Tuberculosis now a worldwide threat

Jun 7 2005

The Journal of the American Medical Association (JAMA) says that Tuberculosis (TB) is on the rise throughout the world and new cases among immigrant populations demands increased attention and funding.

A series of recent studies on tuberculosis shows that the disease is challenging a wide range of populations, from the poorer nations of Africa and Eastern Europe to the U.S. state of California. The disease has now infected a third of the world's population, and 23 countries account for 80 percent of new cases.

The journal's editor-in-chief, Catherine DeAngelis, and managing deputy editor, Annette Flanagin, say it will take the will and resources of the entire world to eradicate this global problem,and they hope that the insight provided by the various articles in the current issue of JAMA will encourage more interest in funding.

The publication of the studies is timely, as U.S. lawmakers in Washington are preparing to vote on the federal budget, and the top United Nations official concerned with tuberculosis is among advocates pressing Congress to triple the funding to fight TB.

TB is a disease that kills about 2 million a year worldwide and causes $12 billion in economic losses.

Paul Nunn, the UN coordinator for tuberculosis, HIV and drug resistance at the World Health Organization, is emphasising his concerns during two days of meeting with House and Senate members on budget-related committees.

One of the reports in the Journal has found that California failed to reduce the proportion of tuberculosis cases that resist treatment with known medications, even as the total number of cases fell by 33 percent from 1994 to 2003.

According to study author Reuben Granich of the U.S. Government's Centers for Disease Control and Prevention, this was primarily due to the number of cases in people from outside the U.S.

Granich found that in California, 83 percent of tuberculosis cases that resist treatment involved foreign-born patients from 30 countries.

Granich and his colleagues say that this statistic highlights the importance of international TB control.

Nunn also says that is one of his arguments in seeking an increase in U.S. funding for international TB prevention and treatment programs, it is far cheaper, he says to control it in the countries of origin.

In another report by Christopher Dye of the World Health Organization he concluds that outbreaks in Africa and Eastern Europe pose the greatest obstacle to international goals for reducing the number of tuberculosis cases and deaths.

Dye says that acheiving the World Health Organization goals set in 1991 of detecting 70 percent of new cases and successfully treating 85 percent of them, is made difficult in Africa and Eastern Europe by the prevalence of HIV infection.

Another study concluded that risks for tuberculosis in the U.S. coincide with many of the factors associated with persistent homelessness, including being male or having a history of incarceration or substance abuse.

Other studies found that the drug Isoniazid, made generically by companies including Novartis AG and part of a treatment for HIV, reduced the incidence of tuberculosis among HIV-infected miners in South Africa. It also found that there is little correlation between the appearance of tuberculosis on chest X- rays and how recently the disease was acquired.