An Ounce of Prevention: Why we must strengthen basic TB control to defeat drug-resistant TBPosted on by
To many, the idea of living in a world where there is no effective treatment for tuberculosis (TB) seems unthinkable. After all, we live in a modern era, with hospitals and drugs at our fingertips. TB is considered by some to be a disease of the past.
But every year, more than 9 million people become sick with TB, placing a huge burden on families and health systems in dozens of countries considered to have a high burden of TB. Another concerning trend is the rise of a strain of TB resistant to our best drugs (also known as multidrug-resistant tuberculosis, or MDR TB), which affected nearly 500,000 people in 2013. These patients face two years of intense treatment, during which time they must see a health provider nearly every day and receive 250 injections and 15,000 pills. The drugs can have serious side effects, like permanent hearing loss, and cost nearly $500,000 for a treatment course in the United States.
Worse, only 1 in 3 people with MDR TB will receive a timely diagnosis. Even after a diagnosis, many find themselves on a waiting list for drugs, or cannot access the expensive medicines needed to treat MDR TB. Among those treated, only 48% are cured.
As if the costs – personal and financial – were not steep enough, globally, the rates of MDR TB are rising. MDR TB has been reported in nearly every country of the world, and a more extreme form of MDR TB known as extensively drug-resistant (XDR) TB has been reported in at least 100.
Without a significant change, these strains of TB threaten to spread in high TB burden countries and also resurge in parts of the world where TB has been declining for decades. Despite being preventable and curable for more than 100 years, TB might also be a disease of our future.
In the United States, TB has now become concentrated among certain vulnerable groups, but anyone who is exposed can get TB. Many US travelers every year visit places in the world where TB is still common, and, as we know, diseases know no borders.
To eliminate TB in the United States, we must also contribute to the global fight to control TB. The spread of MDR TB and XDR TB is a global health security concern worldwide, threatening to erase decades of progress by making TB untreatable once again. Even in countries with a low TB burden, like the United States, MDR-TB cases strain the public health system which struggles to fund and maintain a steady supply of the expensive drugs needed for rare cases.
In CDC’s 2013 report on Antibiotic Resistance Threats in the United States, we identified MDR TB as a serious threat in the United States because of its alarming rise worldwide. The reality is that TB anywhere is TB everywhere, which is why the challenges of addressing TB and MDR TB must be met with a coordinated and focused global response. MDR TB is also part of the Global Health Security Agenda and the National Strategy for Combating Antibiotic-Resistant Bacteria, which emphasize the need to strengthen the epidemiology, surveillance, laboratory, and emergency response capabilities of health systems, critical elements for both basic public health infrastructure and effective TB control programs both in the United States and globally.
The global spread of drug-resistant TB doesn’t have to continue. When drug-susceptible TB is treated properly, the risk for development of MDR TB decreases sharply. So we must strengthen basic TB programs to find, cure, and prevent TB before it develops resistance – in essence “turning off the tap” of new cases.
Find. There are 9 million cases of drug-susceptible TB in the world each year, and these risk turning into MDR TB without rapid intervention. Reaching at-risk populations and strengthening laboratory networks to diagnose TB more quickly are all key pieces to this effort. Proper tracking of cases is also critical to identify the best interventions for preventing infections and saving lives.
Cure. Curing patients of TB requires prescribing the right drugs, monitoring patient response to treatment, and helping patients complete
therapy before MDR TB strains can develop. We know this works. With an infectious disease like TB, effective treatment is also effective prevention.
Prevent. Strong infection control measures in health facilities can reduce the spread of disease and protect our healthcare workers. At the community level, we must better understand TB transmission dynamics in crowded urban settings, identify contacts of TB cases for evaluation, and provide preventive therapy for those most vulnerable to the disease, such as young children and persons living with HIV/AIDS.
At CDC, we work closely with many international partners to build the evidence base for better ways to prevent, find, and cure TB, including MDR TB. Our operational and clinical research efforts are addressing questions directly affecting our partner TB programs: What is the best way to use new diagnostics to reach more patients more quickly? Which shorter treatment regimens are most effective? How can we ensure better treatment outcomes for children? And what approaches best prevent TB transmission in health facilities? We’re providing technical support and training to national TB programs and other partners in more than 25 countries to improve TB surveillance, diagnosis, and treatment of TB, TB/HIV, and MDR TB.
The future of tuberculosis can be changed. Imagine a future where everyone with TB is diagnosed quickly and started on effective treatment – a regimen lasting only a few weeks – and cure was nearly universal. By pairing global efforts to improve public health response capabilities with proven interventions to strengthen TB control, we can come closer to this reality and stop the suffering and cost associated with this deadly disease.
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