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Millions of TB cases going undetected, says WHO

Posted on behalf of Meera Senthilingam.

Around 3 million people who were infected with tuberculosis (TB) in 2012 were not picked up by global health systems, the World Health Organization (WHO) has revealed. In addition, the testing and treatment of patients with drug-resistant forms of the disease are inadequate, according to the body’s 2013 Global Tuberculosis Report, published today.

The report states that in 2012 an estimated 8.6 million people developed TB, and that 1.3 million died from it. This is a decrease from previous years, but the rate of decline in disease incidence is slow, at only 2% per year, and when broken down to the regional and country level, outcomes are not as positive. Overall however, the 2015 United Nations Millennium Development Goals (MDG) of cutting TB incidence rates from the global baseline of 147 per 100,000  in 1990 and the target of reducing TB mortality rates by half from 25 per 100,000 worldwide in 1990, are on track. Mortality rates have already fallen by 45%.

The majority of TB cases in 2012 were in Southeast Asia (29%), Africa (27%) and the western Pacific region (19%). About 80% of those with TB live in one of 22 high-burden countries, only half of which have already met or are on track to meet the 2015 targets. The remaining 11 countries have faced challenges such as resource constraints, conflict and instability and HIV epidemics, which have constrained their control of tuberculosis.

Progress towards improving the diagnosis and treatment of multidrug-resistant TB (MDR-TB) is well below target level, with 450,000 estimated MDR-TB cases in 2012, three quarters of MDR-TB cases remaining undiagnosed and many diagnosed but unable to receive treatment.

“The debt toll of tuberculosis, a disease that is preventable and curable, is far too high,” said Mario Raviglione, director of the WHO Global TB programme, before announcing the five priority actions recommended in the report. These are to (i) reach the 3 million missed TB cases, (ii) address the MDR-TB crisis, (iii) intensify and build on TB-HIV successes, as less than 60 percent of TB patients living with HIV were found to be receiving antiretroviral drugs, (iv) increase domestic and international financing to close resource gaps, and (v) accelerate the rapid uptake of new tools, including diagnostics for resistance such as GeneXpert and the newly available drug for resistance, bedaquiline.

“There is finally momentum to break the TB epidemic, but if we don’t pursue these five actions, then our gains in the past few years are at risk,” concluded Raviglione.

Non-governmental organizations gave a mixed response to the WHO report. “[Médecins Sans Frontières] is finding alarming numbers of cases of DR-TB in many countries where we treat TB, in large part thanks to a breakthrough in diagnostic technology, but we are still very far away from making real progress against this killer disease,” said Grania Brigden, TB adviser for Médecins Sans Frontières’ Access Campaign.

“Funding has increased in recent years but there is still a huge funding gap,” says Osamu Kunii from the Global Fund to Fight AIDS, TB and Malaria. “We need data and information and this global report is critical to make decisions on country allocation of resources and monitoring and measuring progress.”

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    Sergio Stagnaro said:

    In my opinion, what accounts for the reason that millions of TB cases going undetected, according to WHO, is the low efficiency of traditional physical semeiotics, and the poor updating of physicians in the field of such a Medicine discipline.
    For instance, because Koch bacteria are Gram-positive, since 1983 doctors could be able to bedside detect an inflammation, Gram-positive in nature, even in its initial stage: Stagnaro S., Sindrome percusso-ascoltatoria di Iperfunzione del Sistema Reticolo-Istiocitario. Min. Med. 74, 479, 1983 [Medline] .
    In addition, due to a lot of original clinical signs, physician can be able also to localize precisely the inflammatory disorder: Stagnaro-Neri M., Stagnaro S., Appendicite. Min. Med. 87, 183, i996 [Medline] .
    Once diagnosed a human inflammatory disease, doctors may request the investigation of the Laboratory and Image Department in a rational way.

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