News blog

WHO tries to get a handle on drug resistant TB

Posted for Declan Butler

The World Health Organization says a lack of surveillance of drug resistant tuberculosis means it has little idea as to whether incidence of the disease worldwide is increasing or decreasing.

In a new report issued 18 March on the global status of multiple drug-resistant TB (MDRTB) based on data from 2008, the agency estimates that there were some 440,000 cases, and 150 000 deaths, worldwide. Most, unsurprisingly given their large populations, were in China and India.

That’s about 3.6% of all tuberculosis cases, suggesting that MDRTB incidence hasn’t changed much compared with other estimates in recent years.

Only 42 countries carry out routine surveillance of drug resistant TB, while 72 others rely on occasional surveys, making it difficult for WHO to get accurate estimates of incidence and distribution worldwide, much less monitor trends over time.

That didn’t stop WHO issuing a press release on its new report with the dramatic title “Drug-resistant tuberculosis now at record levels”. The supposed new record was in the small region or ’oblast ’ of Murmansk in Russia where levels of drug resistance of 28.3% among new cases of TB were recorded. Rates in Murmansk, however, were not measured in the last WHO survey published in 2008). Low levels of sampling in surveillance means that the difference with the WHO’s previous record of 22% in Baku City, Azerbaijan, is likely of little significance. No countries outside of Eastern Europe and Central Asia have reported levels of MDR-TB among new cases of greater than 6%.

Similarly, WHO noted that the low numbers of cases reported of extensively drug-resistant TB (XDR-TB) – tuberculosis that is also resistant to the drugs used when standards treatments fail, and so is almost untreatable – also meant that little confidence can be put in estimates of XDR-TB’s incidence. By pooling all country data it came up with a global estimate of 5.4% of multidrug resistant cases were XDR-TB, again comparable to past surveys.

Better surveillance being introduced in many countries should help improve future assessments of multi-drug resistant TB, says the report, adding that despite the shortcomings in monitoring, it also suggest that public health actions against drug resistant TB are having an impact.

who tb.bmp

Map: distribution of proportion of MDR-TB among new TB cases, 1994-2009 / WHO

Comments

  1. Report this comment

    Uncle Al said:

    The trivial and economic solution is for the doomed to be doomed. Get on with improving civilization that works. Charity arises from surplus. Social activism has exsanguinated the whole of productive citizenry.

    Let the best proceed unimpeded and the worst proceed unaided. Do nothing and charge nobody for that privilege.

  2. Report this comment

    Counterspell said:

    Uncle Al, it seems that you have been reading too much Ayn Rand and not using your critical mind.

    And you have never been in a third world country. Put the best/brightest when they have no resources and social support, and see them dying without accomplishments.

    Caring for MDR-TB is essential, because if it spreads, it will affect all of us, not only the “doomed”. If it was for people like Uncle Al, we wouldn’t have erradicated smallpox and controlled polio.

Comments are closed.