Tuberculosis

March 24 Is World TB Day

Monday, March 24, is World TB Day, an opportunity to raise awareness about tuberculosis and the need for expanded testing and treatment worldwide. TB remains a threat in high-income countries including the U.S. as well as in resource-limited settings, and it is a major cause of death among people with HIV. The Stop TB Partnership estimates that 9 million people worldwide get sick with TB annually, but 3 million of them do not get the care they need.

Resources:

• New Drugs, Novel Combos Top Tuberculosis News at Conference (CROI 2014 overview)
• CDC: World TB Day
• CDC: Tuberculosis Overview (fact sheet)
• NIH/NIAID: Tuberculosis
• Stop TB Partnership: World TB Day
• World Health Organization: World TB Day

In advance of World TB Day, the U.S. Centers for Disease Control and Prevention (CDC) released 2 new studies, one summarizing the latest national TB surveillance data for 2013, the second looking at the toll of drug-resistant TB in the U.S.

Drug-resistant TB remains uncommon in this country (86 cases in 2012, or 1.2% of all TB cases) but has a high cost: $134,000 for multidrug-resistant TB (MDR-TB) -- rising to $430,000 for extensively resistant cases -- compared with about $17,000 for drug-susceptible cases.

"The extremely high toll on the quality of life for patients is no less tragic," said Philip LoBue, acting director of CDC’s Division of Tuberculosis Elimination. "Many of those being treated for drug-resistant TB must endure severe side effects such as hearing loss, depression, or even psychosis. Patients also face home or hospital isolation."

According to the 2013 surveillance report, published in full in the March 21 edition of Morbidity and Mortality Weekly Report and summarized in a new CDC fact sheet, there were 9,588 reported cases of TB in 2013 -- an all-time low. TB prevalence declined by about 4%, to 3.0 cases per 100,000 population, the lowest rate ever seen since national reporting began in 1953.

Among people with TB, 7% were HIV positive and 6% were homeless. More than half the newly reported cases occurred in 4 states -- California, Florida, New York, and Texas -- all of which have large immigrant populations. Two-thirds of all TB cases occurred among people born outside the U.S. Though TB rates have declined for all racial/ethnic group, they are highest for Asians (18.7 per 100,000), and higher for blacks and Hispanics (5.3 and 5.0 per 100,000, respectively) compared with whites (0.7 per 100,000).

"We have made substantial progress toward TB elimination in this country, but TB remains a formidable opponent with thousands of cases still diagnosed each year," said Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "Too many falsely believe TB is a disease of the past, but to truly relegate this disease to the pages of our history books, we must identify better ways to detect and treat TB and we must stop the emergence of further drug resistance."

The CDC data underscore the fact that TB remains a major uncontrolled health problem worldwide. According to the World Health Organization, approximately one-third of the global population is infected with the bacteria that cause TB, and approximately 8.6 million developed active TB disease in 2012. Advocates are particularly concerned at this time about how political events in Russia and the Ukraine could negatively affect treatment availability and access.

Also this week, Médecins Sans Frontières/Doctors Without Borders issued a new briefing paper that calls on governments, researchers, and the pharmaceutical industry to find new treatments for drug resistant TB. Although 2 new TB drugs, bedaquiline and delaminid, were recently approved -- the first in 40 years -- there is still a need for more effective, faster acting, and better tolerated therapies.

"The DR-TB crisis is everybody's problem and demands an immediate international response," said MSF medical director Sidney Wong. "Each year we are diagnosing more patients with DR-TB, but the current treatments aren't good enough to make a dent in the epidemic."

3/21/14

References

SM Marks, J Flood, B Seaworth, et al. Treatment Practices, Outcomes, and Costs of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis in the United States, 2005--2007. Emerging Infectious Diseases 20(5). May 2014.

NK Alami, CM Yuen, R Miramontes, et al. Trends in Tuberculosis -- United States, 2013. Morbidity and Mortality Weekly Report 63(11):229-233. March 21, 2014.

Médecins Sans Frontières. MSF Crisis Alert: The new face of an old disease: urgent action needed to tackle global drug-resistant TB threat. Briefing paper. March 2014.