Associated Press - March 18, 2010
Maria Cheng, AP Medical Writer

In a new report on the global status of drug-resistant TB based on data from 2008, the agency says almost half of all people with the disease are in China and India, with both countries reporting about 100,000 new cases each.

High rates of drug-resistant TB strains were also seen in eastern Europe and central Asia, with up to 60 percent of people who already had TB in some parts of Tajikistan and Uzbekistan developing drug-resistant versions.

About 4 percent of all TB cases worldwide are thought to be non-responsive to the usual TB drugs. The agency estimated there were between 390,000 and 510,000 cases of drug-resistant TB in 2008, including about 150,000 people who were killed by the disease. But those numbers are based on modeling and come with a big margin of error.

The report is based on information from 35 countries worldwide, leaving a huge gap in the global TB picture.

"The country data reported to WHO make it impossible at this time to conclude whether the (drug-resistant TB) epidemic worldwide is growing or shrinking," the agency wrote in its report.

In the United States, the proportion of TB cases that are resistant to at least two first-line antibiotics remained stable in 2008, at less than 1 percent. And there were no cases that year of extensively drug-resistant TB, which is resistant to most available treatments, according to the U.S. Centers for Disease Control and Prevention.

The CDC does not yet have data on drug-resistant TB for last year. But other, preliminary data indicate a historic drop in new tuberculosis cases of all kinds in 2009 - the largest single-year decrease in more than 50 years of federal record keeping.

TB rates fell more than 11 percent in 2009, to 3.8 cases per 100,000 people. Generally, the annual decline is about 4 percent. CDC officials are investigating, but say it could be related to fewer cases coming in to the country through immigration.

Drug-resistant tuberculosis usually arises when people are poorly treated or take substandard medicines. It takes longer to treat than regular TB and requires more expensive drugs, which also cause bad side effects like liver damage.

In recent years, WHO and other health authorities have warned the collision of TB with the AIDS virus could fuel simultaneous epidemics - and asked for more money to fight both. In its latest report, however, the agency acknowledged there is little proof of that.

Again citing missing data, the agency says "it has not been possible to conclude whether an overall association between (drug-resistant) TB and HIV epidemics exists."

In Estonia, Latvia and Moldova, WHO said people infected with both HIV and TB were more likely to develop drug-resistant TB. But there is no information from many countries across Africa where the most people with HIV live.

Some health experts wondered why WHO's report failed to mention in detail one of the main drivers of drug resistance: bad medicines.

"Many substandard drugs are fakes, but we are also concerned about legitimately manufactured copies - mainly from India and China - which are not made to exacting high standards," said Philip Stevens, a health policy expert at the London think-tank International Policy Network.

Stevens said the lack of global TB data was troubling. "WHO doesn't really have a clue as to the true extent of the problem," he said. "It's difficult then, to start promoting targets and goals when you don't know what baseline you are starting from."

WHO reported rates of drug-resistant TB were dropping in some parts of Russia with previously large outbreaks.

"It's good news that it can be controlled even in those difficult regions," said Ruth McNerney, a TB expert at London's School of Hygiene and Tropical Medicine, who was not connected to the report.

McNerney said that though progress was being made, authorities need more money to fight it, and more information about where the disease is striking. "We've got to find out where there are very serious problems, otherwise we won't know about it until it's too late."

--- AP Medical Writer Mike Stobbe in Atlanta contributed to this report.

--- On the Net: www.who.int

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