Drug-resistant strains of TB increasing worldwide

A Russian prison inmate receives medical treatment for tuberculosis

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March 24, 2000
Web posted at: 2:52 p.m. EST (1952 GMT)

AMSTERDAM (CNN) -- Health officials around the world need to strengthen their control of tuberculosis or face the continued emergence of multiple drug-resistant strains that will have a high cost in lives and resources, according to a report released at the Ministerial Conference on TB in Amsterdam.

Sounding the warning bell is "Anti-Tuberculosis Drug Resistance in the World," a report prepared by the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease. This third annual report on TB was released in time for World TB Day Friday.

The report contains data from 72 areas that contain 28 percent of the world's tuberculosis cases, as well as data on the incidence of drug-resistant tuberculosis in 38 regions.

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According to the new information, China, India, Iran, Mozambique and Russia reported multiple drug-resistant TB in more than 3 percent of new cases of the disease.

The report also shows it has become common in some countries for new TB cases to be resistant to one of the five most effective and affordable first-line drug treatments. Second-line drugs can be 100 times more expensive and 20 times less effective.

"Our biggest worry is that drug-resistant TB will also begin increasing in other developing countries," said Dr. David Heymann, executive director of communicable diseases for WHO.

"North America and Europe may have billions of dollars required to contain this emergency; the worst affected countries in Asia, Africa and Latin America do not," Heymann said.

Outbreaks of drug-resistant TB have increased in Denmark, Germany and New Zealand, the report said. It also said that if drug resistance goes unchecked in developing countries, wealthy countries will inevitably feel the consequences.

Countries using the WHO's recommended tuberculosis control strategy have recorded a drop in the incidence of drug resistance.

The strategy, "Directly Observed Treatment, Short-course," is designed to prevent resistant strains from developing by ensuring that doctors and clinics provide the right medicines, and that patients take the entire course of treatment without interruption. In some cases, patients stop taking their medication after the symptoms abate but before the disease is eradicated, resulting in drug-resistant forms of TB.

More than 100 countries and territories have reported such cases. In the United States, multiple drug-resistant TB has been reported in most states and the District of Columbia, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Fauci said multiple drug-resistant TB is "at least 100 times more expensive to cure than drug-susceptible TB," and that a vaccine would limit the disease's toll.

Scientists can determine what drugs a tuberculosis patient is resistant to by looking at DNA strands

Russian health officials estimate 30,000 Russians are infected with tuberculosis, many with drug-resistant strains.

Prisons populations have been especially hard hit. In some places up to 7 percent of inmates are infected. Overcrowded conditions have helped spread the disease; one TB patient can infect 15-20 other people.

The treatments Russia could afford were not just inadequate, they made the problem worse.

"One of the reasons we have multi-drug-resistant TB today is because we were forced to treat TB with just one drug. It was not our fault, it was our misfortune," said Alexander Yaroshev, the medical director for Vladimir Prisons.

The Russian government is attempting to ease the overcrowding problem by agreeing to an amnesty for 300,000 prisoners. But prison doctors fear that will just transfer the disease into the civilian population.

Russian officials say the way to prevent the spread of tuberculosis is to have more international cooperation. A biochip developed at Argonne Laboratories in the U.S. could help ease the Russian problem. The device looks at the DNA of a patient's TB strain; with that information, doctors can determine in two to four hours what drugs a patient is resistant to.

Russian officials say this kind of help from the West is the only way they can solve a domestic problem that could soon become an international problem.

Medical Correspondent Eileen O'Connor contributed to this report.

Drug-resistant TB spreading through Russian prisons
June 24, 1999
WHO: Better TB treatment needed in Asia
March 24, 1999

World Health Organization
World TB Day
The STOP TB Initiative
International Union Against Tuberculosis and Lung Disease

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