World TB cases fall, but drug-resistance a worry: WHO
CHICAGO (Reuters) - New tuberculosis infections dropped 2.2 percent worldwide last year, but with nearly 9 million new infections, the World Health Organization said TB remains a massive problem that could worsen if countries shortchange funding to fight it.
In its annual assessment released Wednesday, WHO also said only one in five people with drug-resistant strains of TB is being diagnosed each year, leaving hundreds of thousands of people who are potentially infecting others with this particularly deadly form of the disease.
Overall, the report found that 8.7 million people fell ill with tuberculosis in 2011 and 1.4 million died, including nearly 430,000 people who were also infected with HIV, the virus that causes AIDS.
Dr. Mario Raviglione, director of the WHO's Stop TB program, said the report, based on data from 204 countries and territories, paints a mixed picture of progress in the fight against TB, noting that "51 million people have been cured and 20 million lives have been saved" since 1995.
Raviglione also cheered progress in developing rapid diagnostic tools that allow patients to be quickly tested for drug-resistant strains of TB, and he looked forward to the expected addition of at least two new drugs to fight drug-resistant forms of TB in the next year.
But the report cited slow progress in identifying cases of drug-resistant tuberculosis, which health officials called a growing health emergency.
"On the one hand, we have existing as well as new tools on the horizon which could make a significant difference and even support dreams of elimination in some settings," Raviglione told reporters at a press conference.
"On the other hand, we are at risk of stagnation if additional resources are not urgently mobilized by the governments of endemic countries, first, and if the international community then is not ready to fill the gap."
Despite advances in curbing the disease, the report said not all countries enjoyed equal progress.
Cambodia, for example, has made big strides in reducing TB rates, with the number of cases dropping by 45 percent between 2002 and 2011. But the African and European regions are not on track to halve 1990 levels of mortality by 2015.
INDIA AND CHINA
Raviglione said there were 60,000 reported cases of drug resistant MDR-TB from all countries in the report, with India and China representing most of those cases.
MDR-TB is resistant to at least two first-line drugs - isoniazid and rifampicin - while XDR-TB is resistant to those two drugs as well as a powerful antibiotic type called a fluoroquinolone and a second-line injectable antibiotic.
"India and China are the countries that need to accelerate the detection, the diagnosis and the treatment of MDR-TB in order for the entire world then to be able to progress, because they have the majority of cases," Raviglione said.
He said India, China, Russia and South Africa represent two thirds of the world's cases of drug-resistant TB, and he urged those governments to step up efforts to test and treat patients.
"If they don't move, we will always have slow progress."
One bright note is that past investments in technology are beginning to pay off in new and more effective tools.
For example, a new rapid molecular diagnostic test for TB and resistant forms of TB called Xpert, being marked by California-based Cepheid (CPHD.O), is being rolled out in 67 developing countries, with South Africa representing more than a third of that response.
A big part of that is from a deal by the Bill and Melinda Gates Foundation, the U.S. Agency for International Development and UNITAID - a group that facilitates the procurement of AIDS, malaria and tuberculosis drugs - to cut the price of the test from $17 to $10.
"There is also progress in the pipeline towards new drugs and towards new vaccines," Raviglione said.
"We expect at least two if not three entirely new compounds that kill the TB bacillus very effectively to be available in the next few months," he said.
But WHO officials worry about a funding gap that could stall progress in fighting the disease.
Between 2013 and 2015, WHO projects $8 billion per year will be needed to fight TB, and while much of that will be spent by affected countries, WHO said there is already a $3 billion funding gap projected in 2013.
"Particularly serious is the gap for the care of MDR-TB, which will mean millions of unnecessary deaths in the next few years," Raviglione told the briefing.
Dr. Grania Brigden, TB adviser for Doctors Without Borders, said the report reinforces that MDR-TB is an escalating public health emergency.
"With barely one in 20 TB patients being tested for drug resistance, we're just seeing the tip of the iceberg," said Brigden, who called for more treatment and better drugs.
(Reporting by Julie Steenhuysen; Editing by Vicki Allen)
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