Fight against tuberculosis a mixed bag
October 17th, 2012
04:47 PM ET

Fight against tuberculosis a mixed bag

More than 20 million people with tuberculosis (TB) are living today because of successful care and treatment, according to a new report by the World Health Organization (WHO).

The WHO's Global Tuberculosis Report 2012 found that access to care has been expanded significantly and over the last 17 years, 51 million people have been cured of the disease worldwide.  The number of new cases has been on the decline for the last few years.  Since 1990, the TB mortality rate decreased 41%, but the news is still mixed.

"The global burden of TB remains enormous with 8.7 million new cases last year, over 1 million co-infected with HIV and 1.4 million deaths," said Dr. Mario Raviglione, Director of the WHO's Stop TB Department. "The momentum to break this disease is in real danger.  We are now at a crossroads between TB elimination within our lifetime, and millions more TB deaths."

TB is second only to HIV/AIDS in the number of people it kills.  According to the report, TB is one of the world's top killers among women.  Last year alone, an estimated half million women succumbed to the disease.

Sixty-seven developing countries will start using a new molecular test called Xpert MTB/RIF that can diagnose TB including the rifampicin-resistant type of disease within two hours.  Experts hope the test will improve access to care and save more lives.

"This is a slow-growing bug.  It takes six weeks to grow," said Dr. Kenneth Castro, director of the Division of TB Elimination in the Centers for Disease Control's National Center for HIV, STD and TB. "You should be able to identify TB and start treatment the same day.  That is the vision. That is the game-changer."

Progress is slow against multidrug resistant TB (MDR-TB), the report finds.  WHO estimates there are around 310,000 cases of MDR-TB worldwide, yet only about 60,000 cases worldwide or 1 in 5 patients are actually being treated.  Most of those who are not receiving treatment are in India and China, according to the report.

Better treatments may be on the horizon. New and repurposed drugs and vaccines are currently in clinical trials.  The WHO says 11 vaccines are moving through the pipeline in various stages of development.

Castro says there are still challenges to overcome and plenty of work to do. "In the United States, we have had the lowest historic numbers in the last year.  But this is not the time for a premature declaration of victory.  Fifty-one million cures, 20 million lives saved is great, but not enough."

One of the biggest challenges is critical gaps in funding.  The report found about $8 billion is needed in low and middle-income countries over the next three years to cover TB care and control, but there's a gap of $3 billion.  There's also a gap in research and development dollars.

Raviglione says more countries will need to step up.  "If the gaps are not filled, we are going to see and have to accept millions of deaths.  We will not have a decline in incidence, we will not be able to say elimination is possible ... You may get something in the future that may be worse than HIV and with multi-drug resistance."

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institute of Health (NIH), agrees.

"Not addressing this is just not an option," Fauci said. "We are a global society - we really have a moral obligation to address this problem.  It's something that we just can't walk away from ... It is going to be a tough sell, but you are talking about lives that you can absolutely predict will be lost."

The TB Alliance, a group that looks for faster-acting, more affordable TB drugs, says the report shows the outlook for TB is slowly improving, but a commitment to accelerating progress is needed in order to save lives.

"Drug-resistant TB remains one of the world’s most ominous global health threats, but treatments for this disease are antiquated and inadequate," said Dr. Mel Spigelman, president and CEO of the TB Alliance. "Standard treatments for drug-sensitive tuberculosis must be taken every day for as long as six months to ensure that all bacteria in the patient are eradicated.  Drug-resistant TB requires a minimum of 18 months of treatment, which includes more toxic drugs and injections.  We must focus our efforts on developing new drug combinations that are shorter, less complex, cheaper, and that have fewer side effects."

soundoff (44 Responses)
  1. Annabel Kanabus

    Why is WHO so complacent? An estimated 1.4 million deaths is terrible, as is 8.7 million active cases of TB during they year. A fall in the number of cases of 2.2 per cent is hardly significant progress. The problem of drug resistance also seems to be getting worse.
    Why can't we have more global action on TB, in the same way that we have had with HIV/AIDS? It needs to be said loudly and clearly that the current situation is not alright. See http://www.tbfacts.org for more.

    October 18, 2012 at 06:35 | Report abuse | Reply
    • karek40

      Gays are more vocal and a great deal more pushy than third world individuals dying with TB, hope that answers your question

      October 18, 2012 at 14:21 | Report abuse |
    • mikithinks

      TB has morphed to resist the known drugs and we are fighting to develop drugs faster than the bacteria adapts. TB is airborne and spread by more means than aids. There is, therefore, more ways of educating about, and prevention of aids while research is ongoing. While there are many diseases that can be eased. the shotgun may be less effective in overall saving of lives than zoning in on a few at a time.

      October 21, 2012 at 09:34 | Report abuse |
    • SixDegrees

      WHO is far from complacent. The problem with TB isn't a lack of effort – it's the limitation of diagnostic techniques, as noted in the article, which take 6 weeks to complete; and the very poor treatment completion rate. Treatment also takes weeks or months to completely knock out the bacterium, and a huge number of people stop taking their meds and simply vanish once they start feeling a bit better – a perfect environment for breeding resistance. Follow up is notably difficult in under developed countries, where people may not have permanent addresses or phones so they can be contacted to ensure that the disease is truly eradicated. Forced hospital stays have been proposed as one possible solution, but keeping people confined for weeks simply isn't a workable solution.

      October 22, 2012 at 03:32 | Report abuse |
  2. ..

    Annabel, the progress in slowing new HIV infections in developing countries (except Brasil) is dismal. Most people in developing countries either don't understand the germ theory of disease or believe (as many Americans do) wild rumors that are patently untrue. TB is no different. Until massess of people receive and believe the facts concerning disease control, little progress will be made. Prevention of TB? Wear a mask if any respiratory symptoms are present or wear a mask if you live around someone infected. An ounce of prevention is worth a pound of cure. Men everywhere don't like condoms and they choose risk over comfort. People reap what they sow.

    October 18, 2012 at 14:13 | Report abuse | Reply
  3. AJ

    karek40 – did you catch the part that HIV/AIDS is number 1 while TB is number two? YOu're an idiot.

    October 18, 2012 at 20:56 | Report abuse | Reply
  4. Joe

    The larger issue with TB eradication has more to do with diagnosis than with treatment. This article completely misses that point. Diagnostic methods for TB are expensive, slow, and especially ineffective in the HIV coinfected population.

    October 19, 2012 at 08:24 | Report abuse | Reply
    • SixDegrees

      Uh – that's the main point of the article. It's mentioned prominently, more than once, as a singular difficulty. It also mentions new tests which reduce the normal 6 week results to two hours.

      October 22, 2012 at 03:33 | Report abuse |
    • Joe

      What part of expensive in my statement did you not read? The cost of a Xpert MTB/RIF is astronomically expensive and is no way a truly suitable diagnostic method for large scale screening, and still has enormous problems with HIV/TB co-infected patients due to issues with sample collection.

      I read the article, and I articulated that the failing of TB eradication programs is that they still rely on EXPENSIVE, slow, diagnostic techniques.

      October 24, 2012 at 17:14 | Report abuse |
  5. Mj

    If you are visiting the Jacksonville, Florida area, you may want to wear a mask. Florida newspapers reported the cover-up by Governor Rick Scott of an outbreak in the Jacksonville area. The outbreak happened just BEFORE a vote to close the state's only remaining TB hospital, but Legislators were not told about the outbreak before they voted. It is the worst outbreak in 20 years. Apparently, the Governor was not concerned because (at that time) it was "only" affecting the homeless population. There have been thousands of people who came in contact with TB-infected people, and not all those whom were in contact have been located, but Florida's Surgeon General has had the GALL to say that the outbreak has been contained and that there is no problem.

    October 21, 2012 at 14:39 | Report abuse | Reply
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