Drug-resistant tuberculosis poses global threat, warn doctors

World Health Organisation says spread of hardier strains of TB across former USSR nations is of ‘critical concern’

Strains of tuberculosis that are resistant to most of the drugs used to treat them are spreading rapidly across the former Soviet Union and pose a serious global threat, warn doctors.

Drug-resistant TB has been found everywhere in the world. According to the World Health Organisation’s 2014 global tuberculosis report, published on Wednesday, 5% of TB cannot be treated using the routine antibiotics. Among new cases, 3.5% are drug-resistant, which means that the resistant strain has been passed from one person to another.

The global figure is low, although the data from India and Russia is not collected nationally and may underestimate the numbers. But worryingly, in some countries, far higher proportions of TB are resistant. In Belarus, 35% of new cases are drug-resistant.

As well as multi-drug resistant TB (MDR-TB) there is now extensively resistant tuberculosis (XDR-TB), which is susceptible only to the very newest and expensive antibiotics and can take up to two years to cure. The drugs are not available in poorer countries.

Last year, says the report, 9% of drug-resistant disease was XDR-TB. But in Lithuania, that was 24.8%, in Kazakhstan it was 22.7%, in Latvia it was 21.7%, in parts of Tajikistan it was 21% and in Georgia, it was 20%.

Médecins Sans Frontières (MSF), the volunteer doctors who treat TB patients in the region, are very concerned.

“The alarming spread of drug-resistant TB from person to person in the former Soviet Union is of critical concern, along with the growth in MDR-TB and XDR-TB cases,” said Dr Grania Brigden, TB adviser for MSF’s access campaign.

“Access to proper treatment is drastically low: only one person in five with multidrug-resistant TB receives treatment; the rest are left to die, increasing the risk to their families and communities and fuelling the epidemic.

“This dismal news must serve as a wakeup call for governments, donors and drug companies to step up and improve the drug-resistant TB response today.”

Speaking to the Guardian, she said the drug-resistant strains were spreading and there should be no complacency on the part of countries with low rates. “There is a very mobile population who move throughout the region, particularly to and from Russia. When you have a treatment course that is two years long, it can be very hard to get patients to stay in one place,” said Brigden.

“We have to be aware that a TB problem anywhere is a TB problem everywhere because it is airborne and we live in a world where people move much more freely now.”

Some countries are not treating people in line with the latest WHO recommendations, she said. They should be tested to find out which drugs their TB will be sensitive to and they must be put on a powerful combination of newer antibiotics – many are given only one additional drug, which increases the chances that the bacterium will become resistant to that too.

“More than a year after the introduction of two new TB drugs, and with repurposed drugs showing promise in XDR-TB care, most patients remain far from getting improved treatment options,” she said. “To reverse this epidemic’s course, a dramatic increase in collaboration and investment into the development of new and affordable diagnostics and treatment regimens will be essential.”

Source: The Guardian

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By Sarah Boseley

Published: Oct. 22, 2014, 7:58 p.m.

Last updated: Oct. 22, 2014, 8:01 p.m.

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