WHO: Tuberculosis fight a mixed bag
Organization issues its Global Tuberculosis Report 2012
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."
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