World health agency calls for a renewed push against drug-resistant tuberculosis

 

McClatchy foreign staff

The World Health Organization is calling on the international community to step up its efforts to diagnose and treat tuberculosis, noting that one-third of the 9 million people who fall ill with TB each year receive no treatment.

“Reach the 3 million” is the slogan of this year’s world TB day, which WHO is celebrating Monday.

Diagnosis of the disease lags even further for those suffering from its so-called multi-drug resistant form, with fewer than one in four of those who contract MDR-TB receiving timely treatment.

“Earlier and faster diagnosis of all forms of TB is vital,” said Margaret Chan, who’s director general of the United Nations agency. Early diagnosis, “helps stop the spread” of the disease, which ranks as the second leading cause of death from an infectious agent, despite the fact that most people who are treated can be cured of the disease in six months. The first leading cause of death is HIV.

In 2012, an estimated 8.6 million people fell ill with TB, including MDR-TB, and 1.3 million people died from TB, including 320,000 who also were HIV positive, WHO said.

Eighty percent of the TB cases occur in 22 nations, with India and China having the highest caseloads, accounting for 26 percent and 12 percent of the total, respectively.

Other countries with high TB rates are Pakistan, Indonesia, Bangladesh, South Africa, Democratic Republic of the Congo, the Philippines, Vietnam, and Russia.

According to WHO statistics, there were 9,945 reported new and relapsed cases of TB in the United States in 2012.

New diagnostic tests are seen a major hope for combating TB, with new tests yielding results within two hours instead of the three months some old tests took.

"Without diagnostics, medicine is blind," said Catherine Boehme, chief executive officer of the Foundation for Innovative New Diagnostics, a partner in the WHO-led Expand-TB project, whose goal is to make sure the disease can be quickly diagnosed and treated in 27 so-called middle- and low-income countries.

In addition to better diagnostics, the project also aims to slash the price of the new technologies and the costs of the screening tests. "Increased capacity and reduced prices mean more patients can be served," said Philippe Meunier, the French government's ambassador for the fights against HIV/AIDS and communicable diseases.

While TB treatment costs around $25-30 per patient in developing countries, the cost for treating the resistant form is much higher -- perhaps as much as $3,000, said Mario Raviglione, who directs WHO's global TB program

That cost skyrockets in wealthy countries, where treatment of drug-resistant TB can run as much as $40,000, with the treatment for drug resistant TB costing still more because it takes between 20 months and two years, Raviglione said.

The countries with the most cases of drug-resistant TB are India, with 16,588 cases, Russia, with 13,612, South Africa, with 15,419, and Ukraine, which has 6,934, according to WHO statistics.

The Expand-TB project has brought the cost of drugs needed to treat drug-resistant TB down by 32 percent, said Joel Keravec, who manages drug procurement for the Global Drug Facility, a U.S.-sponsored clearing house for purchasing and distribution of TB treatments.

The Expand-TB project also has reduced the cost of the equipment needed to diagnose TB, from $70,000 to $16,000, and the price of cartridges used in the machines has from to less than $10 from $17, thanks to an agreement between the UNITAID, the international agency created to handle such purchases, the United States and the Bill and Melinda Gates Foundation.

Currently on one company, Xpert, manufactures the equipment for rapid diagnosis of MDR-TB, but the development of new technologies are expected to that monopoly and drive prices lower.

The greatest concern is that drug-resistant TB, which currently makes up just 4 percent of cases worldwide, will become the dominant strain. “This is happening already in some parts of the world: Belarus, some Russian oblasts, Ukraine, where up to one-third or one-fourth of the TB cases are MDR-TB,” Raviglione said.

That’s the result, Raviglione said, “of unregulated practices: misuse of antibiotics with inappropriate regimens, perhaps poor quality drugs, compounded with high transmission rates due to lack of infection control.”

For now, drug-resistant TB remains a small part of infections in wealthy countries, but that trend may not hold. Raviglione said rates of drug-resistant TB infection are increasing in Sweden, Austria, Finland and Great Britain.

Zarocostas is a McClatchy special correspondent.

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