May 2, 2008

scientists comment on BMJ study on the rise of drug-resistant tuberculosis

A study published in the British Medical Journal has identified a rise in cases of tuberculosis in England, Wales and Northern Ireland. The study also identified a global increase in rates of resistance to anti-tuberculosis drugs.

Dr James Lewis, Lecturer at the London School of Hygiene and Tropical Medicine, currently based at Aurum Institute for Health Research, Johannesburg, South Africa, said:

“The number of reported TB cases has increased from 6,323 in 2000 to 8,113 in 2006 (in England, Wales and Northern Ireland). Approximately half of all these cases have data on drug susceptibility. These data show that the proportion of cases with resistance to any first line drugs has increased from 6.7% to 7.7% over this time period. When combined with the rising number of TB cases, the number of cases with any resistance has risen from 198 to 358. Over the same time period, the number of cases with multidrug resistance (resistance to at least isoniazid and rifampicin) has increased from 27 to 51. Multidrug resistant TB is clearly on the increase in the UK, leaving no room for complacency. However, given the population size of England, Wales and Northern Ireland, multidrug resistance TB is still rare and remains the exception.”

Prof. Peter Davies, lead clinician for the National Multi-Drug Resistant Tuberculosis Service (MDRTB Service), said:

“The problem with drug resistant tuberculosis is that is is still relatively uncommon but increasing. Individual clinicians will have very little experiencing in managing cases. Since Jan 1st 2008 the MDRTB Service has been in operation. This is an electronically linked instant reaction expert group who can give advice and direct management of cases across the country.
The Baltic states have operated a similar system for some years with good success in reducing their cases.
By assisting clinicians in the management of cases of drug resistant TB the national MDRTB service offers our best hope in overcoming the increasing problem of drug resistance until new drugs become available.”

(Source: Kruijshaar ME, French CE, Anderson C, Abubakar I. Tuberculosis in the UK. Annual report on tuberculosis surveillance and control in the UK 2007. London: Health Protection Agency, 2007).

Dr Mario Raviglione, Director of Stop TB, World Health Organisation, said:

“The study underlines once again that TB care and control measures must be seriously implemented to cure people and prevent drug resistance. Errors in diagnosis and treatment will not be forgiven by TB, and MDR-TB will emerge. The management of a MDR-TB case is 100 times higher in drug costs than that of a normal TB case. The study also proves that no country, no matter how rich and developed, will ever achieve elimination of TB until TB is under control globally. In fact, TB, a classical airborne disease, does not respect, and cannot be stopped at, any border. Quality care by all practitioner everywhere in the world is the key, since we do have tools and knowledge to do a better job.”

Prof. Geoffrey Pasvol, Imperial College London, said:

“This is indeed a study of concern, highlighting the increasing occurrence of drug resistant tuberculosis. Resistant tuberculosis is hard to treat for a number of reasons, particularly because of the sometimes severe side effects of second-line drugs for the patient, the prolonged length of treatment necessary, and the costs, which can be ten times that of an ordinary tuberculosis patient. Clearly there’s the concern of spread in the population, but in our experience, much of the resistant tuberculosis is found in patients who come from abroad, emphasising the need for screening at the earliest possible opportunity. The problem of resistant germs of whatever nature is one of concern, not least so in the case of tuberculosis, because of the large implications in terms of individual patient health, public health and cost. International travel has indeed placed us in a ‘global village’ and I can only emphasize the sentiments of the authors when they say that ‘a global perspective is needed’.”