Why TB remains the world’s deadliest infectious disease

Fewer people died from tuberculosis (TB) last year, however, countries are still not doing enough to end TB by 2030, warns the World Health Organization (WHO).

Though global efforts have averted an estimated 54 million TB deaths since 2000, yet TB remains the world’s deadliest infectious disease.

WHO’s 2018 Global TB Report, released in New York on Tuesday, calls for an unprecedented mobilization of national and international commitments.

It urges political leaders gathering next week for the first-ever United Nations High-level Meeting on TB to take decisive action, building on recent moves by the leaders of India, the Russian Federation, Rwanda, and South Africa. Nearly 50 heads of state and government are expected to attend the meeting.

“We have never seen such high-level political attention and understanding of what the world needs to do to end TB and drug-resistant TB, said Dr.Tedros Adhanom Ghebreyesus, WHO Director-General. “We must capitalise on this new momentum and act together to end this terrible disease.”

To meet the global target of ending TB by 2030, countries need to urgently accelerate their response – including by increasing domestic and international funding to fight the disease. The WHO report provides an overview of status of the epidemic and the challenges and opportunities countries face in responding to it.

Status of the TB epidemic across the globe:

Globally, an estimated 10 million people developed TB in 2017. The number of new cases is falling by 2 per cent per year, although faster reductions have occurred in Europe (5 per cent per year) and Africa (4 per cent per year) between 2013 and 2017.

Overall, TB deaths have decreased over the past year. In 2017, there were 1.6 million deaths (including among 3 lakh HIV+ people). Since 2000, a 44 per cent reduction in TB deaths occurred among people with HIV compared with a 29 per cent decrease among HIV- people;

Drug-resistant TB remains a global public health crisis. In 2017, about 5.6 lakh people were estimated to have developed disease resistant to at least rifampicin – the most effective first-line TB drug.

The vast majority of these people had multidrug-resistant TB (MDR-TB), that is, combined resistance to rifampicin and isoniazid (another key first-line TB medicine).

WHO estimates that a quarter of the world’s population has TB infection.

Challenges and opportunities

Under-reporting and under-diagnosis of TB cases remains a major challenge. Of the 10 million people who fell ill with TB in 2017, only 6.4 million were officially recorded by national reporting systems, leaving 3.6 million people undiagnosed, or detected but not reported. Ten countries accounted for 80% of this gap, with India, Indonesia and Nigeria topping the list.

Less than half of the estimated one million children with TB were reported in 2017, making it a much higher gap in detection than that in adults. Treatment coverage lags behind at 64 per cent and must increase to at least 90 per cent by 2025 to meet the TB targets.

Only around half of the estimated 920,000 people with HIV-associated TB were reported in 2017. Of these, 84 per cent were on antiretroviral therapy. Most of the gaps in detection and treatment were in the WHO African Region, where the burden of HIV-associated TB is highest. Only one in four people with MDR-TB were reported to have received treatment with a second-line regimen.

China and India alone were home to 40% of patients requiring treatment for MDR-TB, but not reported to be receiving it.

Globally, MDR-TB treatment success remains low at 55 per cent, often due to drug toxicity making it impossible for patients to stay on treatment.

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