TB's Even Worse Than We Thought, WHO Says

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A new examination of TB numbers shows there are more than 500,000 more cases globally than anyone thought. And no surprise — governments are not fully funding global health and so efforts to get it under control are failing.

More than 9 million people developed tuberculosis in 2013, the World Health Organization reports, and 1.5 million of them died of it. And there are nearly 10,000 cases a year in the U.S., nearly all of them imported.

It’s the second-biggest infectious disease killer, after the AIDS virus.

As with the outbreak of Ebola, public health experts say it’s a lack of investment in health care systems that lets disease persist and spread in developing countries. TB is virtually gone in rich countries.

The good news is that the mortality rate from TB is still falling and has dropped by 45 percent since 1990, and while the new look at numbers shows more cases than thought, the number of people developing active TB disease is falling by 1.5 percent a year, WHO says in a new report released Wednesday.

Tuberculosis is especially insidious and hard to fight because people can be infected for years and even decades without showing symptoms. It takes weeks if not months of treatment with antibiotics to eradicate it.

TB spreads in the air and, untreated, kills 70 percent of patients, although it can take a decade to do so.

“The multidrug resistant TB (MDR-TB) crisis continues, with an estimated 480,000 new cases in 2013."

Worse, the bacteria that causes tuberculosis has mutated and there are forms that resist multiple antibiotics and even types that are immune to almost every drug. They’re called multi-drug-resistant TB, or MDR-TB for short, and extensively drug-resistant or XDR TB.

“The multidrug resistant TB (MDR-TB) crisis continues, with an estimated 480,000 new cases in 2013,” WHO says in a statement. “Worldwide, about 3.5 percent of all people who developed TB in 2013 had this form of the disease, which is much harder to treat and has significantly poorer cure rates.”

And 9 percent of MDR cases are considered XDR, meaning they resist almost all drugs and are even harder and more expensive to treat.

It only costs about $100 to $500 to cure someone of normal TB in the countries that have the most cases – almost all of them poorer countries in Africa and Asia. If tuberculosis is eradicated before it can mutate into drug-resistant forms, it’s cheaper and easier for all involved, experts say.

“The cost per patient treated for MDR-TB ranged from an average of $ 9,235 in low-income countries to $48,553 in upper middle-income countries,” WHO says.

In the U.S., it costs $134,000, to treat MDR-TB, compared to $17,000 for a normal case. That can shoot up to $430,000 for an extensively resistant case.

“The pharmaceutical industry is less interested in developing countries."

“This dismal news must serve as a wake-up call for governments, donors and drug companies to step up and improve the DR-TB response today,” said Dr. Grania Brigden, TB adviser for Médecins Sans Frontières or Doctors Without Borders.

But companies and countries alike are actually cutting their investments in TB. WHO says $8 billion is needed each year to find and treat patients and to invest in better drugs and work on a vaccine. But only $6 billion is being spent.

“The pharmaceutical industry is less interested in developing countries, where the potential gains are limited,” Dr. Mario Raviglione, director of the global TB program at WHO, told reporters. “The issue is how to push the pharma industry, perhaps through novel financing methods.”