Rep. Eliot Engel (D-NY) made a brief appearance Tuesday at a Congressional briefing, hosted by several TB advocacy organizations, highlighting tuberculosis and its continuation as a global health threat. He called the fact that TB hasn’t been eradicated “a sin,” and then briefly announced the newly formed U.S. House of Representatives TB Elimination Caucus – led by Engel, Rep. Gene Green (D-TX) and Rep. Don Young (R-AK). The three congressmen sent out a letter to colleagues on March 14 calling for them to join the cause. The House also launched an HIV/AIDS caucus in September.
“Here in the U.S., all states continue to record caseloads of TB. In the border states of California, Texas, Florida and New York, TB remains a serious public health problem,” according to the letter. “Drug resistant TB poses a particular challenge to domestic TB control due to drug shortages and exorbitant treatment costs, which range from $100,000 to $300,000 per patient.”
The panelists at Tuesday’s briefing drove that message home – citing that these four states accounted for nearly half of all new TB cases in 2010, according to Ken Castro, director of the Division of TB Elimination at the U.S. Center for Disease Control and Prevention (CDC). TB is 22 times more common in Asian/Pacific Islanders, he said, and in 2010 TB rates were 11 times higher in foreign-born individuals versus U.S.-born – highlighting the need to address TB outside of our borders to tackle TB within our borders. CDC will be updating their national TB surveillance figures for 2011 and releasing them Friday, he said.
Mario Raviglione, MD, director of the Stop TB Department of the World Health Organization, said the world is on track to reach the United Nations Millennium Development Goal to have halted and begun to reverse TB incidence by 2015. There has been a 40 percent decline in death rates worldwide since 1990, he said. Incidence peaked in 2001 and has been falling 1.3 percent per year since 2006.
Still, he warned, TB incidence is declining far too slowly. Brazil, Russia, India, China and South Africa (otherwise known as the “BRICS” countries) are essentially autonomous in terms of their TB response, Raviglione said, with 96 percent of the response covered with domestic financing. However, in the other 17 high-burden TB countries, they rely heavily on donor funding – funding that continues to drop in the face of a worldwide economic downturn. Eighty-five percent of the world’s multidrug-resistant TB (MDR-TB) can be found in the 27 highest burden TB countries, he said.
He also highlighted the GeneXpert MTB/RIF rapid TB diagnostic as the “most important tool we have seen in the last decade,” to combat TB. GeneXpert reduces the time to return a TB diagnosis to 1.5 hours versus weeks for the standard sputum culture test, and has already been rolled out in 47 of the 145 low- and middle- income countries eligible to purchase the machine and cartridges at a reduced price.