Tuberculosis (TB)

Global map of TB

MDR-TB: reaching all corners of the world

In 2008, WHO released the largest survey ever carried out on drug resistant tuberculosis with results from more than 80 countries. The anti-tuberculosis drug resistance in the world report confirmed that the spread of MDR-TB is reaching all corners of the world. But at the same time, the epidemic is far from uniform with regions and countries facing a variety of challenges. It also showed that a few countries had managed to stabilize or reverse the number of cases.

Region of the Americas

The prevalence of MDR-TB is low in the region as a whole. The region has the largest number of Green Light Committee-approved projects. Many countries plan to upgrade laboratory networks due to increased demand for development of second-line testing capacity

African Region

The most critical factor in addressing drug resistance in African countries is the lack of laboratory infrastructure and transport networks that can provide rapid diagnosis. It is possible that current survey methods, which are based on smear-positive cases, may under represent HIV coinfected TB cases, which are more likely to be smear negative. In addition, transmission dynamics of drug resistant TB in a heavily HIV-infected population are not well understood. A large outbreak of XDR-TB in an HIV-positive population in the province of KwaZulu-Natal, South Africa, was associated with extremely high mortality and highlighted the vulnerability of TB patients coinfected with HIV.

European Region

The proportion of MDR-TB was significantly higher in the Eastern European and Central Asian countries, with an average of 10.0% MDR-TB among new TB cases, and 37.7% among previously treated TB cases. Inmost of Central and Western Europe, both proportions and absolute numbers of drug-resistant cases remain low.

Eastern Mediterranean Region

The extent of second-line drug resistance is not known in the region. The primary limiting factor to expanding survey coverage is the high number of countries in conflict situations. Another limiting factor is the poor laboratory infrastructure in many countries.

South-East Asia region

Though resistance in the region is moderate, the overall burden of MDR-TB is considerable. Important progress has been made throughout the region in initiating plans for MDR-TB treatment, and almost all countries have Green Light Committee applications approved or in the pipeline. Virtually, all countries have identified laboratory capacity as the primary bottleneck to scaling up diagnosis and treatment. Also, many countries in the region have growing private sectors that are currently managing most of the MDR-TB cases, and second-line drugs are widely available through the private sector.

Western Pacific region

Information on resistance to secondline drugs is limited. The Western Pacific also faces limited capacity for culture and drug-susceptibility testing. Some countries have extensive culture networks in the public sector, but only one has a significant number of laboratories able to conduct drug susceptibility testing.

MDR-TB among TB

More than 6% of new TB cases are MDR-TB in these locations:

  • Azerbaijan, Baku City (22.3%)
  • Kazakhstan (20%)
  • Republic of Moldova (19.4%)
  • Ukraine, Donetsk (16%)
  • Russian Federation, Tomsk (15%)
  • Uzbekistan, Tashkent (14.8%)
  • Estonia (13.3%)
  • Russian Federation, Mary El (12.5%)
  • Latvia (10.8%)
  • Lithuania (9.8%)
  • Armenia (9.4%)
  • Russian Federation, Orel (8.8%)
  • China, Inner Mongolia (7.3%)
  • China, Heilongjiang (7.2%)
  • Georgia (6.8%)

Top 10 countries with TB patients

  • India
  • China
  • Indonesia
  • Nigeria
  • South Africa
  • Bangladesh
  • Ethiopia
  • Pakistan
  • Philippines
  • Democratic Republic of the Congo