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Drug-resistant tuberculosis levels 10 times higher in eastern Europe and central Asia

The tuberculosis challenge in the European Region [pdf, 105KB]
Fact Sheet EURO/01/04
Copenhagen, 23 March 2004
Also available in: fr[pdf, 95KB], de[pdf, 95KB], ru[pdf, 94KB]

Tuberculosis (TB) control


Press Release WHO/17
Geneva, 16 March 2004
Tuberculosis (TB) patients in parts of eastern Europe and central Asia are 10 times more likely to have multidrug-resistant TB (MDR-TB) than those in the rest of the world, according to a World Health Organization (WHO) report into the deadly infectious disease. China, Ecuador, Israel and South Africa are also identified as key areas.

New data released today confirm geographical concentrations of TB-drug resistance across the Commonwealth of Independent States. Six out of the top ten global hotspots are: Estonia, Kazakhstan, Latvia, Lithuania, parts of the Russian Federation and Uzbekistan, with drug resistance in new patients as high as 14%.

"TB drug resistance is an urgent public health issue for countries from the former Soviet Union," said Dr Mario Raviglione, Director of WHO's Stop TB Department. "It is in the interest of every country to support rapid scale-up of TB control if we are to overcome MDR-TB. Passport control will not halt drug resistance; investment in global TB prevention will."

WHO's leading infectious disease experts estimate there are 300 000 new cases per year of MDR-TB worldwide. There is also new evidence proving that drug-resistant strains are becoming more resistant, and unresponsive to current treatments; 79% of MDR-TB cases are now "super strains", resistant to at least three of the four main drugs used to cure TB.

MDR-TB is TB that is resistant to the two drugs most commonly used to treat it, isoniazid and rifampicin. Without the correct drugs, MDR-TB is untreatable and, in most cases, fatal. Though curing "normal" TB is cheap and effective - a six-month course of medicines costs US$ 10 - treating MDR-TB is a hundred times more expensive. Even then, a cure is not guaranteed. With no effective vaccine, everyone is vulnerable to infection simply by breathing in a droplet carrying a virulent drug-resistant strain.

Highest prevalence of MDR-TB coincides with one of the world's fastest-growing HIV infection rates in eastern Europe and central Asia. Recently the United Nations Development Programme reported more than 1.5 million people living with the virus in the region, compared to just 30 000 in 1995. People whose immune systems are compromised with HIV are many times more susceptible to contracting all forms of TB.

"With people's immune systems compromised, MDR-TB has a perfect opportunity to spread rapidly and kill," said WHO Assistant Director-General for HIV/AIDS, TB and Malaria, Dr Jack Chow. "As a priority to prevent the spread of all forms of TB, we need more investment in resources, programmes and health workers."

New surveys in China, where HIV is also increasing, have also mapped MDR-TB areas of concern. Two provinces revealed that around 1 in every 10 new patients tested positive for MDR-TB. The report's authors fear similar high levels of resistance could exist elsewhere, since only 6 of the country's 23 provinces were represented in the study.

Some successes have been achieved since the last study four years ago, most notably in Cuba, Hong Kong and the United States. Rates in those countries have decreased, as a result of strong and well-maintained TB strategies.

According to the report, "the most effective strategy to prevent the emergence of drug resistance is through implementation of the DOTS". DOTS (directly observed treatment, short-course) is the internationally agreed treatment strategy, and is designed to ensure patients take their medicines properly. It has proved effective in preventing drug resistance.

The report also notes that TB control strategies used in eastern Europe and the Russian Federation have recently begun to improve with the introduction of the DOTS strategy. In the worst-affected areas, innovative DOTS Plus schemes, which diagnose and effectively treat MDR-TB, are being introduced. Patient access to MDR-TB drugs is key to the success of the DOTS Plus strategy. The cost of supplying these medicines has fallen dramatically through initiatives backed by WHO: namely, the Green Light Committee, which engages pharmaceutical companies to fully support the fight to eradicate MDR-TB.

Research into and development of new TB drugs are also urgently required to shorten the length of treatment and to treat drug-resistant strains. After a forty-year standstill in TB drug development, research and development investments are critical now to expand treatment options and overcome resistant strains. The Global Alliance for TB Drug Development, a WHO partner, is building a pipeline of promising new drugs and uniting public and private researchers in the search for a faster cure.

Anti-tuberculosis drug resistance in the world - Third global report presents data from the examination of 67 657 TB patients in 77 countries and regions.

"The more we survey, the more MDR-TB we find," said the report's leading author, Dr Mohamed Aziz. "MDR-TB has now been identified in every region and almost every country surveyed in what is the largest drug resistance surveillance project of its kind. Yet the true burden is unknown and may well be higher in unsurveyed areas, stressing the need for full expansion of drug resistance surveillance."

Editors' note: On 24 March, WHO will release its 2004 global TB control report in tandem with the opening of the second Stop TB partners' forum in New Delhi, where donors, technical agencies and ministers from the 22 high-TB-burden countries will discuss accelerated action to expand DOTS and contain the global epidemic.

For more information contact:
Thomas Schoenemann
Berlin, Germany
Tel. (mobile): +49 (173) 65 05 735

Jove Oliver
Kiev, Ukraine
Tel. (mobile): +380 (505) 948 616

Glenn Thomas
Communication Officer
Stop TB Department
World Health Organization
Geneva, Switzerland
Tel.: +41 22 791 3983
Tel. (mobile): +41 79 509 0677
E-mail: thomasg@who.int

Gwynne Oosterbaan
On aids and HIV:Since HIV/AIDS was first recognised and up until
2000, the HIV virus has infected more than 49
million people worldwide. There are currently over
33 million people infected, and there were 2.6
million deaths in 1999 alone. HIV/AIDS has
become the fourth leading cause of mortality, and
its impact will continue to increase. Over 95% of
all HIV cases and AIDS deaths occur in poorer,
usually tropical, countries. Sub-Saharan Africa is
the worst affected. The newly independent states
of the former Soviet Union recorded the world’s
steepest HIV increase in 1999, with the proportion
of the population infected with HIV doubling
between 1997 and 1999. It is estimated that the
number of infected people rose by over a third in
the remainder of central and Eastern Europe during
1999 reaching a total of 360 000. In Western
Europe, new combinations of anti-retroviral drugs
continue to reduce the number of AIDS deaths
significantly, however, new infections still occur.
The spread of HIV and subsequent AIDS related
deaths have many repercussions, including high
child mortality rates in some countries, increased
numbers of orphans and a significant burden on
health care systems and the economies.

According to the right , aids is God's wrath on homosexuals..This pretty much debunks the myth that aids is the homosexual scorge. If they weren't so full of it ,it would be laughable.So much for truth of information.That is not one of their virtues it seems. Jump on the bandwagon blame it all on gay men.