Global fight against TB advancing, but disease still a leading cause of death

In this photo taken on Thursday, March 26, 2015 Zhdanivskaya prison physician prepares samples for testing at a prison laboratory in the village of Zhdanivka, eastern Ukraine. (AP / Mstyslav Chernov)

The global fight against tuberculosis is advancing, with this year's death rate nearly half of what it was in 1990. However, the disease is still a public health concern, ranking alongside HIV/AIDS as a major cause of global death, according to the World Health Organization.

The WHO released the Global Tuberculosis Report 2015 on Wednesday, giving a snapshot of how far the international health community has come in combating TB.

According to the report, close to 1.5 million people died from TB in 2014. By comparison, HIV’s death toll in 2014 was estimated at 1.2 million, according to the WHO.

The report found that most of the gains in combating TB have come since 2000, the year the UN's Millennium Development Goals were established.

Between 2000 and 2015, effective diagnosis and treatment of TB resulted in 43 million lives saved, the report says. Globally, TB incidence has fallen 1.5 per cent per year since 2000, equalling a total reduction of 18 per cent.

But despite these advances, TB continues to be a major cause of death, says Dr. Mario Raviglione, director of WHO's Global TB Programme.

"We are still facing a burden of 4,400 people dying every day, which is unacceptable in an era when you can diagnose and cure nearly every person with TB," he said in a statement.

TB is an infectious disease caused by mycobacterium. The disease typically effects the lungs, and is spread through the air when infected patients transmit bodily fluids from their throat and lungs through coughing or sneezing.

Symptoms of active TB include a chronic cough, chest pains, weakness, fever, night sweats and weight loss. The disease is treatable with a course of antibiotics, however, if left untreated it can result in death.

This year's report found the global total for new TB cases to be 9.6 million cases. This is higher than in previous years, but it may reflect improvements in data collection rather than an actual increase, the WHO said.

Addressing treatment gaps and multi-drug resistant TB

The report shows the need to improve TB detection, close "treatment gaps," boost funding, and develop new drugs and vaccines, the WHO said.

Detection in particular remains a problem, with the WHO finding that about 37.5 per cent of the new TB cases in 2014 went undiagnosed or were not reported to national authorities.

This is especially serious for patients with multidrug-resistant TB (MDR-TB). The WHO estimates that 3.3 per cent of the new patients have MDR-TB, a level that has not changed over the years. MDR-TB is a form of TB infection caused by bacteria that are resistant to common drug treatments.

"Detection and treatment gaps are especially serious among people with MDR-TB, which remains a public health crisis," the WHO said in a statement. "Of the 480, 000 cases estimated to have occurred in 2014, only about a quarter – 123 000 – were detected and reported to national authorities."

The WHO report found that fewer people were diagnosed with MDR-TB globally in 2014 than in 2013, although the total estimated number of people who developed MDR-TB remained the same.

The WHO said 43 countries reported cure rates for MDR-TB patients of more than 75 per cent. However, global data shows an average cure rate of only 50 per cent for treated MDR-TB patients.

Dr. Grania Brigden, interim medical director from Doctors Without Borders Access Campaign, said the overall picture is "disheartening," and is particularly bleak when it comes to MDR-TB.

"We’re losing ground in the battle to control drug-resistant forms of TB, and without considerable corrective action, the vast majority of people with MDR-TB won’t ever be diagnosed, put on treatment, or cured," she said.

"Drug-resistant forms of TB will continue to spread unless the gap is narrowed between people with undiagnosed TB disease and people who are diagnosed."

Brigden called for a widespread rollout of existing rapid tests and drug-resistance testing.

The WHO said that in 2016, the global community’s goal will shift from controlling TB to ending the epidemic. Its “End TB Strategy,” adopted by all WHO member states, will aim to reduce TB incidence by 80 per cent and TB deaths by 90 per cent by 2030.