,
The 12th annual WHO report on global TB control was released in
advance of World TB Day, observed March 24, and is based on data
from 202 countries and territories.
March 24 commemorates the day in 1882 when German physician and
Nobel laureate Robert Koch announced his discovery of the
bacillus that causes TB. The disease was raging through Europe
and the Americas at the time, killing one in seven people.
According to the WHO report, the 9.2 million new cases of TB in
2006 included 700,000 cases among people living with HIV, and
500,000 cases of multidrug resistant TB. An estimated 1.5 million
people died from TB in 2006 and another 200,000 people with HIV
died from TB. (See "Highest Recorded Rates of Drug-Resistant
TB is difficult to control, Dr. Michael Iseman, senior staff
physician in the Infectious Disease Division at National Jewish
Medical and Research Center in Denver, told America.gov, because
of a clever pathogenic strategy.
"There is an immense reservoir of latent [dormant] infection in
tuberculosis," said Iseman, one of the world's experts on
diagnosing and treating tuberculosis, especially drug-resistant
TB. "It is estimated that roughly half the world has latent
infection in their bodies, but the majority of people who are not
HIV infected never develop active disease."
109 YEARS OF TB TREATMENT
The nonsectarian National Jewish Center, one of the best
hospitals in the world for respiratory diseases, has been
treating TB since 1899 and drug-resistant TB since the 1990s.
Several components make it outstanding, Iseman said, including a
diagnostic laboratory that helps determine the best treatment for
each patient. "It's custom-tailored therapy instead of guessing,
Iseman said. "We're blessed to be able to do it the right way."
Other important elements include a team of experienced
clinicians, a laboratory that can test a patient's blood for
correct drug dosing levels, skilled surgeons who can safely
remove damaged lung tissue and a physical environment that is
safe for physicians, nurses and patients.
Tuberculosis requires a monthslong course of treatment with
several first-line (most effective) drugs. A patient who does not
take the first-line drugs correctly can develop
multidrug-resistant (MDR) TB. For MDR-TB, patients take less
effective, more toxic second-line drugs. If these are not taken
correctly, patients can develop extensively drug-resistant TB, a
virtually untreatable condition that also can spread to healthy
To make sure patients take their medication properly, Iseman
said, "the principle popularized here in Denver was, 'You've got
TB. This is not like high blood pressure or diabetes. You don't
have the option of taking your medicine or not.'"
The practice in the United States, he added, is to have a health
care provider watch patients take their medicine, either by
having patients come to the hospital or by sending someone out to
"It's paternalistic as hell," Iseman said, "but it worked and
that's why we have cut case rates in America in half over a
decade. It's a phenomenal success story that hasn't been widely
A similar principal is at the heart of the WHO Stop TB Strategy.
DOTS (directly observed treatment-short course), Stop TB
spokesman Glenn Thomas told America.gov, includes five elements.
These are political commitment with increased and sustained
financing, case detection through quality-assured bacteriology,
standardized treatment with supervision and patient support, an
effective drug supply and management system, and monitoring and
In the "supervision and patient support" element, Thomas said,
"supervision is also called DOT in some countries. It implies the
task, by the health system, to ensure patients take their drugs
as prescribed, daily or every other day [depending on the
country], and for the total duration of treatment [usually six
months for drug-susceptible TB]."
Such supervision can be realized through health workers in a
clinical facility or through community workers or even volunteers
that can support the patient.
"These individuals watch patients taking their drugs, while
supporting them," Thomas said. "Many different solutions exist,
and all have the final aim to help patients go through their
treatment effectively, thus getting cured and preventing the
creation of drug resistance due to errors in treatment."
Patient support, he said, is paramount and crucial. WHO promotes
a patient-centered approach that facilitates support, education
and counseling to make all patients more responsible for the
proper conduct of their long treatment.
More information about tuberculosis, and TB and HIV/AIDS, is
available online through the U.S. Centers for Disease Control and
Prevention, the President's Emergency Plan for AIDS Relief, the
National Institute of Allergy and Infectious Diseases, the World
TB 2008 Web site, and the WHO Stop TB Partnership.