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Mar 28, 2007
TB Rates Decline, But XDR-TB Lurks in the Wings
Last week’s World Tuberculosis Day brought both good and bad news. First the good: The World Health Organization has announced that worldwide tuberculosis cases as a percentage of the population held steady in 2006, the first year since 1993 when the WHO declared a tuberculosis crisis. Now for the bad: More cases of tuberculosis are identified as extensively drug-resistant (XDR-TB), meaning treatment with both first- and second-line antibiotics have failed to cure it. The spread of XDR-TB is extremely dangerous, as it is effectively an untreatable version of the disease with an extremely high mortality rate, particularly among people infected with HIV.
Every year, tuberculosis bacteria infect 8.8 million people, with 1.6 million deaths; people can carry tuberculosis for years without knowing they are infected. XDR-TB exists because of mismanaged treatment of a TB case, when patients do not take a full cycle of antibiotics or take them incorrectly, thus failing to eradicate the infection and making the strain resistant to medications. Those people can then infect others with the drug-resistant strain. Not surprisingly, XDR-TB epidemics are erupting in some of the world’s most vulnerable countries (South Africa, China, India and Russia), where limited public health infrastructure, poverty and booming HIV-infection rates allow XDR-TB to spread unabated.
The worst part about this problem is that it is so preventable. When treatment is properly managed, TB is a curable disease. Thus, the spread of XDR-TB serves as another reminder that the purchase and distribution of medications is not the only necessary piece of disease prevention. Investments must also be made in the public health infrastructure needed to help patients take medicines correctly, and in enabling health facilities to develop procedures for quarantining XDR-TB patients and preventing airborne infection
World Health Organization: Global Tuberculosis Epidemic Levelling Off
New York Times: Rise of Deadly TB Reveals a Global System in Crisis