Monday, June 18, 2007

Interesting take on XDR-TB

U.S. leadership could eradicate global TB

by Ken Patterson

In early 2006, in a small clinic in South Africa, 52 of 53 patients died of XDR-TB (extensively drug resistant tuberculosis).

But it wasn’t until it came to light that Andrew Speaker got on a flight from Atlanta with XDR-TB in early May that most people, including the media, took notice.

The truth is that this disease storm has been brewing for some time, but because tuberculosis is primarily a disease of the poor, it has attracted little attention.

Without a serious commitment to diagnosing and controlling TB in the U.S. and around the world, it is likely that we will hear more stories like Speaker’s in the future.

So what is XDR-TB? Is it just some rare form of the disease that Speaker happened to picked up in some deep, dark cave?

No, XDR-TB is man-made — it is the common, treatable form of TB gone wild. It forms when dangerous MDR-TB (multi-drug resistant TB) is ineffectively monitored and treated.

In turn, MDR-TB arises when common TB is incorrectly or incompletely treated. So Speaker came into contact with someone who received ineffective treatment for his or her TB twice.

Millions affected

And it is not as rare as the media makes it sound. XDR-TB has been found in 35 countries, including the U.S. In the country of South Africa alone there are an estimated 600 cases of XDR-TB.

Most people do not know that there was an outbreak of around 300 cases of MDR-TB in the late 1980s and early 1990s that cost New York City more than $1 billion to control.

This seems incredibly costly given that common TB can be cured in the developing world for $20 to $100 (the drugs themselves costing only $16).

Probably the most alarming part of the TB story is that nearly one-third of the world’s population (2 billion people) carries TB latently, about 1.6 million people needlessly die of it each year, and around 9 million people develop active cases of TB each year, most in poor countries.

Each new case is an opportunity for someone to develop MDR- or XDR-TB if treatment is poor. And we have allowed many of the world’s people to live in situations where the likelihood of them completing treatment is not good.

In the U.S., an hourly worker with a family to support is unlikely to stay isolated during a six-week treatment period because he or she cannot afford to — who else will he or she infect?

In the developing world, side effects of the medicines are a deterrent to completing treatment for people who suffer of malnutrition. Also, inadequate health clinics, unsteady drug supply, too much expense or poor monitoring can also cause patients to cease treatment (patients may stop taking drugs because they feel better). The good news is that, although common TB is the greatest infectious killer worldwide, effective treatment will cure common TB 95 percent of the time.

A call to action

What now? Thankfully, because they understand the global threat of TB, certain members of Congress and organizations like the Gates Foundation, RESULTS and the international Stop TB Partnership have been working on TB for years. Last year Bill Gates helped introduce the Global Plan to Fight TB, an international business plan to improve TB diagnosis, monitoring and treatment around the globe, with the ultimate goal of eradicating TB by 2050. In the shorter term, the plan, if adequately funded, will save 14 million lives and treat 50 million people for TB, and will work toward new medical solutions for tuberculosis. But executing the plan will require leadership.

There are currently two bills in the U.S. House of Representatives (HR 1567 and HR 1532) and similar legislation in the U.S. Senate that address global and domestic TB. The domestic legislation will increase funding for U.S. TB control and bolster research into new medical solutions for TB. Global legislation will assure that the U.S. does its part in executing the Global Plan to Stop TB. Sens. Elizabeth Dole and Richard Burr, Rep. Shuler and other North Carolina representatives should co-sponsor this legislation. In addition, they should determine what other leadership measures should be taken to prevent a deadly, drug-resistant TB pandemic.

Other Facts on Tuberculosis:

¤ Ten million to 14 million Americans are infected with latent tuberculosis.

¤ TB is predicted to kill 30 million people in the next decade.

¤ TB is the leading global killer of women of reproductive age, ahead of HIV, heart disease and war.

¤ TB is also the leading killer of people with HIV/AIDS.

Ken Patterson is a former Peace Corps administrator and is currently national grass-roots manager for RESULTS.

Original article posted here.

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