An
analysis by Shelley E. Haydel, Arizona University identifies major issues;
- worldwide TB is the second leading cause of death from a single infectious agent
- worldwide the number of new cases has increased (9.4m p/a)
- worldwide the number of deaths is stable (1.8m p/a)
- relative to population increase these numbers have reduced slightly
- worldwide the number of HIV+ and TB+ has increased (525,000 p/a)
- worldwide TB accounts for 25% of HIV deaths
- in 4 years the number of MDR-TB rose by 64% (424,000 in 2004)
- WHO estimates 30,000 cases of XDR-TB p/a
The development of new drugs may not be the answer
ensuring TB drug compliance and susceptibility testing is critical, since the introduction of new antibiotics could, ironically and unfortunately, generate additional antibiotic resistance and further intensify the existing problem.
Perhaps they need to change the way they look at TB
aggressive strategies and innovative approaches are desperately needed to fight XDR-TB or we are likely to lose our grip on TB control and witness the emergence of completely drug-resistant TB.
Certainly there is
evidence that we are losing our grip on TB control
"Of the estimated half a million people who develop multidrug-resistant tuberculosis each year, less than 7% are diagnosed and only one in five of these have access to effective treatment,"
All these
new cases of MDR-TB infect others, in particular their family
"Our findings suggest a worrisome hypothesis: household members face a common and persistent exposure to MDR tuberculosis in the community,"...These findings lend support to international guidelines that recommend prompt assessment of close contacts of all patients with MDR tuberculosis, and to suspect a close contact presenting with active tuberculosis as having MDR tuberculosis until proven otherwise,"
The extra drug resistant strains are more
aggressive
the frequency of active tuberculosis was nearly two times higher in contacts of patients with XDR tuberculosis than it was in contacts of patients with MDR tuberculosis
and more contagious
In the 359 contacts with active tuberculosis, 142..had had isolates tested for resistance against first-line drugs, of whom..90·9%...had MDR tuberculosis.
To tackle drug resistant TB they need to tackle latent drug resistant TB, before it becomes active and infectious.
