English
Apr
03
Tuberculosis: The Disease That Keeps On Giving
Posted on Apr 03, 2009 by Sergio Ulloa (G+)
World Tuberculosis Day was marked on March 24th with a forum in Rio de Janeiro this year and despite this disease having a history dating back to antiquity may be becoming more of a problem today than ever. Tuberculosis is caused by the bacteria Mycobacterium tuberculosis and is the most deadly bacterial disease in the world. The World Health Organization alongside other partners is on a drive to bring mortality and prevalence rates of tuberculosis down to half the levels they were in 1990 by 2015.
The WHO currently estimates that one third of the world's population is infected with the tuberculosis bacteria. Out of everyone infected with the Mycobacterium tuberculosis bacteria only 5-10% of those people will develop active tuberculosis of the lungs, which is the only way to become infectious and transmit the disease. While this may seem like a statistically low number, it is estimated that every second someone new is infected with tuberculosis bacteria.
In spite of the fact that tuberculosis is not only millennia old but also treatable, the goals that the World Health Organization set out to achieve are becoming increasingly hard to attain. While the agency has said that the percentage of the global population becoming ill with tuberculosis has continued the decline first noticed in 2004, they have also said that both Europe and Africa will not meet the intended reductions in either mortality or prevalence rates. So if the percentage of people suffering from tuberculosis is, as a percentage of the world's population, going down, why is there increased concern over the issue?
There are two major reasons that are making tuberculosis an even larger health issue than it has ever been before. The first is that there is an incredible increase in the number of people with active tuberculosis that are also HIV positive, leading to increased complications in treatment and prevention. The second reason is that the disease has evolved into both multidrug-resistant tuberculosis (MRD-TB) and extensively drug-resistant tuberculosis (XDR-TB), which has made some standard treatments ineffective in combating the disease.
Because HIV attacks the body's immune system, it is leading not only to increased rates of infection but also increased mortality rates in people infected with both HIV and tuberculosis. The co-infection of HIV/TB is a seriously threat as the diseases piggy back on each other, each speeding the progress of the other. The WHO's 2009 global TB control report indicates that about one out of four TB deaths are HIV related, which is more than twice as many as was previously indicated. Regions with high levels of HIV infections like Africa are being hit the hardest, with some places like South Africa where numbers of tuberculosis infections almost tripled. In 2007 alone it is estimated that there were 1.37 million new cases of tuberculosis in people infected with HIV as well as 456,000 deaths.
There is, however, somewhat good news arising from the intense scrutiny of data over the years. Having realized the increased threat that HIV/TB co-infection poses, there has been a raised effort to test for HIV in people who are receiving treatment for TB. The WHO report shows that in Africa in 2004, only 4% of patients being treated for tuberculosis were tested for HIV. By 2007 the number of TB patients in the African region getting HIV tests has risen to 37%, with some individual countries testing as many as 75% of their TB patients for the immunodeficiency disease.
The other issue of drug-resistant tuberculosis is beginning to attract increased attention because of concerns about the possibility of a virtually untreatable tuberculosis epidemic. The driving force behind the rise in drug-resistant strains of tuberculosis is that in the places with the highest rates of TB infections, such as Africa, Eastern Europe and Asia often have poor healthcare systems.
One of the gravest problems is that the systems will lose track of tuberculosis patients who do not finish their course of treatment for TB, allowing the disease to morph into a drug-resistant form of the disease. Some places such as India or Russia have poor healthcare where there is either a shortage of doctors and appropriate medication, or little control over the sale and usage of TB drugs.
As health ministers from some of the most direly affected countries, along with the leader of the WHO and Bill Gates gathered in Beijing on April 1st to formulate plans to prevent the spread of drug-resistant tuberculosis, one story has illustrated the need for quality medical insurance networks. A migrant worker named Wang Chong was in the Beijing Chest Hospital for his tuberculosis treatment which has been continuing for over five months. But because he has no insurance of his own and no national healthcare safety net to support him, he must decide whether to continue the treatment which has already cost him more than $5000 dollars, no small amount of money for a migrant worker in China, or to stop treatment and risk his disease evolving into a drug-resistant variety which could kill him.
There are estimated to be more than half a million people in the world with drug-resistant tuberculosis across the globe, with more than a quarter of them in China. Some health advocacy groups say that less than five percent of the people carrying drug-resistant strains of the disease are being treated properly, meaning that they are often out and about spreading the increasingly resilient disease to others.
At the moment, treatment of regular tuberculosis requires taking four different antibiotics and lasts for up to six months. Treatment for extensively drug-resistant tuberculosis is toxic to the patient and may last up to two years, often leading to the confinement of the patient. There are ongoing efforts to find a two drug combination that will work in combating both regular tuberculosis and extensively drug-resistant tuberculosis, with one phase of clinical trials scheduled to be completed by the end of 2009 in South Korea. The recent forums and meetings of the worlds' healthcare leaders in highlights the need for awareness on the topic and the need to make sure you are protected, so that you can be assured a full treatment without having to make the same decisions that Wang Chong is having to make this very moment.