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Report finds drug-resistant TB posing a global threat

Infection Control Monitor, March 25, 2004

The World Health Organization (WHO) said March 16 that cases of multi-drug-resistant tuberculosis (TB) in the former Soviet Union are rising quickly, a trend that threatens the rest of the world, Reuters reports.

The top 10 TB problem areas in the world include Estonia, Kazakhstan, Latvia, Lithuania, parts of the Russian Federation, and Uzbekistan, where up to 14% of new patients have strains of the disease resistant to the most powerful drugs. The rate of drug resistance and multi-drug resistance in the former Soviet Union is about 10 times that of the rest of the world, said a WHO official.

TB affects 9 million people each year and kills 2 million, according to the new WHO report. Population growth, worldwide travel, and multi-drug-resistant TB (MDR-TB) have contributed to the increase in TB. Experts estimate that healthcare professionals diagnose 300,000 new cases of MDR-TB each year.

The highest prevalence of MDR-TB coincides with the world's fastest growing HIV infection rates in Eastern Europe and Central Asia. TB is one of the main opportunistic infections that kills AIDS patients.

Patients with TB receive treatment with the DOTS (Directly observed treatment, short course) program-a multi-level approach adopted by the WHO that involves government commitment, patient surveillance, and treatment with the drugs isoniazid and rifampicin.  But people with MDR-TB do not respond to one or more of the main drugs and require different, more toxic, and expensive treatments.

The WHO report calls for an expansion of the DOTS program, increased funding for a DOTS-plus program, a specific treatment for drug-resistant disease, and more investments in better surveillance of TB and laboratory research.

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