Globe plagued by TB germ warfare

October 27, 2007

We've seen it before with statistics surrounding HIV/Aids. Now the virus's deadly twin, tuberculosis, is taking the HIV/Aids onslaught to frightening new heights.

Figures are so overwhelming they almost take one's breath away.

The World Health Organisation (WHO) states that 8.8 million new cases of this airborne bacterial disease were recorded in 2005. Of these nearly 500 000 are resistant to the few drugs known to work.

The disease kills one person every 20 seconds, and about 4 400 people daily. More than 1.6 million people died from TB in 2005.

Tubercolosis, closely linked to immune suppression, is responsible for one third of Aids deaths globally.

Yet the disease is curable, even for people with HIV.

So what has gone wrong? Why has this disease re-emerged with such aggression?

"The growing threat of drug-resistant TB is a man-made tragedy," says Maria Freire, CEO and President of the Global Alliance for TB Drug Development (TB Alliance).

"It is caused by inadequate or incomplete treatment with a cumbersome, decades-old drug regimen that takes at least six months to cure the disease."

New drugs that fight TB are needed to treat these resistant strains: both multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB). These need to work more quickly, be easier to take, be effective against resistant strains, and work in concert with HIV anti-retroviral drugs (which some TB drugs such as rifampicin do not).

XDR-TB gained prominence last year when an outbreak was reported at Tugela Ferry in KwaZulu-Natal. The outbreak, which killed 52 people, was at first believed to be isolated.

Regions such as sub-Saharan Africa have always borne the brunt of TB.

But XDR-TB is turning into a global threat, rising not only in the dusty, far-flung clinics of Africa, but in the city centres of Johannesburg, New York, London, Moscow and elsewhere.

Friere, and others like her, will tell you that when it comes to fighting these new resistant strains, the cupboard for the most part is empty.

There are not yet any new drugs that have been fully tested and approved.

The mutants, on the other hand, are increasingly common, even in aircraft cabins.

Research is under way to develop critically needed, more effective drugs, vaccines and diagnostics.

But financing the production of new tools remains a challenge.

International working groups such as the Stop TB Partnership believe if the world community doesn't acknowledge TB as a global emergency, the disease burden will continue to grow.

The world's key stakeholders in the fight against TB will meet next week in Cape Town at the 38th Union World Conference on Lung Health.

The TB Alliance, along with global partners: the Bill and Melinda Gates Foundation, the Global Fund to Fight Aids, TB and Malaria, the Medical Research Council of South Africa, the National Institutes of Health, and the WHO, will be urging government leaders to support their efforts to fight TB with better treatments and to help move drug candidates from the laboratory to the clinic - and, ultimately, to patients.

The International Treatment Preparedness Campaign believe TB and HIV programmes need to be combined on a national basis for better treatment and more accurate statistics. (Currently this is not the case in South Africa.)

"TB is a global public health time bomb waiting for an opportune time to explode," warns the official Southern Africa HIV/Aids Information Service.