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Fighting the tuberculosis epidemic in the Western Pacific region: current situation and challenges ahead.
Kekkaku. 2010 Jan; 85(1):9-16.INTRODUCTION: Tuberculosis (TB) remains a major public health problem in the Western Pacific Region. More than 20% of the global burden of TB is found in the Region. In 2007, the latest year for which data is available, there were an estimated 1.9 million incident cases (109 per 100,000 population). Four countries (Cambodia, China, the Philippines and Vietnam) account for 93% of the total estimated incident cases in the Region. Every year an estimated 300 thousand persons die due to TB. The Region is host to an estimated 135,000 multi-drug resistant TB cases, most of which can be found in China. TB PREVALENCE AND TB MORTALITY: The Regional Stop TB strategy aims to halve the prevalence and mortality rates of 2000 by 2010. Based on current estimates, the TB prevalence declined with 24% between 2000 and 2007, while TB mortality declined with 19% in the same period. Given the current annual decrease in TB prevalence and mortality, it is unlikely that the Region will achieve the 50% reduction by 2010. CASE FINDING: Approximately 1.4 million new TB cases were notified in the Region in 2007, of which close to 0.7 million smear-positive cases. Cases from China accounted for 70% of the total notified smear-positive cases. The Regional case detection rate was sustained at 78%. Case detection rates in China, the Lao People's Democratic Republic, Mongolia, the Philippines and Vietnam exceeded the 70% target. TREATMENT OUTCOMES: A total of 92% of the 0.7 million new pulmonary smear-positive cases registered for treatment in 2006 were successfully treated. The treatment success rates exceed the 85% target in all countries with a high burden of TB, except Papua New Guinea where it was reported at 73%. MULTIDRUG-RESISTANT TB: In 2007, the proportion of MDR-TB in new TB cases was estimated to be 4%. A total of 135,411 MDR-TB cases was estimated to have occurred in 2007. Based on the overall case management data, 10,231 new patients and 1,596 re-treatment patients were reported with available drug susceptibility testing (DST) results in the Region. Of these, 1% (89/10,231) and 29% (468/1,596) had MDR-TB, respectively. Capacity to detect and treat MDR-TB cases is still very limited in most countries in the Region. Eighteen countries and areas in the Region have conducted drug resistance surveillance (DRS) since 2000, according to the Global Project on Anti-tuberculosis Drug Resistance Surveillance. Among new TB cases, the prevalence of multidrug-resistant TB (MDR-TB) ranged from 0% in Cambodia to 11.1% in the Commonwealth of the Northern Mariana Islands. MDR-TB prevalence among re-treatment cases ranged from 3.1% in Cambodia to 27.5% in Mongolia. In the five countries with a high burden of TB with available data from surveys (Cambodia, China, Mongolia, the Philippines, and Vietnam), MDR-TB prevalence in new cases and re-treatment cases ranged from 0% in Cambodia to 4.9% in China and from 3.1% in Cambodia to 27.5% in Mongolia, respectively. Notably, there were alarming rates of MDR-TB in several provinces in China among both new and retreatment cases. Increasing numbers of MDR-TB cases are reported from Papua New Guinea. TB-HIV CO-INFECTION: The overall estimated prevalence of HIV in new TB cases in 2007 was 2.7%. With 8.0% in 2008 compared to 11.8% in 2003, Cambodia shows a declining prevalence of HIV in new TB cases. There was a significant increase in the use of anti-retroviral therapy (ART) in the Region. However, detailed and complete data as well as strong collaboration in HIV and TB management are needed to be able to closely monitor the use of ART and its impact on TB-HIV co-infection in the Region. CONCLUSION: In spite of the substantial progress made in most countries with a high burden of TB, substantial challenges remain in the Region. The rate of decline in TB prevalence and mortality is too low to reach the 50% reduction goal in 2010. It will be necessary to further increase TB case detection and address the emerging spread of drug-resistant TB. The slow response in the most affected countries in the Region is a cause for concern. Strong commitment by national governments and their partners is needed to sustain and further strengthen the current TB control efforts.
IMPO NEWSLETTER. 1998 Dec; 3.Worldwide, 2-3 million people die annually from tuberculosis (TB). Unless concerted efforts are taken in Asia, the TB epidemic will continue to worsen, jeopardizing global control efforts. At a 4-day conference in Bangkok of more than 1500 lung disease experts, Dr. Heidi Larson, a senior World Health Organization official, noted that the economic crisis in southeast Asia has increased the risks of TB spreading throughout the region. The danger of a major resurgence of TB has been made worse by drug resistance developed as a result of haphazard treatment of the condition in poor countries. Malnutrition and generally worsening health problems caused by the economic crisis have increased the likelihood of people developing active TB because they have weakened immune systems. Interruptions of drug supplies also broaden the scope for the development of drug-resistant TB. The World Health Organization has identified China, India, and Indonesia as the countries which have experienced the most dramatic increases in cases of active TB. TB can be cured on a large scale, but both national and international political commitment are needed.
Lancet. 1997 Dec 6; 350(9091):1689.Experts from almost 60 medical schools in India have called for phased expansion of India's Revised National Tuberculosis Control Programme (RNTCP) as "perhaps the only chance of controlling the emerging TB epidemic in India during this generation." The RNTCP, which is based on the Directly Observed Treatment, Short Course of the World Health Organization (WHO), was begun in 1993. In a pilot project conducted in 20 sites for 4 years, 8 out of 10 patients were cured; in previous programs, 3 out of 10 were cured. The new goal of the program is to cover the total population of 300 million over the next 3 years. The Medical Officer (TB) of WHO in Delhi, believes "the RNTCP could save more lives in India than any other public health intervention in the next decade." Almost 2 out of 5 TB cases globally occur in India; 50% of all adults there are infected. 2.2 million new cases occur there annually and the total annual number of cases in India is 14 million; 3.5 million of these people are highly infectious. 2 people/minute in India become sputum-positive, almost 1 patient/minute dies of TB, and more than 1000 people die of the disease daily. The HIV epidemic, particularly with reference to multidrug-resistant TB (MDRTB), is also of concern. The current situation regarding MDRTB is unknown because of a lack of good surveillance; WHO has designed a new strategy to meet this need. The WHO Medical Officer (TB) believes that MDRTB must be prevented from emerging and that a poor TB control program, even with unlimited resources, will create MDRTB cases more quickly than they can be cured.
JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PHYSICIANS IN AIDS CARE. 1995 Jun; 1(5):34.Tuberculosis (TB) is the leading killer, globally, of persons who are infected with human immunodeficiency virus (HIV); however, few countries are prepared to deal with this. In response, research experts on acquired immunodeficiency syndrome (AIDS) and TB met the first week of June to identify the best way to improve TB control in areas where HIV is prevalent or increasing. Dr. Arata Kochi, Director of the Global TB Program of the World Health Organization, warned that TB would kill almost one-third of those infected with HIV and would infect many of their contacts, both negative and positive for the virus, as the incidence of HIV rose in Asia. By the end of the decade, around one-third of all deaths among HIV-positive people will result from TB, according to Global TB Program estimates. In Abidjan, 32% of AIDS cases were considered to have died from TB. HIV is spreading more rapidly in Asia, where TB is more widespread than in Africa. Anthony Harries, a physician at Queen Elizabeth Central Hospital in Malawi, states that the co-epidemic complicates efforts to care for AIDS patients and to identify and treat TB patients. While caseloads are increasing, health workers are faced with a shortage of manpower and funds and a lack of appropriate technology. The meeting was convened by the Global Tuberculosis Program.
AIDS ASIA. 1995 May-Jun; 2(3):9.The World Health Organization (WHO) and the Japanese Anti-Tuberculosis Association estimate that tuberculosis (TB) will be responsible for more than 20 million premature deaths in Asia because governments worldwide have stopped fighting TB. About 66% of all TB cases in the world are in Asia. HIV infection is spreading more rapidly in Asia than anywhere else in the world. In the next 10 years, TB and AIDS will probably be responsible for the deaths of more Asians than the combined populations of the cities of Singapore, Beijing, Yokohama, and Tokyo. People with HIV infection are 30 times more likely to develop TB than people with no HIV infection. In fact, an HIV-positive person has a 10% chance of developing TB each year, while an HIV-negative person has a 10% chance of developing TB in his/her lifetime. Just breathing the same air as people infected with TB places the immuno-comprised person at risk of TB. A few weeks after beginning TB treatment, most TB patients, regardless of HIV status, are no longer contagious. Yet, governments' unwillingness to fight TB results in less than 50% of all TB cases being cured of TB. Some poor countries (Tanzania, Mozambique, China, and Peru) have invested in effective TB control programs, resulting in a cure rate as high as 90%. WHO estimates that annual expenditures geared towards HIV control in developing countries need to increase between $1500 million and $2900 million. They must increase between $100 million and $150 million for TB control activities. Yet, funding for WHO's Global Programme on AIDS is decreasing and its TB program operated on $7 million in 1994. The Japanese government provides more foreign aid to WHO's TB Programme than any other developed country. As of 1992, Japan had about 11,000 HIV-infected persons compared to about 30 million persons with TB. More than 32,000 Japanese will probably die from TB during the 1990s.