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The number of new cases of tuberculosis (TB) continued to decline in 2017, and fewer people died of the disease, according to the World Health Organization's (WHO) World Report 2018. But efforts to make the world's deadliest infectious disease a "disease of the past" need to be stepped up, agency officials said today.
While it has been estimated that 54 million deaths have been prevented since 2000, the burden of TB remains high in many low- and middle-income countries, and WHO officials say the burden of TB is high. elimination of tuberculosis.
"Actions in some countries and regions show that progress can accelerate, but overall we are still on the right track," said Teresa Kasaeva, MD, PhD, director of the global TB program. ) sits in New York.
The 2018 edition of the WHO's annual report on TB estimates that 10 million people developed the disease in 2017, of which 5.8 million men, 3.2 million women and 1 million children. This represents a decrease of $ 10.4 million in 2016. Globally, the tuberculosis incidence rate decreases by approximately 2% per year, with annual reductions of 5% and 5% respectively. 4% in Europe and Africa.
But the report says that the global incidence rate needs to decrease by 4 to 5% each year to reach the first milestone of the TB control strategy – a 20% reduction by 2020 (relative to to 2015). The strategy aims to reduce the incidence of TB by 80% by 2030.
Similarly, the estimated number of deaths from TB increased from 1.7 million in 2016 to 1.6 million in 2017. Of those deaths, 300,000 were among HIV-positive people. Since 2000, the number of deaths from tuberculosis in HIV-negative people has decreased by 29%, while the number of deaths among HIV-positive people has decreased by 44%. The case fatality rate has increased from 23% in 2000 to 16% in 2017, but it is expected to fall to 10% by 2020 as part of the End TB strategy, which aims to reduce deaths by 90%. 39, here 2030.
According to the report, diagnosis and treatment are two of the main ways to reduce the incidence of tuberculosis and deaths. Of the 10 million new cases and relapse cases in 2017, only 6.4 million (64%) were officially reported to national authorities and WHO. Ten countries accounted for 80% of the 3.6 million gap, starting with India (26%), Indonesia (11%) and Nigeria (9%). The gap is suspected to be caused by a combination of under-diagnosis and under-reporting.
The global coverage of TB treatment was 64%, the lowest in Africa. The treatment coverage must reach at least 90% by 2025 to reach the objectives of the WHO.
Kasaeva said closing these gaps and increasing preventive treatment for people with latent TB will be essential if global health officials want to effectively eliminate an illness that can be cured for decades, but which affects nearly 4,000 people a year. day. "It is unacceptable that in the 21st century, millions of people are losing their lives because of this preventable and curable disease, "she said.
Drug-resistant TB: a "public health crisis"
The report also highlights the persistent crisis of multidrug-resistant tuberculosis (MDR-TB). The WHO estimates that 558,000 people in 2017 developed rifampicin-resistant TB, the most effective first-line anti-tuberculosis drug. 82% of these cases were multidrug-resistant and 8.5% were extensively drug-resistant. Nearly half of all MDR-TB cases in the world are in India (24%), China (13%) and Russia (10%).
However, efforts to control multidrug-resistant TB continue to be hampered by poor detection and poor treatment. Only 29% of the 558,000 cases were detected and reported, and only 25% of patients with MDR-TB were included in treatment with second-line drugs. In addition, the current success rate for MDR-TB treatment is only about 55%, compared to 82% for non-resistant TB.
"These gaps in access and quality of care have devastating effects on people with the disease and their families, as well as on the community," Kasaeva said.
There is hope, however, that the recently updated WHO recommendations for treatment of multidrug-resistant tuberculosis will increase the rate of success. The recommendations, released in August, prioritize newer antibiotics such as bedaquiline and oral versus injectable medications, which are less effective and have been associated with serious side effects. The data used to update the MDR-TB regimen showed that the new drugs were associated with greater treatment success and lower mortality rates.
Next meeting of the UN
It is also hoped that the UN High Level Meeting on Tuberculosis next week will help world leaders to take action. The meeting is expected to result in a political commitment by UN Member States to scale up their TB control efforts and ensure adequate and sustainable funding for these efforts. It follows a November 2017 meeting in Moscow in which health ministers from 114 countries pledged to accelerate their efforts to end tuberculosis by 2030 and boost investment in the country. research.
Stronger political commitment will be needed to bridge the funding gap highlighted by the WHO report. Although funding for TB diagnosis, treatment and prevention has more than doubled since 2006, the report estimates that in the 119 low- and middle-income countries accounting for 97% of reported TB cases, there is a lack of 3.5 billions of dollars . Without increased funding, this deficit will reach $ 5.4 billion by 2020. An additional $ 1.3 billion will be needed for the development of new drugs, diagnostics and vaccines.
"We all know that a successful high-level meeting means that we must bring the heads of state to take responsibility for the health of their citizens, to take their responsibilities and to commit themselves", said ambassador Eric Goolsby on tuberculosis, said at the press conference. "Not a day, in a meeting, but for the duration of the burden."
See also:
18 September WHO World Tuberculosis Report 2018
August 20 CIDRAP News story "WHO revises MDR-TB treatment with focus on oral medications"
Nov 17, 2017, CIDRAP News story "Health ministers from around the world pledge to end tuberculosis"
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