Map of the Day: Where Tuberculosis Kills

The World Health Organization just released an exhaustive new report about the global fight against Tuberculosis. This first map shows the areas where TB rates are highest.

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And this is where TB mortality rates are highest. The data excludes deaths from TB among people with HIV.

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Globally, the report offers some key insights into how the international community is progressing against TB.  In 2012, there were an estimated 8.3 million people sickened with TB and an estimated 1.3 million deaths.  Both numbers, while high, represent impressive progress against the disease since the Millennium Development Goals were enacted in 2000.

The two MDG targets for TB are: 1) reversing TB incidence by 2015 and 2) reducing deaths by 50%. The first target has been met, and the 1.3 million deaths estimated in 2012 represents a 45% decline in TB mortality, putting the second target within reach.

But the WHO report is not all good news. The WHO says that of the 8.6 million people estimated to have fallen ill with TB last year, only about 5.6 million were reported to national health authorities. This means that an estimated 3 million people are missed by health authorities or not diagnosed at all. This is a huge problem for a disease like TB.

TB is highly infectious.  The medicines used to treat TB are inexpensive, but treatment requires a heavy investment of time on the part of health officials because WHO guidelines say that the patient must be observed taking the drug to ensure compliance. This observation is key because patients often stop taking medicines when they start to feel better, but before the TB is fully eliminated from their system. This can create new strains of TB that are drug resistant–or sometimes resistant to many drugs.

That, in turn, leads to the second big warning issued in today’s report: that so-called Multi-Drug Resistance TB (MDR-TB) is on the rise. In all, about 450,000 people were sickened with MDR-TB last year, with China, Russia and India the worst affected.

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MDR-TB is much more difficult to treat and much more expensive. It is also harder to diagnose. The simple “rapid diagnostic tests” that are available for TB are not available for MDR-TB. The WHO says three out of four MDR-TB cases still remain without a diagnosis.

From the WHO:

Even more worrying, around 16 000 MDR-TB cases reported to WHO in 2012 were not put on treatment, with long waiting lists increasingly becoming a problem. Furthermore, many countries are not achieving high cure rates due to a lack of service capacity and human resource shortages.

“The unmet demand for a full-scale and quality response to multidrug-resistant tuberculosis is a real public health crisis,” says Dr Raviglione. “It is unacceptable that increased access to diagnosis is not being matched by increased access to MDR-TB care. We have patients diagnosed but not enough drug supplies or trained people to treat them. The alert on antimicrobial resistance has been sounded; now is the time to act to halt drug-resistant TB.”

Multi Drug Resistant-TB is a truly frightening condition because it is only one step away from Extremely Drug Resistant-TB, (XDR-TB) which is basically a death sentence for anyone infected.

TB spreads very easily. This is one of those cases where investments in TB diagnostics and treatment can save health systems a lot of money by reducing the incidence of MDR-TB. And preventing and containing MDR TB outbreaks would forestall potentially calamitous outbreaks of XDR-TB.  And here, an ounce of prevention is worth a whole lot more than a pound of cure because, well, there isn’t one.