Giuseppe
Emeritus
[Source: The Lancet Infectious Diseases, full text: (LINK). Abstract, edited.]
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The Lancet Infectious Diseases, Early Online Publication, 24 March 2013
doi:10.1016/S1473-3099(13)70030-6
Drug-resistant tuberculosis: time for visionary political leadership
Original Text
Prof Ibrahim Abubakar FRCP a b, Matteo Zignol MD c, Dennis Falzon MD c, Prof Mario Raviglione FRCP c, Lucica Ditiu MD d, Baroness Susan Masham e f, Ifedayo Adetifa PhD g, Nathan Ford PhD h i, Helen Cox PhD h i, Stephen D Lawn FRCP j, Ben J Marais FCPaed k, Prof Timothy D McHugh PhD l, Peter Mwaba FRCP m n, Matthew Bates PhD l m, Marc Lipman FRCP o, Prof Lynn Zijenah PhD p, Simon Logan MSc e, Ruth McNerney PhD j, Adam Zumla MD m q, Krishna Sarda MD r, Payam Nahid MD s, Prof Michael Hoelscher FRCP t, Michel Pletschette FRCP u, Prof Ziad A Memish FRCP w x, Peter Kim MD ab, Richard Hafner MD ab, Prof Stewart Cole PhD y, Prof Giovanni Battista Migliori FRCP v, Prof Markus Maeurer FRCP z, Marco Schito PhD aa, Prof Alimuddin Zumla FRCP l
Summary
Two decades ago, WHO declared tuberculosis a global emergency, and invested in the highly cost-effective directly observed treatment short-course programme to control the epidemic. At that time, most strains of Mycobacterium tuberculosis were susceptible to first-line tuberculosis drugs, and drug resistance was not a major issue. However, in 2013, tuberculosis remains a major public health concern worldwide, with prevalence of multidrug-resistant (MDR) tuberculosis rising. WHO estimates roughly 630 000 cases of MDR tuberculosis worldwide, with great variation in the frequency of MDR tuberculosis between countries. In the past 8 years, extensively drug-resistant (XDR) tuberculosis has emerged, and has been reported in 84 countries, heralding the possibility of virtually untreatable tuberculosis. Increased population movement, the continuing HIV pandemic, and the rise in MDR tuberculosis pose formidable challenges to the global control of tuberculosis. We provide an overview of the global burden of drug-resistant disease; discuss the social, health service, management, and control issues that fuel and sustain the epidemic; and suggest specific recommendations for important next steps. Visionary political leadership is needed to curb the rise of MDR and XDR tuberculosis worldwide, through sustained funding and the implementation of global and regional action plans.
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a Centre for Infectious Disease Epidemiology, Department of Infection and Population Health, University College London, London, UK; b Health Protection Agency, London, UK; c Stop TB Department, WHO, Geneva, Switzerland; d STOP TB Partnership, Geneva, Switzerland; e All Party Parliamentary Group on Global Tuberculosis, London, UK; f House of Lords, London, UK; g Medical Research Council, Banjul, The Gambia; h M?decins Sans Fronti?res, Cape Town, South Africa; i Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa; j Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; k Sydney Emerging Infections and Biosecurity Institute, University of Sydney, Sydney, NSW, Australia; l Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK; m University of Zambia-University College London Medical School (UNZA-UCLMS) Research and Training Project, University Teaching Hospital, Lusaka, Zambia; n Ministry of Health, Lusaka, Zambia; o Department of Respiratory Medicine, Royal Free Hospital NHS Foundation Trust, University College London, London, UK; p University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe; q School of Pharmacy, London, UK; r India 800 Foundation, New Delhi, India; s Division of Pulmonary and Critical Care, University of California, San Francisco, CA, USA; t Department for Infectious Diseases and Tropical Medicine, Klinikum of the University of Munich, Munich, Germany; u Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland; v WHO Collaborating Centre for TB and Lung Diseases, Fondazione S Maugeri, Care and Research Institute, Tradate, Italy; w Ministry of Health, Riyadh, Saudi Arabia; x College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; y Global Health Institute, ?cole Polytechnique F?d?rale de Lausanne, Lausanne, Switzerland; z Department of Microbiology, Karolinska Institute, Stockholm, Sweden; aa Henry M Jackson Foundation-Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA; ab Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
Correspondence to: Prof Alimuddin Zumla, Centre for Clinical Microbiology, Department of Infection, University College London Royal Free Campus, Royal Free Hospital, London NW3 2PF, UK
-doi:10.1016/S1473-3099(13)70030-6
Drug-resistant tuberculosis: time for visionary political leadership
Original Text
Prof Ibrahim Abubakar FRCP a b, Matteo Zignol MD c, Dennis Falzon MD c, Prof Mario Raviglione FRCP c, Lucica Ditiu MD d, Baroness Susan Masham e f, Ifedayo Adetifa PhD g, Nathan Ford PhD h i, Helen Cox PhD h i, Stephen D Lawn FRCP j, Ben J Marais FCPaed k, Prof Timothy D McHugh PhD l, Peter Mwaba FRCP m n, Matthew Bates PhD l m, Marc Lipman FRCP o, Prof Lynn Zijenah PhD p, Simon Logan MSc e, Ruth McNerney PhD j, Adam Zumla MD m q, Krishna Sarda MD r, Payam Nahid MD s, Prof Michael Hoelscher FRCP t, Michel Pletschette FRCP u, Prof Ziad A Memish FRCP w x, Peter Kim MD ab, Richard Hafner MD ab, Prof Stewart Cole PhD y, Prof Giovanni Battista Migliori FRCP v, Prof Markus Maeurer FRCP z, Marco Schito PhD aa, Prof Alimuddin Zumla FRCP l
Summary
Two decades ago, WHO declared tuberculosis a global emergency, and invested in the highly cost-effective directly observed treatment short-course programme to control the epidemic. At that time, most strains of Mycobacterium tuberculosis were susceptible to first-line tuberculosis drugs, and drug resistance was not a major issue. However, in 2013, tuberculosis remains a major public health concern worldwide, with prevalence of multidrug-resistant (MDR) tuberculosis rising. WHO estimates roughly 630 000 cases of MDR tuberculosis worldwide, with great variation in the frequency of MDR tuberculosis between countries. In the past 8 years, extensively drug-resistant (XDR) tuberculosis has emerged, and has been reported in 84 countries, heralding the possibility of virtually untreatable tuberculosis. Increased population movement, the continuing HIV pandemic, and the rise in MDR tuberculosis pose formidable challenges to the global control of tuberculosis. We provide an overview of the global burden of drug-resistant disease; discuss the social, health service, management, and control issues that fuel and sustain the epidemic; and suggest specific recommendations for important next steps. Visionary political leadership is needed to curb the rise of MDR and XDR tuberculosis worldwide, through sustained funding and the implementation of global and regional action plans.
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a Centre for Infectious Disease Epidemiology, Department of Infection and Population Health, University College London, London, UK; b Health Protection Agency, London, UK; c Stop TB Department, WHO, Geneva, Switzerland; d STOP TB Partnership, Geneva, Switzerland; e All Party Parliamentary Group on Global Tuberculosis, London, UK; f House of Lords, London, UK; g Medical Research Council, Banjul, The Gambia; h M?decins Sans Fronti?res, Cape Town, South Africa; i Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa; j Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; k Sydney Emerging Infections and Biosecurity Institute, University of Sydney, Sydney, NSW, Australia; l Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK; m University of Zambia-University College London Medical School (UNZA-UCLMS) Research and Training Project, University Teaching Hospital, Lusaka, Zambia; n Ministry of Health, Lusaka, Zambia; o Department of Respiratory Medicine, Royal Free Hospital NHS Foundation Trust, University College London, London, UK; p University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe; q School of Pharmacy, London, UK; r India 800 Foundation, New Delhi, India; s Division of Pulmonary and Critical Care, University of California, San Francisco, CA, USA; t Department for Infectious Diseases and Tropical Medicine, Klinikum of the University of Munich, Munich, Germany; u Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland; v WHO Collaborating Centre for TB and Lung Diseases, Fondazione S Maugeri, Care and Research Institute, Tradate, Italy; w Ministry of Health, Riyadh, Saudi Arabia; x College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; y Global Health Institute, ?cole Polytechnique F?d?rale de Lausanne, Lausanne, Switzerland; z Department of Microbiology, Karolinska Institute, Stockholm, Sweden; aa Henry M Jackson Foundation-Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA; ab Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
Correspondence to: Prof Alimuddin Zumla, Centre for Clinical Microbiology, Department of Infection, University College London Royal Free Campus, Royal Free Hospital, London NW3 2PF, UK
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