Untreatable TB threat 'apocalyptic scenario'
Pastor Dale Morgan
Untreatable TB threat 'apocalyptic scenario'*
30,000 infected annually now, but toll could become 8 million 'time bombs'
Posted: June 24, 2007
World Health Organization
The World Health Organization is appealing for billions of dollars in
funding to avert the apocalypse en route if a virtually untreatable form
of tuberculosis that already infects 30,000 people a year is left unchecked.
The TB, called XDR-TB for extensively drug resistant, is virtually
immune to currently available antibiotics, turning aside the effects of
both front-line and secondary drugs, officials have said.
It has been in the news of late because of an American airline
passenger, Andrew Speaker, an Atlanta, Ga., lawyer, who was diagnosed,
then traveled to Europe for his wedding, and returned, on commercial
airliners, potentially exposing hundreds of people to the frequently
fatal disease.
He now is being treated at a special center in Denver that deals with
cases of tuberculosis.
"XDR-TB is a threat to the security and stability of global health. This
response plan identifies costs, milestones and priorities for health
services that will continue to have an impact beyond its two-year time
line," said WHO Director-General Dr. Margaret Chan.
The organization is appealing for $2.15 billion in funding to develop a
battle plan – and tools – to fight the drug-resistant TB. It is expected
that it would save 134,000 lives over two years, and many more in the
future.
The extensively drug resistant TB has been reported in 37 countries in
all parts of the world since it first was identified in 2006, the agency
said.
"There is somewhere between 25,000 and 30,000, we roughly estimate,
cases of extensive drug resistant TB each year," Paul Nunn, coordinator
of WHO's Stop TB Department, informed a recent meeting.
The program, called "Global MDR-TB and XDR-TB Response Plan 2007-2008"
sets out measures needed to prevent, treat and control those threats.
MDR-TB is multiple-drug resistant, while XDR-TB is extensively drug
resistant.
WHO officials said the plan also launches "actions" that would reach a
2015 goal of providing access to drugs and diagnostic tests to all
MDR-TB and XDR-TB patients, "saving the lives of up to 1.2 million
patients," officials said.
Included will be investments in programs to treat patients, building
capacity in diagnostic laboratories, expanding infection control and
surveillance, and funding research into new attacks on the disease.
"We have sounded the alarm on the potential for an untreatable XDR-TB
epidemic. Today we issue our response on behalf of all patients and
communities whose lives are most at risk. It is an ambitious plan that
must be fully supported if we are to keep a stranglehold on
drug-resistant TB," said Dr. Mario Raviglione, director of the WHO Stop
TB Department.
It was in March 2006 when researchers reported their encounter with the
extensively resistant TB strains. Within a few months, a cluster of
"virtually untreatable" XDR-TB cases was reported in South Africa,
aggravated by a high prevalence of HIV.
"All but one of the 53 patients died in an average of 25 days after
samples were taken for drug resistance tests," the agency said. Then
Speaker's case, "focused attention on the need to address the TB
epidemic as an immediate international priority."
"A highly important element of the plan is a steady supply of quality
drugs to treat MDR-TB and XDR-TB in underserved countries," said Dr.
Marcos Espinale, executive secretary of the Stop TB Partnership. "The
Partnership's Global Drug Facility is ensuring supply of these drugs to
a growing number of countries, after our Green Light Committee has
verified that applicant countries meet its technical standards and will
use the drugs correctly."
MDR-TB is defined as being resistant to main first-line drugs such as
isoniazid and rifampicin. More than 400,000 such cases are reported each
year, and it emerges generally when it is spread from one person to
another, or the drugs used to battle ordinary TB are mismanaged,
allowing a resistance to develop, officials said.
The XDR-TB develops when there is resistance to all of the most
effective anti-TB drugs, and the fluoroquinolone drugs as well as some
of the second-line injectable drugs, amikacin, capromycin and kanamycin.
The problem is with the tendency for such infections to grow
exponentially, said Raviglione.
"That is the big threat here. If you have more and more of these cases,
you will automatically magnify the problem by having transmission going
on to other individuals ... Once they become infected they are sort of a
time bomb," he said.
"If this is kept unchecked and goes on, then you may also see an
apocalyptic scenario where the present epidemic of TB is replaced by an
epidemic of TB which is now fully resistant to everything," he added.
In such a situation, the toll could be massive. Currently 8.8 million
people each year develop normal TB, a bacterial infection (Mycobacterium
tuberculosis) that usually attacks the lungs. It already kills 1.6
million annually, WHO said.
"The possibility is that you could replace that epidemic with a
drug-resistant epidemic, in other words you could have 8 million cases
of drug-resistant TB wandering around. And then you will be back to the
pre-antibiotic era," said Nunn.
"We really now have to focus on problems of infection control. We can't
allow drug-resistant MDR or XDR to get into populations of HIV-infected
people," he added.
Ordinary TB can be diagnosed with a microscope, but drug-resistant forms
require much more sophisticated tests – and labs, which are missing in
many poor countries. And ordinary TB usually can be treated over a
course of six months or so; the more drug-resistant varieties could take
two years.
"It's basically a death sentence. If people are failing first- and
second-line drugs and we don't have in the pipeline a new drug for
immediate use, that's a crisis," said Espinale.