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Growing drug resistance of TB a major concern

3 April 2009 -- This week, in the Chinese capital of Beijing, health leaders gathered to discuss the threat of the new forms of tuberculosis that are resistant to drugs.

Transcript of the podcast

Veronica Riemer: You’re listening to the WHO podcast, and my name is Veronica Riemer. This week, in the Chinese capital of Beijing, health leaders gathered to discuss the threat of the new forms of tuberculosis that are resistant to drugs. In this episode, we look at the growing drug resistance of tuberculosis and what is being done to stop it.


Tuberculosis can usually be treated with a course of four standard anti-TB drugs. If these drugs are misused or mismanaged, multidrug-resistant tuberculosis, or MDR-TB, can develop. MDR-TB takes longer to treat and requires drugs which are more expensive and have more side-effects.

Mismanagement of MDR-TB can lead to extensively drug-resistant tuberculosis - also known as XDR-TB. The bacteria in this case is resistant to the most effective anti-TB drugs. Mario Raviglione from the WHO's Stop TB Department tells us about the growing trend in these drug-resistant forms of TB.

Mario Raviglione: There are, with the new estimates, now roughly 500 000 cases a year of multidrug-resistant TB out of the total of 9.3 million cases. About 10% of these MDR-TB cases are XDR-TB, i.e. extensively drug-resistant, i.e. resistant not just to the first line standard drugs but also to the -- most important -- reserve drugs that we use. So that makes it somewhere around 40-50 000 a year of the XDR-TB cases. And, also we are now 55 countries around the world that have reported to us the diagnosis of at least one case of XDR-TB, meaning that this is a problem that is expanding and involving more countries.

Veronica Riemer: TB is a major cause of death among people living with HIV/AIDS. But HIV-positive people can easily be screened for TB and treated if necessary. Kevin de Cock from the HIV/AIDS Department of WHO tells us more.

Kevin de Cock: HIV-infected people are highly vulnerable to getting TB and if they get a variety of TB that is resistant against drugs they have very high case fatality rates, very high death rates. We have seen outbreaks of such events in South Africa, in other countries related to hospitals, antiretroviral therapy clinics, prisons and so on. Just to point out this is a reflection of weak TB programmes and inadequate health systems that these situations arise, so the whole issue of infection control and the prevention of drug resistance is extremely important for people living with HIV.

Veronica Riemer: At this week's meeting in Beijing, the Bill & Melinda Gates Foundation announced a grant of US$ 33 million to help China introduce innovative TB control methods to reduce the growing threat of drug-resistant TB. Iain Simpson of the Gates Foundation’s Global Health Communications team tells us why China has been selected for this grant, and what they hope to achieve.

Iain Simpson: This is really the first time where we have worked together with a national government to improve the delivery of technologies and to improve the way that those technologies are used. We have chosen to work with China because of the ability of the Chinese government to do things at scale. China has acknowledged a problem with drug-resistant tuberculosis. It is very keen to do something about this problem, and so together we are hoping that we'd be able to rapidly increase and improve the control of basic TB in China, and by doing that prevent the emergence of more drug-resistant cases.

Veronica Riemer: If these pilot projects are successful, this is likely to become part of the way TB treatment and care is delivered in China and in other countries.

Iain Simpson: One of the reasons for doing this in China is that it is possible to test these innovations in a very large population and if they are successful then we expect that other countries to be watching and learning from this pilot project in China and then to take these innovations -- both the tools themselves and the way that they are being delivered -- and to deliver them and use them for their own populations.

Veronica Riemer: That was Iain Simpson from the Gates Foundation. If you would like to learn more about this subject, there are links to related information on the transcript page of this podcast episode. Look for the link to the podcast on the home page of our web site, at

That's all for this episode of the WHO podcast. Thanks for listening.

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For the World Health Organization, this is Veronica Riemer in Geneva.

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