Drug-resistant TB on the rise

MANILA, Philippines - The World Health Organization (WHO) stressed yesterday the urgent need for countries to strengthen their health systems to tackle the spread of tuberculosis amid the growing threat of a new strain of drug-resistant TB.

The WHO’s Western Pacific regional adviser Pieter van Maaren said the Philippines is the second hardest-hit country in the region, with up to 6,000 new cases of drug-resistant TB a year.

Van Maaren said there were 112,000 new cases of drug-resistant TB in China alone in 2007 and figures for 2008 were likely to be similar. Vietnam had an estimated 3,000 to 4,000 new cases of multi-drug-resistant TB in 2007, while Cambodia had fewer than 1,000 cases, van Maaren said ahead of World Stop TB Day on Tuesday.

Estimates for 2008 are not yet out but van Maaren said the rate of new infections will “likely be in the same range” as 2007.

Exact figures are not available, he said, saying not all of the cases are diagnosed.

Tuberculosis is a contagious lung disease that spreads through the air, including through coughing and sneezing.

Van Maaren, based at the WHO’s Western Pacific headquarters in Manila, warned that drug-resistant TB was more difficult to diagnose and that drugs to treat it were limited and costly, and had more side-effects.

It was “a man-made problem caused by insufficient or inappropriate treatment, a result of patients stopping treatment before they are cured,” he said.

This can be seen in the Philippines and partly in China, where many TB patients resorted to “self-medication” without getting the proper medical advice, allowing the TB bacilli to survive, he added.

In contrast, the rates of drug-resistant TB in Vietnam and Cambodia were lower partly because of their good control programs and also because powerful anti-TB drugs had only been introduced in those countries in the past decade, “so the TB bacilli did not have time to develop resistance.”

WHO regional director for the Western Pacific Shin Young Soo said despite gains using the WHO-recommended TB control strategy, effective TB control had been hampered by weaknesses in health systems such as chronic staff shortages, inadequate financial resources, low access to quality care, poor laboratory capacity and flawed links between service providers in the public and private sectors.

“Our available tools work but they are not enough. To progress, we must think bigger and look beyond DOTS to the actual setting in which TB programs operate – national health systems,” said Shin.

Recommended by WHO, the DOTS is a strategy focused on detecting at least 70 percent of new smear-positive TB cases and cure some 85 percent of them.

It had been projected that DOTS could prevent 80 percent of TB-related deaths.

Under DOTS, a TB patient must undergo an uninterrupted treatment course, among other approaches.