Published Date: 2008-02-28 21:00:16
Subject: PRO/EDR> Tuberculosis, MDR, XDR - Worldwide: WHO
Archive Number: 20080228.0813
TUBERCULOSIS, MDR, XDR - WORLDWIDE: WHO
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Date: Tue 26 Feb 2008
Source: WHO (World Health Organization) News releases 2008 [edited]
<http://www.who.int/mediacentre/news/releases/2008/pr05/en/index.html>
Multidrug-resistant tuberculosis (MDR-TB) has been recorded at the
highest rates ever, according to a new report published today [26 Feb
2008]. The report presents findings from the largest survey to date
on the scale of drug resistance in tuberculosis. The report,
"Anti-tuberculosis drug resistance in the world," is based on data
collected between 2002 and 2006 on 90 000 TB patients in 81
countries. It found that extensively drug-resistant tuberculosis
(XDR-TB), a virtually untreatable form of the respiratory disease,
has been recorded in 45 countries.
The report also found a link between HIV infection and MDR-TB. Surveys
in Latvia and Ukraine found nearly twice the level of MDR-TB among TB
patients living with HIV compared with TB patients without HIV.
Based on the analysis of the survey data, WHO estimates there are
nearly half a million new cases of MDR-TB a year, which is about 5
percent of 9 million new TB cases of all types. The highest rate was
recorded in Baku, the capital of Azerbaijan, where nearly a quarter
of all new TB cases (22.3 percent) were reported as multidrug-resistant.
Proportions of MDR-TB among new TB cases were 19.4 percent in
Moldova, 16 percent in Donetsk in Ukraine, 15 percent in Tomsk Oblast
in the Russian Federation, and 14.8 percent in Tashkent in
Uzbekistan. These rates surpass the highest levels of drug resistance
published in the last WHO report in 2004. Surveys in China also
suggest that MDR-TB is widespread there.
"TB drug resistance needs a frontal assault. If countries and the
international community fail to address it aggressively now we will
lose this battle," said Dr Mario Raviglione, director of the WHO Stop
TB Department. "In addition to specifically confronting
drug-resistant TB and saving lives, programmes worldwide must
immediately improve their performance in diagnosing all TB cases
rapidly and treating them until cured, which is the best way to
prevent the development of drug resistance."
For the 1st time, the global survey includes analysis of XDR-TB.
However, because few countries are currently equipped to diagnose it,
limited data were available for this report.
The report also points to some successes. Estonia and Latvia were
singled out by WHO as drug-resistant TB "hotspots" 13 years ago.
Following a substantial investment and a sustained assault on MDR-TB,
rates in these 2 Baltic countries are today stabilizing and TB case
notification rates are falling.
The true scale of the problem also remains unknown in some pockets of
the world. Only 6 countries in Africa -- the region with the highest
incidence of TB in the world -- were able to provide drug resistance
data. Other countries in the region could not conduct surveys because
they lack the equipment and trained personnel needed to identify
drug-resistant TB. "Without these data, it is difficult to estimate
the true burden and trends of MDR-TB and XDR-TB in the region. It is
likely there are outbreaks of drug resistance going unnoticed and
undetected," said WHO TB expert Abigail Wright, the principal author
of the report.
WHO estimates that USD 4.8 billion is needed for overall TB control
in low- and middle-income countries in 2008, with USD 1 billion for
MDR-TB and XDR-TB. But there is a total finance gap of USD 2.5
billion, including a USD 500 million gap for MDR-TB and XDR-TB. "The
threat created by TB drug resistance demands that we fill these gaps,
as laid out in the Global Plan to Stop TB, a roadmap for halving TB
prevalence and deaths compared with 1990 levels by 2015," said Dr
Marcos Espinal, executive secretary of the Stop TB Partnership. "The
Plan also calls for another imperative -- sufficient resources for
research to find new diagnostics, new drugs effective against
resistant strains and an effective TB vaccine."
Related links
-------------
[Anti-tuberculosis drug resistance in the world: 4th global report
<http://www.who.int/tb/publications/2008/drs_report4_26feb08.pdf>;
The Global MDR-TB & XDR-TB response plan 2007-2008
<http://whqlibdoc.who.int/hq/2007/WHO_HTM_TB_2007.387_eng.pdf>;
2007-2008 XDR & MDR tuberculosis global response plan (English)
<http://www.who.int/tb/challenges/xdr/xdr_mdr_factsheet_2007_en.pdf>]
For copies of the report or more information contact:
Glenn Thomas
WHO Stop TB Department
<thomasg@who.int>
Judith Mandelbaum-Schmid
<schmidj@who.int>
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[According to the WHO survey, which involved 90 000 patients in 81
countries from 2002-2006, about one in 20 new cases of tuberculosis
worldwide is multidrug-resistant (MDR) (defined as resistant to
isoniazid and rifampin), or approximately 450 000 of the 9 million
new tuberculosis cases that are detected each year. As reported
previously in ProMED-mail post "Tuberculosis, XDR - Botswana,
South Africa 20080118.0222," the US CDC (Centers for Disease Control
and Prevention) and the WHO in a survey of an international network
of TB laboratories found that of 17 690 TB isolates collected during
2000-2004, 20 percent were MDR and 2 percent were XDR (resistant to
isoniazid, rifampin, fluoroquinolones, and at least one of the 3
injectable anti-tuberculosis drugs capreomycin, kanamycin, and
amikacin) (MMWR Morb Mortal Wkly Rep 2006; 55: 301-5).
The post from WHO News above says that the new survey finds the
highest rate of drug-resistant TB to date was recorded in Baku, the
capital of Azerbaijan, where nearly a quarter of all new TB cases
(22.3 percent) were reported as multidrug-resistant. However, as
reported in a prior ProMED-mail posting, in a study of TB in patients
living in the Western Province of Papua New Guinea (PNG) -- who
sought treatment between 2000 and 2006 in the Australian Torres
Strait Islands because of limited access to health care in the
Western Province of PNG -- of the 60 TB isolates, 15 (25 percent)
were MDR
(<http://www.mja.com.au/public/issues/188_03_040208/gil10334_fm.html>).
In truth, because of poor surveillance and lack of resistance
testing, the frequency of MDR TB in many parts of the world is
unknown and may be much higher than has been as yet reported.
According to WHO
(<http://www.who.int/entity/tb/features_archive/xdr_mdr_policy_guidance/en/index.html>):
"The laboratory plays a critical role in identifying MDR- and XDR-TB
cases; however, as a result of historical neglect, few national TB
programmes have capacity for drug-susceptibility testing (DST) for
the 1st-line drugs and even fewer have the capacity to test for
2nd-line drug resistance. Assessment of recent laboratory capacity
indicates that less than 5 percent of MDR-TB cases are currently
detected."
Anti-TB drug-susceptibility testing should be performed on initial
_Mycobacterium tuberculosis_ isolates from all TB patients. Isolates
obtained after relapse or apparent treatment failure should also be
tested for drug susceptibility. Indeed, a recent study (Pillay M,
Sturm AW. Clin Infect Dis. 2007; 45: 1409-14) postulated that the
introduction of the directly observed therapy-based
tuberculosis-control programs in the absence of susceptibility
testing or drug resistance surveillance was instrumental in the
development of XDR in a highly transmissible strain in KwaZulu Natal,
South Africa. - Mod.ML]
See Also
Tuberculosis, MDR - South Africa 20080208.0521Tuberculosis, MDR - Papua New Guinea 20080206.0478
Tuberculosis, XDR - Botswana, South Africa 20080118.0222
2007
----
Tuberculosis, XDR, MDR: genome sequences 20071122.3780
Tuberculosis - Uganda (02): MDR, susp. RFI 20071004.3284
Tuberculosis - Uganda: deadly strain, RFI 20071002.3255
Tuberculosis, XDR - South Africa (11): fugitives 20071002.3251
Tuberculosis, XDR - South Africa (10): Western Cape 20070627.2071
Tuberculosis, XDR - worldwide (02) 20070623.2034
Tuberculosis, XDR - South Africa (09): Western Cape 20070604.1805
Tuberculosis, XDR, airplane exposure - multicountry (03) 20070601.1778
Tuberculosis, XDR, airplane exposure - multicountry (USA, France,
Canada, Czech Rep.) 20070529.1738
Tuberculosis, XDR - South Africa (08): Western Cape 20070425.1349
Tuberculosis, XDR, 2003-2006 - Europe (Germany, Italy) 20070403.1132
Tuberculosis, XDR - South Africa (07): Eastern Cape 20070326.1044
Tuberculosis, XDR, 1993-2006 - USA 20070322.1005
Tuberculosis, XDR - South Africa (06) 20070319.0959
Tuberculosis, XDR, 1991-2003 - Spain 20070302.0738
Tuberculosis, XDR - South Africa (05) 20070228.0717
Tuberculosis, XDR - South Africa (04) 20070220.0638
Tuberculosis, XDR - South Africa (03) 20070209.0504
Tuberculosis, XDR - worldwide 20070205.0456
Tuberculosis, XDR - South Africa (02) 20070128.0375
Tuberculosis, XDR - South Africa: interventions 20070126.0349
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