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Tuberculosis (TB) has long been a major killer in the developing
world. A staggering one-third of the world's population is
estimated to be infected with Mycobacterium tuberculosis.
Indeed, in 1993 the World Health Organisation declared TB
a global emergency. The disease kills three million people
annually - of these 98% are in the developing world. It is
estimated that eight million new cases occur each year.
In Europe, TB was almost eliminated a generation ago, but
a new form of the disease, resistant to current drug treatments,
is increasingly taking hold. The number of cases of TB rose
by 25% in Russia and in 18 of the 26 Eastern European countries
from 1994 to 1996. Nearly 22% of all TB cases in Latvia are
multidrug resistant (MDR) and over 25% of all cases in Russia
and Estonia are resistant to at least one drug.
Thus a global emergency has been fuelled by the resurgence
of MDR TB, plus disease caused by Mycobacterium avium complex
(MAC), an opportunistic infection gaining hold in the HIV/AIDS
population. The issues which need urgent attention are:
- Improved methods of detection and diagnosis
and faster methods of identification of the susceptibility
of isolates to specific drugs
- Improved vaccines
- New drugs
Spread of MDR TB in Russia
A huge prison population is behind the spread of MDR TB in
Russia. Of the 300,000 prisoners released each year, 10,000
are carrying MDR TB and each passes on the disease to at least
20 others.
The problem has been exacerbated by much reduced spending
on healthcare since the collapse of the Soviet Union, and
a reluctance by health officials to adopt more targeted anti-TB
programmes. WHO's recommended strategy is known as DOTS, or
'Directly Observe Treatment, Short-course'. This has proven
extremely successful in other countries.
The shortage of money in Russia has meant that single drug
treatment regimens have been used instead of the triple drug
combinations regarded as essential in order to prevent multidrug
resistance developing rapidly. This approach is having devastating
consequences, causing MDR TB to spread into the general population
with worrying speed.
The number of TB cases has risen from 34 cases per 100,000
people to 78 per 100,000 since the fall of the USSR. Western
health officials are alarmed, as they believe it will not
be long before MDR TB crosses borders into other European
countries. The incidence of MDR and AIDS-related TB is also
increasing in the US.
02 Mar 2000, Copyright IMS HEALTH
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