Emerging Diseases: Article

WHO Warns of Massive Worldwide Tuberculosis Epidemic

3-18-98

LONDON - A tuberculosis epidemic is out of control in many countries and unless action is taken nearly 1 billion more people will become infected and 70 million will die in the next two decades, the World Health Organization says.

At a three-day meeting in London that ends Thursday, public health and tuberculosis experts have been assessing whether 22 countries which account for 80% of the world's TB cases are making progress towards controlling the infectious disease.

"The TB epidemic is now increasing in many countries, with devastating consequences," WHO said in a statement summarizing a report to be released Thursday. "This year, more people will die of TB than in any other year in history."

Tuberculosis, which attacks mainly the lungs, intestines, skin and brain, is a bigger killer than malaria and AIDS combined, and kills more women than all the combined causes of maternal mortality. Every year, between 2 and 3 million people die from TB, including 100,000 children, the Geneva-based U.N. agency said.

In 1993, WHO took an unprecedented step and declared tuberculosis a global emergency. Between 1993 and 1996, TB cases increased 13% worldwide.

Experts on the Ad Hoc Commission on the Global Tuberculosis Epidemic have been examining new data to see how well the 22 worst-affected countries are meeting WHO's global targets of detecting 70% of infectious TB cases and curing 85% of those by the year 2000.

The countries are Afghanistan, Bangladesh, Brazil, China, Democratic Republic of Congo, Ethiopia, India, Indonesia, Iran, Mexico, Myanmar, Nigeria, Pakistan, Peru, Philippines, Russia, South Africa, Sudan, Tanzania, Thailand, Uganda and Vietnam.

One-third of the world's population is infected with the TB bacillus, and between 5 and 10% will become sick with pulmonary TB during their lifetime, the WHO said. Only those who are sick are infectious, and they can transmit the disease by coughing, talking or spitting.

"It is estimated that between now and 2020, nearly 1 billion more people will be newly infected, 200 million people will get sick, and 70 million will die from TB - if control is not strengthened," the group said.

According to the WHO, there are nearly 3 million new TB cases in southeast Asia every year and nearly 2 million new cases in sub-Saharan Africa.

More than a quarter of a million new cases occur annually in Eastern Europe, which is experiencing an increase in TB deaths after almost 40 years of steady decline, WHO said.

Since the 1940s, there have been drugs to treat tuberculosis.

But WHO said poorly managed TB treatment programs are causing drug-resistant strains of tuberculosis to emerge, "which could render TB incurable."

Up to 50 million people may be infected with drug-resistant TB, either because they did not take all their medicines regularly for the required period - often because they start to feel better - or because they receive the wrong drugs or don't have a reliable drug supply, WHO said.

TB treatment costs around $2,000 per patient, but rises 100-fold to about $250,000 for patients with drug-resistant strains, WHO said.

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