Tuberculosis patient in India. Photo by WHO/David Rochkind.
For the first time on record, the number of people suffering from tuberculosis around the world is dropping, but a drug-resistant strain of the disease continues to spread at an alarming rate.
New World Health Organization data reveal a drop in tuberculosis cases from 9 million in 2005 to 8.8 million in 2010. Tuberculosis deaths also fell to the lowest level in a decade, hitting 1.4 million in 2010 after peaking at 1.8 million in 2003.
The report credits the gains to large countries like Kenya, Tanzania, Brazil and China that have increased screening and treatment to combat the deadly airborne disease.
“In many countries, strong leadership and domestic financing, with robust donor support, has started to make a real difference in the fight against TB,” said WHO Director-General Margaret Chan. “The challenge now is to build on that commitment, to increase the global effort – and to pay particular attention to the growing threat of multi-drug-resistant TB.”
Despite the overall improvement in tuberculosis outlook, the number of patients diagnosed with multi-drug-resistant tuberculosis has been growing in recent years, WHO said. The most affordable and widely-used tuberculosis drugs don’t work on drug-resistant TB, making it expensive and difficult to treat, especially in poor regions with limited access to second line treatments.
In 2010, there were an estimated 650,000 cases of multi-drug-resistant tuberculosis, or MDR-TB, around the globe.
More than half of the countries with the highest burden of MDR-TB are located in Eastern Europe, and the region implemented a crisis plan earlier this year to try to stop the disease from sweeping through more communities. Drug resistant tuberculosis can arise from incomplete treatment of TB, late diagnosis of TB or overuse of common TB drugs. It spreads like regular tuberculosis through water droplets in the air, and can swiftly pass from person to person.
Gaps in testing and treatment of multi-drug resistant tuberculosis are particularly troubling — only an estimated 16 percent of drug-resistant tuberculosis infected patients actually receive treatment, according to the WHO. Dr. Mario Raviglione, director of the WHO’s Stop TB program, said new faster tools are revolutionizing diagnosis of the disease, but better detection will have to be met with better treatment infrastructure.
“[T]he promise of testing more people must be matched with the commitment to treat all detected,” he said. “It would be a scandal to leave diagnosed patients without treatment.”
Treatment of multi-drug-resistant TB can cost up to $8,000 a person, Raviglione said, so efforts will have to be made to make treatment more affordable. There are also periodic issues with stock-outs of rarer second-line drugs that would have to be addressed if treatment is to be expanded.
But health experts also say vigilance in detection and treatment of traditional tuberculosis is also key to preventing new cases of drug resistant tuberculosis and preventing a resurgence of tuberculosis cases in countries finally seeing declines.
“The U.S. really dropped the ball in TB control in the late 1980s and early 90s,” warned Dr. Harold Jaffe, acting global TB coordinator at the Centers for Disease Control and Prevention, when the country experienced a resurgence in cases fueled by the HIV epidemic and deteriorating services. “We underfunded programs…to focus on other issues, and we paid the price.”