WHO releases report on global scale of drug-resistant TB

The report, titled Anti-Tuberculosis Drug Resistance in the World, estimates that there are about 500,000 new cases of multi-drug resistant TB annually, or about 5% of the nine million total new TB cases each year (Maugh, Los Angeles Times, 2/27). The report includes data collected between 2002 and 2006 from 90,000 people living with TB in 81 countries. It recorded the highest numbers of MDR-TB and found that extensively drug-resistant TB, which is resistant to the two most potent first-line treatments and some of the available second-line drugs, has been recorded in 45 countries worldwide. It is the first time that the survey included an analysis of XDR-TB, according to a WHO release (WHO release, 2/26).

In Baku, Azerbaijan, MDR-TB accounts for 22.3% of all new TB cases, which was the highest rate recorded (Altman, New York Times, 2/27). The percentage of MDR-TB among new TB cases was 19% in Moldova; 16% in Donetsk, Ukraine; 15% in the Tomsk region of Russia; and 15% in Tashkent, Uzbekistan (McKay, Wall Street Journal, 2/27). The percentages exceed the highest levels of MDR-TB published in WHO's last TB report in 2004. The findings also show a link between HIV and MDR-TB. Among people with HIV/TB coinfection in Latvia and Ukraine, the report found that MDR-TB was almost twice as common compared with people who had TB and were HIV-negative (WHO release, 2/26). In addition, WHO said that in sub-Saharan Africa, HIV/AIDS is "dramatically fueling the spread of TB" (New York Times, 2/27).

High rates of drug-resistant TB also were found in China and India, the AP/Google.com reports. However, China disputed the data, saying that 94% of TB patients complete their first course of TB treatment in the country (Cheng, AP/Google.com, 2/26). In addition, the report highlighted TB control success in Estonia and Latvia, which were considered drug-resistant TB "hotspots" 13 years ago, Reuters Health reports. Significant investment and consistent efforts to control MDR-TB have helped stabilize rates of the disease in these countries, and notification rates also are declining, according to the report (Reuters Health, 2/26).

Although the report is the largest survey of drug-resistant TB, statistical information was only available from half of the world's countries, and it includes information from six African countries (AP/Google.com, 2/26). According to the Los Angeles Times, many countries in sub-Saharan Africa were not able to report data because of a lack of laboratory capacity to diagnose drug-resistant TB (Los Angeles Times, 2/27). Mario Raviglione, director of WHO's Stop TB Department, said it is likely that a number of people with drug-resistant TB and even entire outbreaks are being missed. "We really don't know what the situation is in Africa," he said, adding that if MDR-TB has "penetrated Africa and coincides with AIDS, there's bound to be a disaster" (AP/Google.com, 2/26).

According to the Post, WHO estimates that about $4.8 billion will be needed for overall TB control in low- and middle-income countries this year, or about $2.5 billion more than is available now (Washington Post, 2/27).

Reaction

"TB drug resistance needs a frontal assault," Raviglione said, adding, "If countries and the international community fail to address it aggressively now, we will lose this battle." He added, "In addition to specifically confronting drug-resistant TB and saving lives, programs worldwide must immediately improve their performance in diagnosing all TB cases rapidly and treat them until cured, which is the best way to prevent the development of drug resistance" (Reuters Health, 2/26).

Tido von Schoen-Angerer, executive director of Medecins Sans Frontieres Campaign for Access to Essential Medicines, said, "We are totally off-track right now," adding that only 30,000 people with MDR-TB received treatment last year. MDR-TB is a "threat to every person on the planet," according to Mark Harrington, executive director of the Treatment Action Group. "TB is a threat to every person who takes a train or a plane," Harrington said (AP/Google.com, 2/26).

The report is available online.