Important note: Information in this article was accurate in 2000. The state of the art may have changed since the publication date.
Newsday - March 24, 2000
Laurie Garrett, Staff Writer
At least 8 million people developed active TB last year, WHO reported, and 2 million of them died.
Adding to the grim picture is the spread of multidrug-resistant tuberculosis, according to the report. Until fairly recently, drug-resistant strains were rarely seen in newly infected patients; the bacteria would become drug-resistant within the patients' bodies as a result of interrupted or inappropriate antibiotic use.
Now, however, drug-resistant strains are spreading and causing initial infections. The National Institute of Allergy and Infectious Diseases in Bethesda, Md., estimates that multidrug-resistant tuberculosis cases are 100 times more expensive to treat than normal tuberculosis. Such strains are considerably harder to cure-death rates can be up to 30 times higher.
Based on surveys conducted over the past four years in 72 regions of the world, and in 100 laboratories, WHO finds:
The incidence of drug-resistant tuberculosis in Denmark and Germany increased by 50 percent from 1996 to 1999.
Only three countries-the United States, France and the Netherlands-significantly reduced both their overall TB rates and incidences of drug-resistant tuberculosis during that time.
Worldwide, at least 100 nations now have drug-resistant strains of TB in circulation, totaling 11 percent of all new tuberculosis infections in 1999.
The highest incidences of new drug-resistant infections were seen in China and eastern Europe, where 30 to 40 percent of all new TB is resistant to at least one antibiotic.
Multidrug-resistant TB rates in 1999 were highest in Estonia (14.1 percent of all new cases), Henan Province, China (10.8 percent), Latvia (9 percent), Central Russia (9 percent) and Iran (5.8 percent).
In the tiny Baltic nation of Estonia, 8.5 percent of all 1999 TB infections involved strains of bacteria that can resist four or more of the 10 antibiotics used to treat the disease.
To counter this trend toward growing drug resistance, WHO is pushing a treatment strategy called DOTS, or directly observed therapy, short-course. Patients are given four antibiotics for six to eight months-a treatment WHO says is 80 percent curative if properly implemented.
But proper implementation has been a challenge-so much so that billionaire financier George Soros, who has pumped hundreds of millions of dollars into TB control efforts in Russia, has said WHO is actually responsible for the emergence of drug-defying TB. Soros and scientists working around the world under grants from his Open Society Foundation say these mutant strains arise when public health infrastructures are too chaotic or impoverished to properly dole out DOTS medications.
Soros' group has called for DOTS-Plus, a treatment that uses up to six drugs, given to each patient for some 18 months. Proponents argue that DOTS-Plus cures 100 percent of properly treated patients infected with all but the most extremely resistant forms of the bacteria.
WHO hedges on the DOTS vs. DOTS-Plus debate, saying that when one approach fails, the other is also likely to face defeat. The agency does, however, have DOTS-Plus pilot projects under way in several regions.
With such grim trends in place, the National Institute of Allergy and Infectious Diseases in the United States has radically beefed up its TB research budget, which has been increased 15-fold since 1989, now topping $42.5 million a year. Its primary goal is development of an effective tuberculosis vaccine.
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