WHO Global TB report: New data raises estimates of illness, death

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While more than half a million fell ill with drug-resistant tuberculosis requiring second-line treatments last year, just one in five received it

whoglobaltb2016Improved data collection shows a larger than previously estimated global disease burden and toll of tuberculosis, while progress against the disease remains stalled, the World Health Organization’s 2016 Global Tuberculosis Report shows. The report says that with a reduction of new cases from the previous year, in 2015 10.4 million people fell ill with tuberculosis and 1.8 million people died of the disease. Last year’s WHO report estimated the number of new cases at 9.6 million, and deaths at 1.5 million.

Increases reflected in the revised estimates mean that two years after the World Health Assembly resolved to reduce TB deaths by 95 percent and to cut new cases by 90 percent between 2015 and 2035, the rate of decline in new tuberculosis cases and deaths remains unchanged, with drops of only 1.5 percent.

Between the raised estimates and stalled drops in fatalities, that means that tuberculosis, while curable, has returned to the list of the top ten causes of death worldwide, while remaining the world’s leading infectious disease killer.

“The overall progress in adopting new attitudes towards fighting tuberculosis remains abysmal,” WHO Global TB Programme director Mario Raviglione said, at a release of the report in Washington, DC.

Monica Dias of WHO, Dr. Mario Raviglione of WHO, Dr. Ariel Pablos-Mendez of USAID

Monica Dias of WHO, Dr. Mario Raviglione of WHO, Dr. Ariel Pablos-Mendez of USAID

The new data with raised estimates came from improved tuberculosis surveillance methods in India, including through household survey information, private health sector sales of anti-tuberculosis medicines, and new analysis of death records. Of the six countries that are home to 60 percent of the world’s TB burden, India is at the top, in terms of absolute numbers and rates, and depends the most on international funding. And international funding continues to be inadequate, the report says.

The report also notes that investment in research and development falls far short of need, saying that while discovering and producing new drugs, diagnostic tools and preventive measures requires at least $2 billion a year, funding for tuberculosis innovation between 2005-2014 has never exceeded $0.7 billion a year.

In the meantime the toll of tuberculosis resistant to one or more first-line treatments continues with only one in five of the estimated 580,000 people needing second-line treatments receiving them in the last year.

Only half of them were treated successfully. For patients with extensively drug-resistant tuberculosis (resistant to three oral first-line drugs and one injected second-line drug) the outcomes are even worse with only a quarter of those patients treated successfully.

Raviglione called the continued toll of multidrug-resistant tuberculosis a crisis.

“We keep calling it a crisis and a crisis that unfortunately is not being taken seriously enough,” he said. Raviglione emphasized that while multidrug-resistant tuberculosis accounts for a significant burden of all infections that don’t respond to first-line treatments globally, addressing it is insufficiently factored into the growing movement to fight antimicrobial resistance.

The report also highlights the essential need for universal access to antiretroviral treatment for people living with HIV. While tuberculosis is the leading cause of death for people living with HIV, nearly a quarter of people co-infected with tuberculosis and HIV remain without access to antiretroviral treatment.

Organizations addressing global health issues (including the Infectious Diseases Society of America, which produces this blog) responded to the updated data today by calling for increased leadership from the next United States President in fighting tuberculosis worldwide.

“Only 3 percent of the total $8.5 billion in U.S. global health funding goes to programs specific to TB,” a statement released by the groups said. “It has been 16 years since U.S. bilateral TB funding has seen a substantial increase, despite the escalating threat of drug-resistant TB. Instead, for five years in a row, the Obama Administration has proposed cuts in bilateral TB funding. And while TB causes one in three AIDS deaths, TB-HIV funding from PEPFAR is only about 4 percent of its annual expenditures, declining since 2011 as PEPFAR funding has flattened.”

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