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Is It Possible to Eliminate Tuberculosis?

Results of a new study suggest that the spread of multidrug-resistant tuberculosis (TB) is reversible, and that the disease, which often affects people with HIV/AIDS, can be set on a path -- albeit a slow path -- to elimination.

An estimated one-third of the world's population has tuberculosis infection of the lungs. Although the disease is curable, the widespread use and misuse of medication has led to the emergence of multidrug-resistant strains of TB.

Using data from the World Health Organization (WHO), Christopher Dye and Brian Williams looked at TB rates in 10 groups of countries. They found that except in Russia, strains of drug-sensitive and drug-resistant TB are reproducing less than before. The findings, which appear in the October 21, 2009 online edition of Science Translational Medicine, published by the American Association for the Advancement of Science (AAAS), indicate that current efforts to slow the spread of multidrug-resistant TB are working.

An infected person spreads TB by coughing; the number of secondary infections caused by a given infected person -- a value called "R" -- determines how fast TB spreads throughout the population. If R can be kept to a value of less than 1 by means of rapid diagnosis and treatment, the disease will eventually burn itself out.

The study authors determined the values of R for TB strains that were sensitive or resistant to 2 key anti-TB drugs in 20 European countries, the United Kingdom, the United States, Hong Kong, and Russia, and analyzed this data with a computer model describing the spread of disease.

The results indicate that, with the exception of Russia, the value of R for each of the drug-resistant strains tested in each country is less than 1.

The authors noted that their conclusions must be verified and expanded with more data from a wider range of countries including India and China, where the number of new multidrug-resistant TB cases each year is highest. They also stated that in order to reach the goal of TB elimination by mid-century, more intensive control efforts will be needed, based on new technology.

Office of HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland; South African Centre for Epidemiological Modelling and Analysis, Matieland, Stellenbosch, South Africa.

10/23/09

Reference
C Dye and BG Williams. Slow Elimination of Multidrug-Resistant Tuberculosis. Science Translational Medicine 1(3). October 21, 2009 (online edition). (Abstract).