Missed Tuberculosis Cases in China, India Spur Global Spread

Mar 18 2008

By Simeon Bennett

March 18 (Bloomberg) — Missed tuberculosis cases in India and China are enabling the lethal disease to spread, jeopardizing global efforts to slash new infections by 2015, the World Health Organization said.

For every five TB cases diagnosed globally in 2006, four went undetected, the Geneva-based WHO said yesterday in its annual Global Tuberculosis Control report. Progress in case detection slowed globally in 2006, the most recent year for which data are available, and began to stall in China and India.

A third of the world’s population is infected with TB, which depletes the incomes of the world’s poorest communities by $12 billion a year, according to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The average rate at which new TB cases were detected fell to 3 percent a year between 2005 and 2006 from 6 percent between 2001 and 2005, according to the report.

“You reach a certain stage where most of the cases that are easily detectable are being detected, and now it is time for countries to step up their efforts to get those cases that are more difficult to reach,” Peter van Maaren, the WHO’s Manila- based regional adviser on tuberculosis in the Western Pacific region, said in a telephone interview today.

Delays in finding and treating TB may prevent the WHO from reaching its goal to cut TB deaths by half by 2015 from 1990 levels, according to the report. WHO estimates 9.2 million people became infected in 2006, though only 5.1 million were diagnosed that year. Africa, Southeast Asia and the Western Pacific accounted for 83 percent of notified cases, it said.

India, China, Indonesia, South Africa and Nigeria had the most cases, the WHO report said. Left untreated, each person with active TB will infect between 10 and 15 people on average every year, the United Nations health agency says.

Drug Resistance

TB’s global spread, including to patients weakened by HIV/AIDS, is encouraging the emergence of drug-resistant strains, which now account for about 5 percent of new cases.

About 700,000 people with HIV were diagnosed with TB in 2006, mostly in Africa. Of the 1.7 million estimated deaths from TB, 200,000 also had the AIDS-causing virus. About 500,000 people worldwide are infected with drug-resistant strains that kill at least 30 percent of patients.

Drug resistance makes TB more dangerous and treatment more expensive. Costs of hospitalization, surgery and treatment with stronger “second-line” drugs, such as Eli Lilly & Co.’s Capastat, can reach as much as $500,000 for each case in the U.S. That’s 100 times more costly than using first-line therapies. About half of patients with extensively drug-resistant, or XDR, tuberculosis die of the disease.

The bacterial infection becomes resistant when patients don’t complete a full treatment of medication. Drug-resistant TB, like the regular form, can be transmitted through the air to a non-infected person.

The WHO expects funding to combat tuberculosis to “remain flat” in 2008 in almost all of the countries most affected by the disease, it said. An additional $1 billion is needed across the 90 nations which provided financial data to the WHO to fight resistant strains and TB-HIV co-infection, the agency said.

To contact the reporter on this story: Simeon Bennett in Singapore at sbennett9@bloomberg.net

Last Updated: March 18, 2008 00:59 EDT

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