Global anti-tuberculosis campaign now ‘at a crossroads’

By Helen Albert, Senior medwireNews Reporter

Tuberculosis (TB) care and control has improved dramatically over the last two decades, but numbers of cases and deaths are still high and multidrug resistant (MDR)-TB is an under-reported and ever-increasing problem, suggest findings from the World Health Organization (WHO) Global TB Report 2012.

The report shows that the Millennium Development Goal to stop and reverse the worldwide TB epidemic by 2015 has already taken place. The number of new TB cases occurring worldwide between 2010 and 2011 fell by 2.2% and global TB mortality has decreased by 41% since 1990 and is predicted to drop to the target of 50% by 2015. Access to TB care has also increased dramatically since the WHO introduced a new global TB strategy in the 1990s.

"In the space of 17 years, 51 million people have been successfully treated and cared for according to WHO recommendations. Without that treatment, 20 million people would have died," said Mario Raviglione (WHO, Geneva, Switzerland) in a statement to the press.

"This milestone reflects the commitment of governments to transform the fight against TB."

However, despite the reduction in mortality and the number of new cases, the global burden of disease is still very high with 8.7 million new cases reported worldwide in 2011, a significant percentage of whom (13%) are co-infected with HIV. The number of deaths was also high, at 1.4 million people, including 500,000 women, making TB one of the "top killers of women" in the world.

The authors of the report also note that although worldwide TB mortality has decreased significantly and global targets should be reached by 2015, African and European regions are not on target to halve TB mortality by this date.

"The momentum to break this disease is in real danger," said Raviglione. "We are now at a crossroads between TB elimination within our lifetime, and millions more TB deaths."

Another factor is that of MDR-TB, with the progress in responding to the recent outbreak remaining slow. The number of MDR-TB cases reported in 2011 reached 60,000, but this is estimated to only represent between one in five and one in 10 of the actual number of cases in the 27 countries with a high MDR-TB burden.

A new fully automated nucleic acid amplification test that is able to test and diagnose patients with TB and drug-resistant TB in 100 minutes and is now available in 67 countries, was highlighted in the report as being a significant advance in the field.

No new TB drugs have been developed for over 50 years, but 10 new drugs are being trialed and the authors of the report suggest that some could be on the market as early as 2013. Ten new vaccine candidates are also currently being tested, the most advanced of which should go into phase III clinical trials within the next 2 to 3 years.

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