- The Washington Times - Wednesday, February 27, 2008

Leaders of the World Health Organization yesterday said that drug-resistant tuberculosis has been recorded at its highest rates ever and that wealthier countries must step up efforts quickly to help poorer countries fight the disease or the world could be heading toward a disastrous situation.

“If we don’t act now we are really going to risk a disaster,” said Mario Raviglione, director of WHO’s Stop TB department, which released a report on drug-resistant TB yesterday. “TB drug resistance needs a frontal assault.”

The WHO report — the largest survey on the topic to date — found that multidrug-resistant tuberculosis, known as MDR-TB, has been recorded at its highest levels worldwide and that 45 countries have recorded cases of the most extensively drug-resistant form of the disease, known as XDR-TB.

Dr. Raviglione said that given the ease of travel and the fact that TB can lie dormant before manifesting itself, “no country in the world is safe” and “it’s quite important for every country to react in the same forceful way.”

Quick diagnosis and proper treatment are the best ways to stop the drug-resistant forms from developing, he said.

According to an analysis of the data in the report, WHO leaders estimate that nearly a half-million cases of MDR-TB develop each year, which is about 5 percent of 9 million new TB cases of all types. The report is based on data WHO collected from 81 countries from 2002 to 2006.

It found the highest rate in Baku, the capital of Azerbaijan, where 22.3 percent of the new TB cases are multidrug-resistant. Of the 20 areas surveyed with the highest proportion of MDR-TB, 14 are in countries of the former Soviet Union and four are in China.

The lowest proportions of MDR-TB are in the Americas, Central Europe and Africa, with the exceptions of Peru, Rwanda and Guatemala, the report found. Dr. Raviglione noted that only six countries in Africa had the capacity to report the data, so the situation there could be worse.

The report said significant reductions of the burden of MDR-TB in the U.S. and Hong Kong populations continue.

Drug-resistant TB typically develops when the infected person doesn’t receive proper initial treatment, according to WHO. A person with a drug-resistant strain of the disease can pass that strain directly to another person.

MDR-TB is TB that keeps growing even when exposed to isoniazid and rifampicin, the two most powerful anti-TB drugs. XDR-TB keeps growing when exposed to those drugs, as well as another type known as fluoroquinolones and any one of the second-line anti-TB injectable drugs.

The WHO released other reports on drug-resistant TB in 1997, 2000 and 2004.

The House Foreign Affairs Committee is set to vote today on a Democrat-crafted bill that would renew President Bush’s anti-AIDS initiative, which also includes efforts to fight TB and malaria worldwide. Joanne Carter, legislative director of the anti-poverty group Results, praised the bill for calling for about $4 billion to ramp up anti-TB efforts.

Dr. Raviglione said drug-resistant TB can be stopped. He noted that since Estonia and Latvia were identified as drug-resistant TB “hot spots” in the 1990s, money and attention were focused on the disease and the rates in those countries have stabilized.

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