For the first time, the number of people infected with tuberculosis (TB) each year is declining, according to Mario Raviglione, MD, director of the World Health Organization (WHO)’s Stop TB program.
He spoke here today during 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.
In a numbers-heavy talk, Dr. Raviglione highlighted a mix of positive and sobering news from the report. Among achievements, he noted that:
• The number of people who were infected with TB decreased to 8.8 million in 2010, after peaking at 9 million in 2005.
• 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.
• All regions except Africa are on track to achieve a 50% decline in mortality by 2015.
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.
Worldwide, major funding hurdles now need to be overcome, 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.
One bright spot in the fight against TB has been China, according to the report. The TB death rate there declined by nearly 80%, 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.
Laboratory tests are not available to test everyone, Dr. Raviglione said, citing 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.”
The WHO report is notable because it is the first since 1997 in which research and development are explicitly part of the report, noted Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.
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.
In the past he has joked about the need to bring TB research into the 21st century from the 19th century. To make the research and development pipelines more robust, fundamental questions need answers, he said, particularly those that get at the relationship between the microbe and the host. Why do 10% of people not immunosuppressed during a lifetime go from latent to active TB? What are biomarkers for disease activity?
He compared TB with HIV, saying that the latter has a menu of more than 30 drugs that can rapidly bring the viral load below detectable levels. Biomarkers can tell what effect the drug has on a person with HIV down to the RNA copy of one, he said. “Can you imagine something even approaching that to understand where we stand with