24 March 2000
DRUG-RESISTANT STRAINS OF TB INCREASING WORLDWIDE
report shows super-deadly TB strain is spreading.
Amsterdam -- A new report released today by the World Health Organization and the International Union Against TB & Lung Disease warns that if countries do not act quickly to strengthen their control of TB, the multidrug resistant strains that have cost New York City and Russia hundreds of lives and more than $1 billion each will continue to emerge in other parts of the world.
In response, top government officials of 20 countries meeting today in Amsterdam are expected to announce an ambitious strategy to "turn off the tap" of drug resistance in the worst-affected countries. The focus of these efforts will be the tripling of access over the next five years to a strategy proven to prevent MDR TB from developing.
"For the first time, we have evidence the drug resistant TB outbreaks that have shaken New York City and Russia are increasing elsewhere," said Dr Gro Harlem Brundtland, Director General of the World Health Organization. "Later today, the countries most severely affected by TB will be announcing their plans to prevent this threat from worsening."
Resistance to at least one TB drug has increased by 50% in both Denmark and Germany since 1996, and it has doubled in New Zealand. In all three countries, foreign-born TB patients are nearly twice as likely as native-born patients to be harbouring a drug resistant strain. The report reveals that when drug resistance is permitted to flourish in developing countries, the consequences are inevitably felt by wealthy countries.
"Improved screening of immigrants will not solve this problem," said Dr Arata Kochi, director of the Stop TB Initiative. "The only safeguard for wealthy countries is to help countries with poorly-functioning TB control programmes to fix the problem immediately, by helping them strengthen their programmes.
In Estonia, the percentage of MDR TB strains -- those resistant to the two most powerful anti-TB drugs -- isoniazid and rifampicin -- has increased from 13.5% in 1997 to 18.1% one year later.
The report also provided first-ever data on levels of MDR-TB in 38 geographical regions. The findings were particularly alarming in China (Henan and Zhejiang), India (Tamil Nadu), Iran, Mozambique and Russia (Tomsk). Each reported high levels of MDR TB of over 3% in new cases. Additionally, Israel, Italy, Mexico (Baja California, Oaxaca and Sinaloa) reported MDR TB in over 6% of both new and previously treated cases combined.
"Our biggest worry is that drug resistant TB will also begin increasing in other developing countries," said Dr David Heymann, Executive Director of Communicable Diseases for WHO. "North America and Europe may have the billions of dollars required to contain this emergency. The worst affected countries in Asia, Africa and Latin America do not."
But there is also hopeful news in the report. Countries that use WHO’s recommended TB control strategy known as DOTS have been able to prevent drug resistance from increasing. Some countries using DOTS, such as Cuba and Nepal, have even begun to see declining levels of drug resistance. The DOTS strategy is designed to ensure patients take their medicines properly. Drug resistance most often develops when patients forget to take all of their prescribed medicines regularly for the entire course of treatment.
China provides the most striking example of the effectiveness of DOTS. Drug resistance is three times lower in regions using DOTS than in regions not using the strategy. Worldwide, MDR TB rates are many times lower in countries using DOTS to treat almost every TB patient than in countries making infrequent use of the strategy.
In Amsterdam later today, the governments of the 20 countries with the largest number of TB patients are expected to announce a series of initiatives to prevent the MDR crisis from worsening. The World Health Organization and the World Bank have called together the meeting with Ministers of Health, Finance and Planning from high-burden countries, and top leadership from UNICEF, UNAIDS and development agencies to plan strategies to stop the spread of MDR TB, and reduce deaths from TB in half over the next decade.
At 12:45 Amsterdam time, Friday 24 March, Dr Brundtland, Donna Shalala of the U.S. Department of Health and Human Services, and Ministers from endemic countries will issue a press statement on the global response to this crisis.
Anti-Tuberculosis Drug Resistance in the World - Report No. 2 represents the first report ever to provide information on trends in global drug resistance. The report presents data from 72 countries and regions. "We suspected that drug resistance was worsening in many parts of the world when we compiled the first report in 1997," said WHO’s Marcos Espinal, who headed the project. "This report confirms our worst fears."
Multidrug resistant TB is a strain of TB that cannot be cured with the most effective anti-TB medicines. Like all forms of TB, it is spread through the air. In 1991, New York City experienced an outbreak of MDR TB that eventually claimed more than 500 lives. Recently, an MDR TB outbreak in Russia has killed many more.
For more information, contact, in the United States, Jim Palmer at +1-202-262-9823; in the United Kingdom, Janice Muir at +44-171-407-3313; in the Netherlands, Linda Verkerk at +31-70-318-4405; at WHO Geneva, Gregory Hartl, +41-22-791-4458. A summary of "Anti-Tuberculosis Drug Resistance in the World, Report No. 2", Fact Sheets, and electronic press statements can be found athttp://www.stoptb.org.
All WHO Press Releases, Fact Sheets and Features can be obtained on Internet on the WHO home page http://www.who.int