The alarming news from this report is that in some areas of the world, one in four people who were infected with tuberculosis became ill with a form of the disease that can no longer be treated with standard drug regimens. A region in Russia reported that 28% of those diagnosed with TB had the multidrug-resistant form – the highest level ever reported to WHO.

As background, multidrug-resistant tuberculosis (MDR-TB) is difficult and expensive to treat, frequently failing to respond to standard first-line drugs. Extensively drug-resistant tuberculosis (XDR-TB) is a deadlier strain, resistant to even more of the existing tuberculosis treatment.

Of the estimated 9.4 million new TB cases in 2008, approximately 440,000 were MDR-TB, and a third of those infected with this form died. It is estimated that 69,000 cases of MDR-TB occurred in Africa, with the vast majority going undiagnosed due partly to limited labratory capacity. There are no official estimated on the number of XDR-TB cases, but the WHO still suggests it may be around 25,000 annually with most cases being fatal. 58 countries have reported at least one case of XDR-TB since 2006.

Strong tuberculosis programs can have a significant impact on reducing MDR-TB rates, as seen in countries like Estonia, Latvia, the U.S. and China, Hong Kong Special Administrative Region. Additionally, new technologies that can cut the diagnosis time to two days from up to four months, offer hope in the fight against TB.

As we observe World TB Day 2010, it’s important to reflect on the progress being made in combating this disease (36 million people have been cured of tuberculosis in the last fifteen years), while acknowledging the challenges that remain, particularly in the growing area of drug resistance.

You can download the full report here.

Last week, the WHO released it’s newest study on the disease, reporting that while TB cases have been slowly falling since 2003, a drug-resistant strain of TB (MDR-TB) is on a steep rise. Worldwide we can expect about 9 million new cases of TB this year, and 500,000 new cases of MDR-TB.

Learn more at the World TB Day site.

And scroll though the ONE Blog’s “TB” tag for our recent postings.

Including:

• Alexandra Fullem’s (of the the Global Health Council) excellent account of the Congressional briefing in honor of World TB Day on the 13th and the status of TB overall.
• A summary of the WHO’s February report on TB and MDR-TB
• A LA Times editorial urging world leaders for more funding to fight the drug-resistant strain of TB.

And more.

Yesterday the Global Health Council, Aeras Global TB Vaccine Foundation and the American Thoracic Society hosted a Congressional briefing in honor of World TB Day 2008. We learned from our 3 speakers more about the threat of MDR and XDR TB, more about the perfect storm of TB/HIV co-infection and about the great work that is being done in the push to find a vaccine. The speakers were Dr. Payam Nahid from the University of California, San Francisco, Thomas Kenyon from the Office of the Global AIDS Coordinator and Sylvie Kwedie from the Aeras Global TB Vaccine Foundation.

So, why is TB, an ancient disease, continuing to plague us after 5000 years? There are many reasons and the speakers outlined these for us. The first is poverty. The disease spreads quickly through the air and so we are all at risk, but those living in poverty even more so. The second is the rise of the HIV/AIDS epidemic. 1/3 of the population is carrying a latent form of TB. Once your immune system is compromised it becomes much more likely you will progress to active TB. In fact, TB is the leading cause of death for HIV patients with up to 40% of HIV deaths being TB related. The third reason that TB is still with us is poor TB control programs worldwide and poor laboratory capabilities, especially in endemic countries.

A fourth reason is that the drugs we are using to treat TB all date from the 1940′s, 50′s and 60′s.We are treating this disease with very old technology.

This, together with high level of adherence needed in treatment have led directly to MDR and XDR TB. These conditions are when you are resistant to the first line drugs (MDR) and the first and second line drugs (XDR). XDR TB is a death sentance for most patients. We need to develop new treatments that are easier to adhere to and do not have resistance already in the population.

Now for some shocking numbers that Dr. Nahid shared with us – in 2008 we expect 9 million new cases of TB to be diagnosed. This is equivalent to the entire population of New Jersey. Also in 2008, 1.6 million people will die of this preventable and curable disease. This number is equal to 2 times the population of San Francisco. 1 person dies every 15-20 seconds of TB. During the time that we sat in the briefing over 300 people perished.

So, what is the US government doing about it? Quite a lot actually. Through PEPFAR and USAID together we have invested nearly $1 billion since 2005 in fighting TB. Through PEPFAR the government is working to integrate TB and HIV programs on the ground, which is essential to getting patients proper care. To date, PEPFAR has provided care and treatment for 367,000 people living with HIV/TB. They are also implementing preventative therapy for HIV patients with no signs of active TB. This is a great start, but of course there is more work to be done.

We learned from Aeras that they hope to have a vaccine by 2015 and currently have many clinical trials in different phases throughout the world. In setting up these clinical trials they are also doing great things for health infrastructure – building state of the art labs and training local researchers and health care workers. With the great work that Aeras is doing, there is certainly hope that a vaccine will be forthcoming.

In short, TB is a global problem that has proven quite persisent. We too must show that same persistance in fighting it. We must be vigilent in controlling it, vigilent in treating it and vigilent in finding a vaccine.

-Alexandra Fullem, Policy Series Manager, Global Health Council