Global Campaign Against Tuberculosis Makes Headway, but AIDS and Africa Have Big Problems

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Efforts to overcome tuberculosis (TB) are making gradual headway worldwide, but serious problems remain in containing the mycobacterial disease in Africa and among people with the AIDS, says the World Health Organization (WHO).

In an annual update, the UN agency said that in 2003 -- the latest year for which figures are available -- there were around 8.8 million new cases of TB. Half of the new cases occurred in six Asian countries: Bangladesh, China, India, Indonesia, Pakistan and the Philippines.

Around 1.7 million people died of TB in 2003, including those co-infected with HIV, the report said. "In 2003, the TB incidence rate was falling or stable in five out of six WHO regions, but growing at 1.0 percent globally," it said.

"The exception is Africa, where incidence has been rising more quickly in countries with higher HIV prevalence rates. But for the strongly adverse trends in Africa, prevalence and death rates would be falling more quickly worldwide."

In eastern Europe, another regional hotspot, TB incidence peaked in 2001 and has fallen, it noted.

The WHO report paid tribute to the so-called DOTS strategy (Directly Observed Treatment, Short Course), which seeks to improve detection of TB and combating the worsening problem of resistance to mainstream antibiotics.

The DOTS guidelines require care workers to monitor patients carefully to ensure that they complete a short course of powerful drugs. Patients with TB often fail to adhere to the drug regimen right to the end, after their symptoms disappear. That helps surviving TB germs to rebound, opening the way for that patient to fall sick again and to infect other people. It also greatly encourages the rise of resistant strains of the microbe. More than 17 million patients took part in DOTS programs from 1995-2003.

The WHO-initiated guidelines have now been adopted, either nationally or regionally, in 182 countries, and are helping to improve the rates for diagnosis, the report maintained. Even so, a long path lies ahead, the WHO said.

In 2003, less than 45 percent of infectious TB cases were detected, which means that the majority of people in the disease went without treatment and were still capable of spreading it to others. The Millennium Goals set a target of 70 percent in 2005. This target, though, seems very distant given the co-infection with the AIDS virus, which is often undiagnosed.

A piece of good news, the WHO said, was that funding for TB in poorer countries was on the rise.

Around 2.2 billion dollars are needed globally in 2005 to tackle the disease. Poor and transitional countries account for 1.3 billion dollars of this; 1.2 billion has already been raised, thanks to additional government funding in China, Indonesia and Russia and to grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Other organisations pitched for greater awareness about the dangers of tuberculosis as the WHO released its report, which coincided with World TB Day on Thursday.

According to the World Economic Forum's Global Health Initiative, TB costs businesses around 12 billion dollars in lost worker productivity each year, even though the cost of DOTS treatment per patient is as low as 10 dollars in some countries.

The international agency Medecins Sans Frontieres (MSF - Doctors Without Borders) called for an effort to overhaul time-consuming diagnostic tests that are based on 123-year-old lab procedures, and introduce a better vaccine and a new generation of antibiotics.

TB is a lung disease caused by a bacterium. It is spread by germs contained in sputum, coughed out in fine droplets by the patient. Millions of people carry the TB germ but do not develop the disease. However, the disease can readily develop among people whose immune systems have been compromised by HIV or other infectious disease.

Tuberculosis in the presence of HIV infection constitutes an AIDS-defining illness, according to the US Centers for Disease Control AIDS staging guidelines.

03/25/05

Source
Agence France Presse

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