(From the 2011 TB Progress Report)
# 7025
To coincide with World TB Day, The Lancet Infectious Diseases today has published a series of six papers (and comments) on the ongoing battle against tuberculosis, and the rising tide of of multidrug resistant (MDR) and extensively drug-resistant (XDR) TB infections around the globe.
Roughly 1/3rd of all new TB cases fall into the MDR-TB or XDR-TB category. Just over a year ago new alarm bells began ringing when an ahead-of-print letter to the journal Clinical Infectious Diseases announced that four cases of TDR (totally drug resistant) tuberculosis had been identified in India.
The term TDR-TB was quickly labeled as controversial, and poorly-defined. From the January 2012 ECDC report New drug resistant form of tuberculosis reported in India.
Total drug resistant TB is a relative notion and depends on the local drugs available and tested on. This term/expression should either be avoided or should be defined worldwide. The World Health Organization (WHO) has internationally-endorsed treatment recommendations for the treatment of drug-susceptible, MDR-TB and XDR-TB.
During this time, Maryn McKenna – Flublogia’s favorite scary disease girl – wrote extensively about these developments on her Superbug Blog:
Totally Resistant TB: Earliest Cases in Italy
- By Maryn McKenna January 12, 2012
India Reports Completely Drug-Resistant TB
- By Maryn McKenna January 9, 2012
Totally Drug-Resistant TB: A Patient Is Missing
- By Maryn McKenna January 14, 2012
A couple of my efforts included Resistant TB: The Limits Of Surveillance & Reporting & EID Journal: Challenges To Defining TDR-TB.
Recently the World Health Organization released their 2012 Global Tuberculosis Report, with the following statement regarding reports of TDR-TB.
“Totally drug-resistant TB” and developments in India in 2012
In December 2011, clinicians in Mumbai, India reported TB patients with what was termed “total drug resistance”.1 As a result of the intense public interest generated by this episode, in March 2012 WHO convened 40 experts to discuss its implications, whether current evidence makes it possible to define patterns of drug resistance beyond extensively drug resistance TB (XDR-TB) and if better guidance on appropriate treatment options for these patients was possible. While the group acknowledged that patients such as those described in Mumbai pose a formidable challenge to clinicians and public health authorities, no reliable definition beyond XDR-TB could be proposed.
Without having a better evidence base, no changes to the current guidelines on how to design treatment regimens for patients with broad patterns of resistance could be recommended. Improvements in the accuracy of drug susceptibility testing to certain drugs and the release of innovative new drugs will, however, change this position in future.
Since December 2011, several important measures have been taken by the Indian government. In Mumbai, laboratory and hospital facilities were improved, contact-tracing stepped up and efforts made to train staff on drug-resistant TB and infection control. Medical staff and funding were increased substantially. Access to second-line drugs was provided to eligible patients. National regulations governing private sales of anti-TB medication were strengthened. By the end of 2012, all 35 states in the country are expected to provide
programmatic management of drug-resistant TB. In May 2012, India made TB a notifiable disease and data collection on TB using a webbased system was initiated.2
Despite the academic debate over the definition (and existence) of TDR-TB, in January of this year - in EID Journal: The Emergence Of `Totally Resistant TB’ - more evidence was presented suggesting that TDR-TB is either already here, or on its way.
In a similar vein, one of the articles appearing in the Lancet today called Drug-resistant tuberculosis: time for visionary political leadership, warns that:
WHO estimates roughly 630 000 cases of MDR tuberculosis worldwide, with great variation in the frequency of MDR tuberculosis between countries. In the past 8 years, extensively drug-resistant (XDR) tuberculosis has emerged, and has been reported in 84 countries, heralding the possibility of virtually untreatable tuberculosis.
While a free registration is required, these articles are available online in their entirety. Follow the links to read:
Published March 24, 2013
Executive summary
To commemorate World TB Day 2013, The Lancet Infectious Diseases publishes a Series of papers on tuberculosis, a disease that has long plagued human beings and was declared a global emergency in 1993 by WHO. Without concerted action from political leaders, health policy makers, funders, and others, health systems worldwide are at risk of being overwhelmed by increasing numbers of patients with treatment-resistant tuberculosis.
As new diagnostic tests, drugs, and drug regimens become available that have the potential to radically improve the detection and management of tuberculosis, the papers in the Series explore the challenges for successful implementation of these interventions.
Comments
Tuberculosis 2013 Series
John McConnell, Sally Hargreaves
Zero deaths from tuberculosis: progress, reality, and hope
Alimuddin Zumla, Peter Kim, Markus Maeurer,Marco Schito
Progress and challenges in childhood tuberculosis
Ben J Marais, Stephen M Graham, Markus Maeurer,Alimuddin Zumla
Series Papers
Advances in tuberculosis diagnostics: the Xpert MTB/RIF assay and future prospects for a point-of-care test
Stephen D Lawn, Peter Mwaba, Matthew Bates, Amy Piatek, Heather Alexander, Ben J Marais, Luis E Cuevas, Timothy D Mchugh, Lynn Zijenah,Nathan Kapata, Ibrahim Abubakar, Ruth McNerney, Michael Hoelscher, Ziad A Memish, Giovanni Battista Migliori, Peter Kim, Markus Maeurer,Marco Schito, Alimuddin Zumla
Tuberculosis biomarkers discovery: developments, needs,and challenges
Robert S Wallis, Peter S Kim, Stewart Cole, Debra Hanna, Bruno B Andrade, Markus Maeurer, Marco Schito, Alimuddin Zumla
Tuberculosis comorbidity with communicable and non-communicable diseases: integrating health services and control efforts
Ben Marais, Knut Lönnroth, Stephen D Lawn, Giovanni B Migliori, Peter Mwaba, Philippe Glaziou, Matthew Bates, Ruth Colagiuri, Lynn Zijenah,Soumya Swaminathan, Ziad Memish, Michel Pletschette, Michael Hoelscher, Ibrahim Abubakar, Rumina Hasan, Afia Zafar, Guiseppe Pantaleo,Gill Craig, Peter Kim, Markus Maeurer, Marco Schito, Alimuddin Zumla
Alignment of new tuberculosis drug regimens and drug susceptibility testing: a framework for action
William A Wells, Catharina C Boehme, Frank G J Cobelens, Colleen Daniels, David Dowdy, Elizabeth Gardiner, Jan Gheuens, Peter Kim, Michael E Kimerling, Barry Kreiswirth, Christian Lienhardt, Khisi Mdluli, Madhukar Pai, Mark D Perkins, Trevor Peter, Matteo Zignol,Alimuddin Zumla, Marco Schito
Drug-resistant tuberculosis: time for visionary political leadership
Ibrahim Abubakar, Matteo Zignol, Dennis Falzon, Mario Raviglione, Lucica Ditiu, Baroness Susan Masham, Ifedayo Adetifa, Nathan Ford,Helen Cox, Stephen D Lawn, Ben Marais, Timothy D McHugh, Peter Mwaba, Matthew Bates, Marc Lipman, Lynn Zijenah, Simon Logan,Ruth McNerney, Adam Zumla, Krishna Sarda, Payam Nahid, Michael Hoelscher, Michel Pletschette, Ziad Memish, Peter Kim, Richard Hafner,Stewart Cole, Giovanni-Battista Migliori, Markus Maeurer, Marco Schito, Alimuddin Zumla
Engaging communities in tuberculosis research
Renaud F Boulanger, Stephanie Seidel, Erica Lessem, Lee Pyne-Mercier, Sharon D Williams, Laia Ruiz Mingote, Cherise Scott, Alicia Y Chou, James V Lavery, on behalf of the Critical Path to TB Drug Regimens' Stakeholder and Community Engagement Workgroup
