Giuseppe
Emeritus
NEJM -- The Global Burden of Tuberculosis -- Combating Drug Resistance in Difficult Times (Extract, first paragraph, edited)
The Global Burden of Tuberculosis ? Combating Drug Resistance in Difficult Times
Peter R. Donald, M.B., Ch.B., M.D., and Paul D. van Helden, Ph.D.
According to the 13th annual tuberculosis report of the World Health Organization (WHO) ? published on World TB Day, March 24, 2009 ? there were an estimated 9.27 million new cases of tuberculosis worldwide in 2007.
Although this figure represents an increase from 9.24 million in 2006, the world population has also grown, making the number of cases per capita a more useful measure of the problem; this figure peaked in 2004 at 142 per 100,000 and fell to 139 per 100,000 in 2007.
An estimated 1.32 million people who were not infected with the human immunodeficiency virus (HIV) died of tuberculosis in 2007, as did an estimated 456,000 people who were HIV-positive. Prevalence and mortality rates appear to be falling in all six WHO regions. Thus, the Americas, the eastern Mediterranean, and Southeast Asia appear likely to meet the Millennium Development Goals target, set in conjunction with the Stop TB Partnership and the World Health Assembly, of halving tuberculosis prevalence and tuberculosis-related mortality between 1990 and 2015.
This target will probably not be met by the African and European regions.
Nevertheless, do the new statistics, at last, represent the turn of the tuberculosis tide and provide reason for cautious optimism?
Some 22 high-burden countries collectively account for 80% of the global tuberculosis burden. In 2007, the countries with the highest prevalence were India (with 2.0 million cases), China (1.3 million), Indonesia (530,000), Nigeria (460,000), and South Africa (460,000); of the estimated 1.37 million cases in HIV-positive persons, 79% were in Africa and 11% in Southeast Asia.
Disturbingly, there were an estimated 500,000 cases of multidrug-resistant (MDR) tuberculosis in 2007 (including 289,000 new cases); of these, 131,000 were in India, 112,000 in China, 43,000 in Russia, 16,000 in South Africa, and 15,000 in Bangladesh; 55 countries had reported cases of extensively drug-resistant (XDR) tuberculosis by the end of 2008.
These last figures are reason for considerable concern and highlight a potential threat to our ability to treat tuberculosis, both in individual patients and in the context of a treatment program.
(...)
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<cite cite="http://content.nejm.org/cgi/content/full/360/23/2393?query=TOC">NEJM -- The Global Burden of Tuberculosis -- Combating Drug Resistance in Difficult Times</cite>Peter R. Donald, M.B., Ch.B., M.D., and Paul D. van Helden, Ph.D.
According to the 13th annual tuberculosis report of the World Health Organization (WHO) ? published on World TB Day, March 24, 2009 ? there were an estimated 9.27 million new cases of tuberculosis worldwide in 2007.
Although this figure represents an increase from 9.24 million in 2006, the world population has also grown, making the number of cases per capita a more useful measure of the problem; this figure peaked in 2004 at 142 per 100,000 and fell to 139 per 100,000 in 2007.
An estimated 1.32 million people who were not infected with the human immunodeficiency virus (HIV) died of tuberculosis in 2007, as did an estimated 456,000 people who were HIV-positive. Prevalence and mortality rates appear to be falling in all six WHO regions. Thus, the Americas, the eastern Mediterranean, and Southeast Asia appear likely to meet the Millennium Development Goals target, set in conjunction with the Stop TB Partnership and the World Health Assembly, of halving tuberculosis prevalence and tuberculosis-related mortality between 1990 and 2015.
This target will probably not be met by the African and European regions.
Nevertheless, do the new statistics, at last, represent the turn of the tuberculosis tide and provide reason for cautious optimism?
Some 22 high-burden countries collectively account for 80% of the global tuberculosis burden. In 2007, the countries with the highest prevalence were India (with 2.0 million cases), China (1.3 million), Indonesia (530,000), Nigeria (460,000), and South Africa (460,000); of the estimated 1.37 million cases in HIV-positive persons, 79% were in Africa and 11% in Southeast Asia.
Disturbingly, there were an estimated 500,000 cases of multidrug-resistant (MDR) tuberculosis in 2007 (including 289,000 new cases); of these, 131,000 were in India, 112,000 in China, 43,000 in Russia, 16,000 in South Africa, and 15,000 in Bangladesh; 55 countries had reported cases of extensively drug-resistant (XDR) tuberculosis by the end of 2008.
These last figures are reason for considerable concern and highlight a potential threat to our ability to treat tuberculosis, both in individual patients and in the context of a treatment program.
(...)
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