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Epidemiology of antituberculosis drug resistance (the Global Project on Anti-tuberculosis Drug Resistance Surveillance): an updated analysis.
Lancet. 2006 Dec 16; 368(9553):2142-2154.The burden of tuberculosis is compounded by drug-resistant forms of the disease. This study aimed to analyse data on antituberculosis drug resistance gathered by the WHO and International Union Against Tuberculosis and Lung Disease Global Project on Anti-tuberculosis Drug Resistance Surveillance. Data on drug susceptibility testing for four antituberculosis drugs--isoniazid, rifampicin, ethambutol, and streptomycin--were gathered in the third round of the Global Project (1999-2002) from surveys or ongoing surveillance in 79 countries or geographical settings. These data were combined with those from the first two rounds of the project and analyses were done. Countries that participated followed a standardised set of guidelines to ensure comparability both between and within countries. The median prevalence of resistance to any of the four antituberculosis drugs in new cases of tuberculosis identified in 76 countries or geographical settings was 10.2% (range 0.0-57.1). The median prevalence of multidrug resistance in new cases was 1.0% (range 0.0-14.2). Kazakhstan, Tomsk Oblast (Russia), Karakalpakstan (Uzbekistan), Estonia, Israel, the Chinese provinces Liaoning and Henan, Lithuania, and Latvia reported prevalence of multidrug resistance above 6.5%. Trend analysis showed a significant increase in the prevalence of multidrug resistance in new cases in Tomsk Oblast (p < 0.0001). Hong Kong (p = 0.01) and the USA (p = 0.0002) reported significant decreasing trends in multidrug resistance in new cases of tuberculosis. Multidrug resistance represents a serious challenge for tuberculosis control in countries of the former Soviet Union and in some provinces of China. Gaps in coverage of the Global Project are substantial, and baseline information is urgently required from several countries with high tuberculosis burden to develop appropriate control interventions. (author's)
Lancet. 2004 Apr 3; 363(9415):1122.With just 20 months to go before the World Health Assembly’s (WHA) tuberculosis (TB) treatment target is due to be met, it is clear that the deadline will not be reached. In May, 2000, the WHA pledged to combat TB— which infects 9 million people each year and kills 2 million—by setting goals that demand detection of 70% of cases of infectious TB, and treatment of 85% of these by December, 2005. But, new data announced at the second meeting of Stop TB Partners’ Forum (March 24–25, 2004; New Delhi, India), where WHO’s 2004 Global Tuberculosis Report was also released, confirmed fears that TB is still far from under control. Treatment is now successful in 82% of cases, just 3% shy of the cure target. But smear-positive case detection remains low at 37%—just over half the goal of 70%. (excerpt)