TB rates decline for the first time: WHO report

By Dr. Ananya Mandal, MDOct 12 2011

According to Mario Raviglione, director of the World Health Organization (WHO)'s Stop TB program, for the first time, the number of people infected with tuberculosis (TB) each year is declining. He was speaking at a press conference to release Global Tuberculosis Control 2011, WHO's 16th annual report on TB, which summarizes advances made and challenges ahead. The report features data on TB in nearly 200 countries with treatment results and financing trends.

Dr. Raviglione pointed out some heartening figures like the number of people who were infected with TB decreased to 8.8 million in 2010, after peaking at 9 million in 2005. Additionally in 2010, TB deaths declined to the lowest level in a decade, to 1.4 million deaths, after reaching 1.8 million deaths in 2003. The TB death rate dropped 40% between 1990 and 2010. Additionally all regions except Africa are on track to achieve a 50% decline in mortality by 2015.

Also in 2009, 87% of patients treated were cured, bringing the total successfully treated to 46 million cured and 7 million lives saved under WHO guidelines since 1995. “It's a major achievement,” he said.

However, although 6 million TB cases are reported every year from countries worldwide, in another 3 million cases, no one knows whether diagnosis and treatment are appropriate, because patients are not notified. “We fear most are detected late, and their outcomes are uncertain,” said Dr. Raviglione.

Speaking on funding hurdles he said, countries are reporting a funding gap of $1 billion for TB implementation in 2012. Continued international funding is more critical than ever, especially for the lower-income countries, he said. Without further help, Africa might be the 1 region in 2015 that does not see a 50% decline in TB deaths since 1990. Worldwide, 86% of TB financing comes from domestic sources, but only about 50% is from domestic sources in the lowest-income countries, particularly those in Africa.

WHO's Director-General Margaret Chan says strong leadership in many countries, coupled with domestic financing and foreign donor support, has begun to make a difference in the fight against tuberculosis. Calling upon renewed and continued support Dr. Raviglione said, “I am concerned that the momentum that has been created by these achievements may actually be lost…So that’s why we are calling for an increase in the intensity of tuberculosis control and research.”

Brazil and China, by far has fared the best. The TB death rate there declined by nearly 80% in China, from 216,000 to 55,000 deaths, between 1990 and 2010. In addition, the incidence of TB infections was cut in half, from 215 to 108 per 100,000 people, he said.

One area that continues to pose a major challenge is multidrug-resistant (MDR) TB. Less than 5% of new and previously treated patients with TB were tested for MDR-TB in most countries in 2010, and the reported number of patients being treated reached only 16% of the 290,000 cases of MDR-TB estimated among notified patients with TB in 2010.

Further there is a $200 million gap in funding for MDR-TB. One cause for optimism he cited was a new rapid molecular test for TB called Xpert MTB/RIF (Cepheid) that has the potential to substantially improve and speed diagnosis of TB and MDR-TB. The test is being used in 26 developing countries. By the end of the year, he said, 40 countries would be using it, just 6 months after WHO endorsed it.

“I've never seen a transfer of technology that was so rapid,” he said. “The promise of testing more people for MDR-TB must be met now with the commitment to treat all of those who are detected. In fact, it would be a real scandal if we left people diagnosed with MDR-TB without drugs and without treatment, which is a real concern today.”

Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health said chapter 7 of the report looks at research and development and offers a line-up of menus of diagnostics, therapeutics, and vaccines in various stages of the pipeline that Dr. Fauci calls “quite encouraging.” He also spoke at the press conference.