The survey, published Monday 26th February and titled Anti-tuberculosis drug resistance in the world, covers 90,000 TB patients in 81 countries and also found that 45 countries have recorded cases of extensively drug-resistant tuberculosis ((XDR-TB). This is the first time the WHO survey has covered this virtually untreatable form of TB, and because many countries are not equipped to diagnose it, the real picture could be worse.

TB is an infectious airborne respiratory disease caused by a bacteria that is spread by the coughing of infected people. Despite the disease being preventable and curable, 8.8 million people caught it and 1.6 million died in 2005.

If detected early and treated completely, a person with TB can quickly become non-infectious and will eventually be completely cured. However, the bacteria has evolved into numerous drug resistant forms, a scenario that presents public health authorities with major challenges in the campaign to eradicate the disease.

Director of the WHO Stop TB Department, Dr Mario Raviglione, said:

"TB drug resistance needs a frontal assault. If countries and the international community fail to address it aggressively now we will lose this battle."

He added that, as well as confronting resistant forms of TB and saving lives:

"Programmes 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."

There are nearly half a million new cases of MDR-TB globally a year, the WHO estimates from the new survey data. This represents about 5 per cent of all new 9 million TB infections.

The highest incidence of MDR-TB was found in Baku, the capital of Azerbaijan, which lies between Eastern Europe and Western Asia. Here the survey found nearly a quarter of new cases of TB were of the multidrug resistant type.

Other Eastern European and Asian countries were next in line: Moldova (19.4 per cent), Donetsk in the Ukraine (16 per cent), Tomsk Oblast in the Russian Federation (15 per cent), and Tashkent in Uzbekistan (14.8 per cent). These rates exceed the highest levels of drug resistant TB published in the 2004 WHO report.

According to the WHO, there are comparable rates of widespread MDR-TB in China.

The new survey also found a significant association between HIV infection and MDR-TB, typified by the situation in Latvia and the Ukraine where MDR-TB is nearly twice as common in patients with HIV as in TB patients without HIV.

However, all is not doom and gloom and the new report also highlights successes. Estonia and Latvia, two Baltic countries that 13 years ago were classed as drug-resistant TB hotspots, are said to be showing signs of stabilizing, with notification of new TB cases falling. This follows a substantial injection of funds to support a campaign against MDR-TB.

The survey included data on drug resistant forms of TB from only six African countries, not enough to reveal the extent of the problem in a part of the world with the highest overall incidence of TB.

According to the WHO, it is virtually impossible to get data on drug resistant TB in Africa because of lack of the right equipment and staff trained to spot the drug resistant forms of the disease.

Principal author of the report, and TB expert with the WHO, Abigail Wright, said:

"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," she added.

Nearly 5 billion dollars is needed to establish overall control of TB in low and middle income countries in 2008, estimates the WHO. 1 billion of this is needed for MDR-TB and XDR-TB. But all the money is not yet forthcoming: there is a shortfall of 2.5 billion, which includes a half billion gap for MDR-TB and XDR-TB.

Executive Secretary of the Stop TB Partnership, Dr Marcos Espinal pointed to the seriousness of this shortfall:

"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."

Full Reort from Who

Other Reports:
“A dangerous form of tuberculosis (TB) that is resistant to the most powerful drugs available is spreading rapidly around the world as efforts to combat it are lagging behind, a new World Health Organization (WHO) report says.

Rates of multidrug-resistant (MDR) tuberculosis in parts of the former Soviet Union have reached the highest levels ever recorded, reflecting the effects of poor funding for TB treatment, slow diagnoses that prevent health officials from pinpointing cases of MDR-TB quickly and a failure to treat patients until they are fully cured, the United Nations public health agency said.

The report is the largest to date on the scale of TB drug resistance, with data gathered between 2002 and 2006 on 90,000 TB patients in 81 countries, the WHO said. …” [The Wall Street Journal/Factiva]

The Washington Post reports that “… Around the world, there are about 9 million new tuberculosis cases each year and about 1.6 million deaths from it (out of 62 million deaths from all causes). The disease, which usually attacks the lungs, is second only to AIDS in deaths caused by infectious illness. …

Tuberculosis that responds to drug treatment can be cured for about $20, while the medications needed for MDR and extensively drug-resistant TB infections can cost $1,500 to $15,000 on the world market. Countries can buy the drugs through WHO for as little as $1,000 if they can demonstrate the need and ensure proper usage. WHO estimates that about $4.8 billion will be needed for overall TB control in low- and middle-income countries this year -- about $2.5 billion more than is available now. …” [The Washington Post/Factiva]

NYT writes that “… The highest rate was in Baku, Azerbaijan, where 22.3 percent of new TB cases were resistant to the standard anti-TB drug regimen during the survey period, from 2002 to 2006. That exceeded the previous high of 14.2 percent, in Kazakhstan. Drug-resistant TB is widespread in the Inner Mongolia and Heilongjiang regions of China, where the rates are about 7.25 percent, the WHO said. … The survey also found alarmingly high rates in Moldova (19.4 percent), Donetsk in Ukraine (16 percent), Tomsk, an oblast in Russia (15 percent), and Tashkent in Uzbekistan (14.8 percent). …” [The New York Times/Factiva]

AFP notes “… the report noted that data collected in hardest-hit Africa had been limited, with only six countries on the continent able to provide drug resistance data due to lack of technology, equipment and personnel. ‘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 lead author of the report. …” [Agence France Presse/Factiva]