Drug-resistant TB spreading fast around the globe
As World TB Day comes round again, there are warnings from doctors that drug-resistant forms of the disease are spreading fast and urgent calls for new medicines and more funding to deal with a mass killer.We should never have stopped being alarmed by tuberculosis, but a certain complacency set in when antibiotics stopped it in its tracks across Europe and the United States. That was when people believed in magic bullets.
Now TB is back in ever more lethal forms. Multidrug resistant strains of the disease have evolved, sometimes because patients have not been given a full six months course of treatment for their regular TB. MDR-TB can take as long as two years to treat and the antibiotics needed are not available in the poorest countries.
According to the latest observations this week by Médecins Sans Frontières ahead of World TB Day on Saturday, MDR-TB is spreading at a frightening rate. MSF says its own doctors are shocked. The data is patchy, but it is hard to dispute the trend:
Uzbekistan 65 percent of patients treated by MSF in 2011 were diagnosed with MDR-TB. Of those patients, 30-40 percent had presented to the MSF clinic for the first time, which means their TB was not a resistant form recurring because of poor treatment first time round – they had actually become infected with MDR-TB from somebody else. MSF says that proportion is “an unprecedented number globally”.
South Africa The TB burden here is one of the highest in the world. MSF has seen a 211 percent increase in TB diagnosis per month in its program in KwaZulu Natal, following the introduction of a new rapid diagnostic test. Of those patients confirmed with TB, 13.2 percent were resistant to the drug rifampicin, one of the most effective first-line drugs for treating TB.
India Over-the-counter drug sales and an unregulated private health sector continue to fuel the development of drug resistance. An estimated 99,000 people are infected with MDR-TB each year, of whom only one percent receive adequate treatment.
Myanmar Of an estimated 9,300 new cases of MDR-TB every year, so far just over 300 patients in total have received treatment. The cancellation of an entire round of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria threatens to seriously undermine a five-year plan to reach a further 10,000 people living with MDR-TB in Myanmar, along with scale-up plans in many other countries.
MSF president Dr Unni Karunakara says:
Wherever we look for drug resistant TB we are finding it in alarming numbers, suggesting current statistics may only be scratching the surface of the problem. With 95 percent of TB patients worldwide lacking access to proper diagnosis, efforts to scale-up detection of MDR-TB are being severely undermined by a retreat in donor funding – precisely when increased funding is needed most.
We need new drugs, new research, new programmes, and a new commitment from international donors and governments to tackle this deadly disease. Only then, will more people be tested, treated and cured. The world can no longer sit back and ignore the threat of MDR-TB. We must act now.
A year ago, MSF launched a web project featuring bloggers with MDR-TB, enabling them to talk about their feelings and make their voices heard on their treatment. There are 13 bloggers from all over the world and, says MSF, they have now become a real community, highlighting the issues that most matter to them – family, side effects, treatment, HIV and stigma. It can be found here.
One piece of good news is that a new trial has been launched by TB Alliance of two drugs taken in combination. The big hope is that it could shorten the treatment from six months to four months in not only ordinary TB but also some forms of drug-resistant TB. There is more here.
Writter Sarah Boseley Twitter @sarahboseley