E-DRUG: WHO TB drug resistance report
--------------------------------------
For those who want to find out more about MDR-TB see
recently released WHO report (links first + press
release below)
Anti-Tuberculosis Drug Resistance in the World - Third
Global Report, World Health Organization, March 2004
REPAIR URLs!:
Executive summary [pdf 568kb]
<http://www.who.int/gtb/publications/drugresistance/2004/drs_report_exec.pdf
Report - Part I [pdf 1.4mb]
<http://www.who.int/gtb/publications/drugresistance/2004/drs_report_1.pdf>
Report - Part II [pdf 553kb]
<http://www.who.int/gtb/publications/drugresistance/2004/drs_report_2.pdf>
Report - Part III [pdf 451kb]
<http://www.who.int/gtb/publications/drugresistance/2004/drs_report_3.pdf>
Below is the press summary of WHO on this report
http://www.who.int/mediacentre/releases/2004/pr17/en/
Drug resistant tuberculosis levels ten times higher in
Eastern Europe and Central Asia
16 MARCH 2004 | GENEVA -- Tuberculosis patients in
parts of Eastern Europe and Central Asia are 10 times
more likely to have multidrug-resistant TB (MDR-TB)
than in the rest of the world, according to a World
Health Organization (WHO) report into the deadly
infectious disease. China, Ecuador, Israel and South
Africa are also identified as key areas.
New data released today confirm geographical
concentrations of TB drug resistance across the
Commonwealth of Independent States. Six out of the top
ten global hotspots are: Estonia, Kazakhstan, Latvia,
Lithuania, parts of the Russian Federation and
Uzbekistan, with drug resistance in new patients as
high as 14%.
"TB drug resistance is an urgent public health issue
for countries from the former Soviet Union," said Dr
Mario Raviglione, Director of WHO's Stop TB
Department. "It is in the interest of every country to
support rapid scale-up of TB control if we are to
overcome MDR-TB. Passport control will not halt drug
resistance; investment in global TB prevention will."
WHO's leading infectious disease experts estimate
there are 300 000 new cases per year of MDR-TB
worldwide. There is also new evidence proving drug
resistant strains are becoming more resistant, and
unresponsive to current treatments. 79% of MDR-TB
cases are now "super strains", resistant to at least
three of the four main drugs used to cure TB.
MDR-TB is TB that is resistant to the two medicines
most commonly used to treat it, Isoniazid and
Rifampicin. Without the correct drugs MDR-TB is
untreatable and in most cases fatal. Though curing
'normal' TB is cheap and effective - a six month
course of medicines costs US$ 10 - treating drug
resistant TB is a hundred times more expensive. Even
then a cure is not guaranteed. With no effective
vaccine, everyone is vulnerable to infection simply by
breathing in a droplet carrying a virulent drug
resistant strain.
Highest prevalence of MDR-TB coincides with one of the
world's fastest growing HIV infection rates in Eastern
Europe and Central Asia. Recently the United Nations
Development Programme reported more than 1.5 million
people living with the virus in the region, compared
to just 30 000 in 1995. People whose immune systems
are compromised with HIV are many times more
susceptible to contracting all forms of TB.
"With people's immune systems compromised, MDR-TB has
a perfect opportunity to spread rapidly and kill,"
said WHO Assistant Director-General of HIV/AIDS, TB
and Malaria, Dr Jack Chow. "As a priority to prevent
the spread of all forms of TB, we need more investment
in resources, programmes and health workers."
New surveys in China, where HIV is also increasing,
have also mapped MDR-TB areas of concern. Two
provinces revealed around one in every ten new
patients tested positive with MDR-TB. The report's
authors fear similar high levels of resistance could
exist elsewhere, since only six of the country's 23
provinces were represented in the study.
Some successes have been achieved since the last study
four years ago - most notably in Cuba, Hong Kong and
the United States. Rates in those countries have
decreased, as a result of strong and well-maintained
TB strategies.
According to the report "the most effective strategy
to prevent the emergence of drug resistance is through
implementation of the DOTS." DOTS is the
internationally agreed treatment strategy, and is
designed to ensure patients take their medicines
properly. It has proven effective in preventing drug
resistance.
The report also notes TB control strategies used in
Eastern Europe and the Russian Federation have
recently begun to improve with the introduction of the
DOTS strategy. In worst affected areas innovative
"DOTS Plus" schemes which diagnose and treat
effectively drug resistant TB, are being introduced.
Patient access to MDR-TB drugs is key to the success
of the DOTS Plus strategy. The cost of supplying these
medicines has fallen dramatically through initiatives
backed by the WHO, namely the Green Light Committee,
which engages pharmaceutical companies to fully
support the fight to eradicate drug resistant TB.
Research and development into new TB drugs is also
urgently required to shorten the length of treatment
and to treat drug resistant strains. After a 40 year
standstill in TB drug development, R&D investments are
critical now to expand treatment options and overcome
resistant strains. The Global Alliance for TB Drug
Development, a WHO partner, is building a pipeline of
promising new drugs and uniting public and private
researchers in the search for a faster cure.
"Anti-Tuberculosis Drug Resistance in the World -
Third Global Report" presents data from the
examination of 67 657 TB patients in 77 countries and
regions.
"The more we survey, the more MDR-TB we find," said
the report's leading author Dr Mohamed Aziz. "MDR TB
has now been identified in every region and almost
every country surveyed in what is the largest drug
resistance surveillance project of its kind. Yet the
true burden is unknown and may well be higher in
unsurveyed areas, stressing the need for full
expansion of drug resistance surveillance."
Klara Tisocki
B. Pharm., M.Sc., Ph.D.
Phone: + 965 7975493
Fax: +1 775 4169388
Kuwait City
ktisocki@yahoo.ie
--
To send a message to E-Drug, write to: e-drug@healthnet.org
To subscribe or unsubscribe, write to: majordomo@healthnet.org
in the body of the message type: subscribe e-drug OR unsubscribe e-drug
To contact a person, send a message to: e-drug-help@healthnet.org
Information and archives: Essentialdrugs.org