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Tuberculosis

Updated 19 September 2018

TB remains the world's deadliest infection, according to the WHO

TB is still the deadliest infectious disease and South Africa's figures remain a major concern.

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In 2017, 1.6 million people around the world died of tuberculosis (TB) which persists as the globe's top infectious disease killer, despite being preventable and curable.

This is according to the World Health Organization's (WHO) latest Global Tuberculosis Report, which includes data from 205 countries and territories, published on Tuesday.

Deaths are down slightly from the 1.7 million in 2016, but the disease still claims 4 000 lives every day.

"It is unacceptable that millions lose their lives, and many more suffer daily from this preventable and curable disease," said Dr Tereza Kasaeva, who heads up the WHO's TB programme.

South Africa featured on all three lists

The report published three lists for the top 30 countries with the worst TB epidemics:

  • Top countries with the highest burden of TB
  • The highest TB and HIV co-infection rate
  • The nations with the most cases of drug-resistant TB (DR-TB)

An estimated 10 million people fell ill with TB in 2017, just under the 2016 figure: 10.4 million. Two thirds of these new cases were found in just eight countries, including South Africa.

The number of new cases is falling by an average of 2% a year, which is not nearly enough to meet the global target of ending TB by 2030.

Not enough progress is being made

South Africa is one of the countries with the most significant decline in new cases with a 7% reduction between 2010 and 2017, mostly due to access to new diagnostics, medicines and HIV medication.

South Africa has the largest share of people living with both HIV and TB (39%), but is one of only eight countries that achieved over 50% in terms of access to HIV medication for patients with both conditions.

According to the report, the deadliest form of the disease, DR-TB, "remains a global public health crisis".

Treating DR-TB takes up to two years and barely half of people who take their medicine religiously are cured. Yet, only one in four people with DR-TB had access to the right drugs.

Receiving effective treatment

But South African patients with DR-TB fare much better than the global average and the country ranks second for the proportion of DR-TB patients who received the right drugs, behind Kazakhstan. Almost two thirds of the 15 986 patients with multi-drug resistant TB in South Africa received appropriate DR-TB treatment.

This is, in part, due to the fact that South Africa was the first country to offer the blockbuster anti-DR-TB drug bedaquiline to all patients earlier this year.

In August, the WHO included bedaquiline in its DR-TB guidelines, as it is less toxic and more effective than existing treatments, following South Africa's decision. About 80% of TB patients on bedaquiline reside in South Africa and Russia.

South Africa is also leading the way in the run up to the first ever United Nations (UN) High-Level Meeting on TB set to take place in New York next week. The country pioneered negotiations around access to new medicines like bedaquiline for low and middle-income countries.

Recognition for strides made

Dr Eric Goosby, from the UN, said that it is critical that the commitments made by country leaders at this meeting "translate into action".

"Equally important, we must ensure that we hold our leaders accountable for the actions they promise to take," he said.

About 50 heads of state have committed to attend the meeting including President Cyril Ramaphosa, who received praise for this by the WHO.

"The world's leaders must seize the opportunity of the first-ever TB summit to curb and reverse TB's deplorable trajectory," said Doctors Without Borders' Sharonann Lynch. "Seven years in a row now, about 40% of people with TB persistently remain undiagnosed, when we have the means to do so much better. If we're not even diagnosing people with TB, how are they supposed to get treated?"

Said the WHO's Kasaeva, "We need to join forces and root out this disease that has a devastating social and economic impact on those who are 'left behind', whose human rights and dignity are limited, and who struggle to access care. The time for action is now."

Image credit: iStock