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New WHO Survey Finds Highest Rates of Drug-resistant TB to Date

According to a recent WHO report, multidrug-resistant tuberculosis is at its highest ever rate worldwide.

Multidrug-resistant tuberculosis (MDR-TB) has been recorded globally at the highest rates ever seen, with parts of the former Soviet Union particularly vulnerable, according to a recent WHO report.

In a report based on data from 81 countries, the WHO estimated that nearly half a million people a year worldwide become infected with a form of TB resistant to two or more of the primary drugs used to treat it, accounting for approximately 5% of the 9 million new TB cases annually. It found that extensively drug-resistant tuberculosis (XDR-TB), a virtually untreatable form of the respiratory disease, has been recorded in 45 countries. Parts of the former Soviet Union were among the countries hit hardest by drug-resistant TB.

"If countries and the international community fail to address it [tuberculosis drug resistance] aggressively now we will lose this battle."

The report also found a link between HIV infection and MDR-TB. Surveys in Latvia and Ukraine found nearly twice the level of MDR-TB among TB patients living with HIV compared with patients without HIV.

"TB drug resistance needs a frontal assault. If countries and the international community fail to address it aggressively now we will lose this battle," said Mario Raviglione, director of the WHO Stop TB Department. "In addition to specifically confronting drug-resistant TB and saving lives, programs worldwide must immediately improve their performance in diagnosing all TB cases rapidly and treating them until cured, which is the best way to prevent the development of drug resistance."

The true scale of the problem also remains unknown in some pockets of the world. Only six countries in Africa - the region with the highest incidence of TB in the world - were able to provide drug-resistance data. Other countries in the region could not conduct surveys because they lack the equipment and trained personnel needed to identify drug-resistant TB. "Without these data, it is difficult to estimate the true burden and trends of MDR-TB and XDR-TB in the region. It is likely there are outbreaks of drug resistance going unnoticed and undetected," said WHO TB expert Abigail Wright, the principal author of the report.

The report also points to some successes; 13 years ago, Estonia and Latvia were singled out by the WHO as drug-resistant TB 'hotspots'. Following a substantial investment and a sustained assault on MDR-TB, rates in these two Baltic countries are today stabilizing and TB case notification rates are falling.

The WHO estimates that US$ 4.8 billion is required for overall TB control in low- and middle-income countries in 2008, with US$1 billion for MDR-TB and XDR-TB. However, there is a total finance gap of US$2.5 billion, including a US$500 million gap for MDR-TB and XDR-TB.

"The threat created by TB drug resistance demands that we fill these gaps, as laid out in the Global Plan to Stop TB, a roadmap for halving TB prevalence and deaths compared with 1990 levels by 2015," said Dr Marcos Espinal, Executive Secretary of the Stop TB Partnership. "The Plan also calls for another imperative - sufficient resources for research to find new diagnostics, new drugs effective against resistant strains and an effective TB vaccine."



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