Wall Street Journal (10.18.12)
Data in a World Health Organization report released October 17 states that drug-resistant TB is going largely undetected in many countries, undermining progress made against the disease over the past decade. Those falling ill with TB have been declining steadily for nearly a decade after a surge in the 1990s, with a 2.2 percent drop globally in 2011. Approximately 8.7 million individuals became ill with TB, and there were 1.4 million fatalities from the disease in 2011, including 430,000 individuals who were co-infected with HIV, making them more susceptible to TB infection.
The WHO estimates that only 19 percent of those infected with forms of TB that are resistant to multiple TB drugs are being diagnosed, citing a lack of funding and technology for appropriate diagnostic testing in the countries where the drug resistance is flourishing. According to Mario Raviglione, director of WHO’s Stop TB Department, patients in many countries are not tested fully for multidrug-resistant TB, so it is difficult to know how widespread that form of the disease is. In 2011, fewer than 60,000 new cases of MDR-TB infection were reported, mostly in Europe and Africa. But that is only 19 percent of an estimated 310,000 individuals diagnosed with TB last year that was actually a drug-resistant form. There are about 650,000 cases of MDR-TB globally.
India, China, Russia, and South Africa account for nearly two thirds of all MDR-TB cases, reports Dr. Raviglione, and detection, diagnosis, and treatment of these types of cases needs to be accelerated. The drug resistance also appears to be deepening, with 84 countries now reporting cases of more extensive drug-resistant TB— a form that is resistant to at least four core TB drugs. In addition, examples of an even more resistant form of TB that resists all traditional treatment have been reported in India.
New technologies include a rapid molecular test that can diagnose TB and a common form of resistance in 100 minutes. WHO says 11 new or repurposed TB drugs are currently in clinical trials and offer a new line of attack against drug resistance, possibly shortening treatment time as well. WHO has formed a task force to determine how to use the new drugs without creating further drug resistance in the future.