The spread of resistant strains of TB has experts worried, writes CLIFFORD COONANin Beijing
THE GATES Foundation, a fund set up by software mogul Bill Gates, has announced it will spend €25 million to pay for tests of new treatments for tuberculosis patients in China, helping about 50,000 sufferers each year.
TB is one of the top epidemic killers in China and the plan is part of a worldwide effort to stop emerging, hard-to-cure strains of the disease.
China has the second-worst TB problem in the world after India. The country accounts for 14 per cent of the world’s overall TB cases and up to 22 per cent of its drug-resistant cases, with about 130,000 deaths from the disease each year.
Tuberculosis is caused by germs that spread when a person with active TB coughs, sneezes or speaks. It’s ancient and treatable but now has evolved into stronger forms: multidrug-resistant TB (MDR), which does not respond to two top drugs, and extensively drug-resistant TB (XDR-TB), which is practically untreatable.
Data shows that the rise in the number of people resistant to the drugs means 120,000 new multi-drug resistant (MDR) TB patients a year. China has five million TB patients and 80 per cent of them in the countryside.
Tests show that the prevalence of active and smear-positive TB cases is 2.4 times and 2.8 times higher in the countryside than in cities. A higher proportion of these are young adults, and there is no gender difference.
China’s health minister Chen Zhu says the emergence and spread of multi-drug resistant TB has seriously hindered the process of prevention and treatment of tuberculosis in China, making it a serious public health issue.
“This tuberculosis control programme aims to establish an effective prevention model through the exploration of new diagnostic tools and methods,” says Chen.
Left unchecked, people with drug-resistant TB could spread the disease to others, creating a widespread epidemic in the highly mobile global economy, a scenario seen during the Sars epidemic in 2003.
One of the world’s oldest and deadliest infectious diseases, mutations have seen TB mutate into forms that can withstand many of the most common medicines.
Drug resistance affects 28 per cent of China’s total TB patients. This often comes about from improper treatment by healthcare workers and failure to ensure that patients complete the whole treatment course.
New approaches being tried include tests that diagnose drug-resistant TB in hours instead of weeks and drug combinations that reduce the number of pills patients have to take by up to 70 per cent. Mobile phone text messages will be used to track patients and their treatments, and patients will be supplied with kits with built-in alarms.
“This partnership with China comes at a critical time in the world’s response to tuberculosis,” says Bill Gates, the billionaire founder of Microsoft and co-chairman of the foundation.
“TB is an increasing threat because of gaps in the way the disease is diagnosed and treated. This partnership will help cut off drug resistance at its source by applying innovative approaches to strengthen basic TB control,” he says.
The plan will initially cover 20 million people in six provinces and will be expanded to 100 million people over five years.
WHO director-general Margaret Chan told a meeting of health ministers and senior officials from 27 countries worst affected by the new drug-resistant strains of TB that they needed to make dramatic improvements in detecting infections and build stronger healthcare systems.
“Call it what you may – a time bomb or a powder keg. Any way you look at it, this is a potentially explosive situation,” she told the meeting in Beijing.
Chinese premier Wen Jiabao applauded Gates for his help for China in HIV/Aids and TB prevention and treatment.
In 2007, 1.75 million people worldwide died of tuberculosis. Of the more than 9 million people around the world who contract the disease every year, about 500,000 get multi-drug resistant TB. The WHO estimates that 150,000 people die of drug-resistant TB every year worldwide.
The WHO says there were 9.27 million new cases of TB in 2007, with about half occurring in five countries: India, China, Indonesia, Nigeria and South Africa. Only about two-thirds of the cases were diagnosed. About 5.3 million new cases or 57 per cent of the total were being treated, which generally requires that a person take a combination of drugs for six months.
The incidence of tuberculosis in 2007 was 139 new infections per 100,000 people, a decline from 142 in 2004. Because of the growth in the world’s population, the number of new cases in 2007 was slightly higher than in the few years prior.
About 1.3 million tuberculosis patients who were not infected with HIV, and about 456,000 who were, died of the disease in 2007. TB is the leading cause of death in Aids patients and accounted for about one-quarter of the 2 million Aids deaths worldwide.