By Mariel Selbovitz
Commemorating the same date in 1882, when Dr. Robert Koch discovered the mycobacterium that produces tuberculosis, the World Health Organization warned on Monday, World Tuberculosis (TB) Day, that drug-resistant tuberculosis is a growing problem worldwide.
New TB Threats…
Multi-drug resistant (MDR) and extensively drug resistant (XDR) TB are major health threats on the rise in several countries, including the United States. MDR-TB occurs when a person’s TB is resistant to at least two first-line therapies. XDR-TB is diagnosed when there is resistance to first-line therapies and at least one of three injectable second-line therapy drugs.
According to the World Health Organization (WHO), without expanded treatment, global gains in fighting the disease “can be easily lost,” because the bacteria that causes the disease has quickly developed resistance to many of the dozen-or-so drugs used to treat it.
In South Africa, there have been reports of totally drug-resistant tuberculosis. Worldwide, the tuberculosis kills about 1.4 million people annually, more than any infectious disease besides HIV.
A Spreading, Often Fatal Threat…
MDR- and XDR-TB can occur in people who are being treated for TB where the medications have been misused or mismanaged. These drug resistant strains of TB can also be spread from person to person in the same ways that non-resistant TB is spread. MDR- and XDR-TB, particularly XDR-TB, are often fatal. Like other forms of TB, XDR-TB is spread through the air. When a person with infectious TB coughs, sneezes, talks or spits, TB germs, known as bacilli, are propelled into the air. Inhaling even a small number of bacilli leads to an infection.
The true scale of XDR-TB is not known as many countries lack the necessary infrastructure and capacity to accurately diagnose it. It is, however, estimated that there are around 40,000 cases per year globally. As of June 2008, 49 countries confirmed XDR-TB cases. By 2010, that number rose to 58. Margaret Chan, Director General of WHO, has stated, "We are treading water at a time when we desperately need to scale up our response to MDR-TB."
New Drugs and Funding Sources Are Critical…
Doctors also said that XDR-TB raises concerns of a future TB epidemic with restricted treatment options, jeopardizing the major gains made in TB control and progress on reducing TB deaths among people living with HIV/AIDS. It is vital that TB control is managed properly and new tools are developed to prevent, treat and diagnose the disease, they said. More medications for XDR-TB must be developed to provide options for people with this devastating illness. In January of this year, a drug for resistant tuberculosis, Sirturo (bedaquiline), was approved by the FDA.
The majority of funding to fight TB comes from the Global Fund. It is vital that efforts to raise money for WHO this year are successful, because of the rising threat of MDR- and XDR-TB. The Global Fund and the WHO have found a gap of $1.6 billion in yearly international support to combat TB in 118 low and middle-income nations, in addition to the $3.2 billion that could be provided by those countries themselves. Dr Mark Dybul, Executive Director of the Global Fund to Fight AIDS, TB and Malaria concluded, "It is critical that we raise the funding that is urgently needed to control this disease. If we don't act now, our costs could skyrocket. It is invest now or pay forever."
The following are links to some resources to learn more about drug-resistant TB: