Rising toll of Multi Drug-resistance TB presents global challenge

Diana Esther Wangari - CNS
MDR-TB is a form of TB that is resistant to at least the medicines rifampicin (R) and isoniazid (H). This makes it more difficult and expensive to treat. Compared to six months for a typical TB case, it can take up to two years to treat MDR-TB and the treatment is 100 times more expensive. Proof of the efficacy of shorter treatment regimens would signal real progress in helping to reduce the time and cost of addressing some cases of MDR-TB and this topic is addressed in several sessions during the conference.

The WHO Global TB Report 2013, released in London last week, reports that 3.6 per cent of newly diagnosed and 20.2 per cent of retreatment cases of TB had MDR-TB.  The report states that an estimated 450,000 people developed MDR-TB and 170,000 died from the disease in 2012.  It also concludes that less than one-third of the people estimated to have MDR-TB were detected in 2012.

The highest levels of MDR-TB are found in Eastern Europe and Central Asia and treatment success rates for TB remain lowest in the European Region. The number of MDR-TB cases is increasing even in countries like France, where the overall burden of TB is static or decreasing.

In Kenya,data from the routine MDR-TB surveillace reported of 118 cases of MDR-TB in 2007 alone and as of April 2009 one case of XDR-TB had been reported in the Western part of Kenya in Busia, according to a study published in the African Journal of Health Sciences, Volume 20 'Anti-tuberculosis drug resistance in Nairobi, Kenya'. But in as much as Kenya was ranked 13th in the list of high TB burden countries worldwide, we have doubled our efforts in the fight against the TB epidemic.

This was evidenced by the launch of the KEMRI/CDC lab in Nyanza which was the first lab to undertake TB culture testing apart from the Central Reference lab based in Nairobi. The decentralization was a much needed change as Dr. Joseph Sitienei, Director of the National Leprosy and TB control Programme (NLTP) explained, “The emergence of multi drug resistant TB is posing a great threat to TB treatment especially in Nyanza where TB cases are on the increase.” He went on to reveal that Kenya is the first country in East and Central Africa to detect Extensively Drug Resistant TB (XDR-TB). Thus, a new concept is introduced.

XDR-TB is a form of TB caused by organisms that are resistant to isoniazid and rifampicin as well as any fluoroquinolone and any of the second line injectable anti-TB drugs. Yes, just as we were beginning to combat MDR-TB, the strain of XDR-TB emerges with a 9% worldwide incidence rate. In addition, 4 new cases of a Totally Drug Resistant TB (TDR-TB) have been reported in India, though it is yet to be clearly described. Regardless, these forms of TB do not respond to the standard TB treatment course and can take up to three years to treat with more toxic, more expensive and less potent drugs. As far as TB treatment goes, appropriate use and international standards must be maintained as the infection could outsmart us.

“MDR-TB is a real and present threat to global health”, says José Luis Castro, Interim Executive Director of The Union. “It puts a greater burden on health systems and budgets, as well as the obvious harm it causes to MDR-TB patients and their families. Cases are found all over the world, irrespective of a country’s overall level of TB prevalence. We all have an urgent and vested interest in identifying MDR-TB and controlling its spread”.

Diana Esther Wangari, Citizen News Service - CNS
October 2013

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