Tuberculosis

02 April 2009

DR-TB a 'time bomb': WHO

Health officials warned against deadly drug-resistant tuberculosis, which are spreading fastest in developing countries that lack the infrastructure to tackle the disease.

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Health officials gathered in Beijing on Wednesday warned against deadly drug-resistant strains of tuberculosis, which are spreading fastest in developing countries that lack the infrastructure to tackle the disease.

Over half of new cases of tuberculosis that are resistant to multiple drugs are resistant right from the start, and not as a direct result of substandard treatment, the head of the World Health Organisation (WHO) warned.

"This is the true alarm bell. This tells us that resistant strains are now circulating in the general population, spreading widely and largely silently in a growing pool of latent infection," director-general Margaret Chan said.

Can spiral out of control
"Obviously this is a situation set to spiral out of control. Call it what you want, a time bomb or a powder keg, any way you look at it this is a potentially explosive situation."

According to the WHO, of nine million new TB cases annually, about 490 000 are multiple-drug resistant TB (MDR-TB) and about 40 000 are extensively drug resistant (XDR-TB) based on 2006 data.

People with XDR-TB, which has cropped up in 55 countries, have few treatment options and death rates are high.

The spread of those strains could compromise the global fight against tuberculosis, which relies on drugs developed decades ago.

"The situation is already alarming, and is poised to grow much worse very quickly," Chan said.

Affordable treatment, quicker tests
China announced steps to provide health coverage for people suffering from drug-resistant tuberculosis, helping to close a gap that has allowed the more deadly strain of the disease to take hold.

China's measures, funded by a $33 million grant from the Bill & Melinda Gates foundation, include more affordable treatment at hospitals, quicker tests for the strains of tuberculosis that are resistant to standard treatment, and follow-up for patients to make sure they take their medicine.

China ranks second among countries with high rates of MDR-TB, just after India. If not cured, patients can infect 10 to 15 people a year, according to the WHO.

Health officials from 27 countries with high MDR-TB rates gathered in Beijing to work out new strategies. Their nations account for about 85% of all cases.

Many people aren't being detected, and fewer than 3% worldwide are being treated according to WHO recommendations.

Not yet conquered

While tuberculosis is largely under control in developed countries, it still haunts the poor in developing countries.

Experts fear the rise of drug-resistant strains will complicate the fight against the contagious lung disease, since the drugs needed to fight the tougher strains are far more expensive and unpleasant.

"China provides free treatment to tuberculosis patients, but to date there has not been free treatment for Chinese patients with MDR," said Chu Naihui, a senior doctor at the Beijing Chest Hospital, at a break between meetings with out-patients.

"This meeting, and the big infusion of funding, is good news for tuberculosis patients and especially for MDR patients."

A two-year round of treatment for MDR could cost about 10 000 yuan, or well over a year's salary for China's urban poor, who are more vulnerable to tuberculosis.

Patients stop taking meds
The side effects and the hassle of taking 15 to 20 pills a day for six months meant many patients stopped taking medicines as soon as they felt better, contributing to the development of drug resistance.

"Especially in the third world, it is extremely difficult to keep patients on therapy for such a long time," said Mel Spigelman, head of the TB Alliance, which is partnering with the Chinese Academy of Sciences to develop newer, faster drugs from natural sources, including traditional Chinese medicines. – (Lucy Hornby and Ben Blanchard/Reuters Health, April 2009)

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