Year : 2017 | Volume
: 9 | Issue : 4 | Page : 129--130
State of the globe: The global battle for survival against Mycobacterium tuberculosis
Vivek Chauhan1, Suman Thakur2,
1 Department of Medicine, IGMC, Shimla, Himachal Pradesh, India
2 Department of Microbiology, Dr. RPGMC Kangra at Tanda, Kangra, Himachal Pradesh, India
IGMC, Shimla - 171 001, Himachal Pradesh
|How to cite this article:|
Chauhan V, Thakur S. State of the globe: The global battle for survival against Mycobacterium tuberculosis.J Global Infect Dis 2017;9:129-130
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Chauhan V, Thakur S. State of the globe: The global battle for survival against Mycobacterium tuberculosis. J Global Infect Dis [serial online] 2017 [cited 2018 Sep 21 ];9:129-130
Available from: http://www.jgid.org/text.asp?2017/9/4/129/220405
Mycobacterium tuberculosis (TB) is undoubtedly the most efficient killer of humans among all infections that they have ever encountered. This Bacillus is thriving worldwide despite unprecedented human progress in all areas of science and medicine over the past century. With its tremendous survival and adaptation capabilities, TB has infiltrated 30% of the human race on this planet. With a masterly inactivity, it waits inside us for a lifetime. Whenever it gets a chance, it attacks us from the inside and finds its way to infect our fellow humans. Our knowledge, drug combinations, surveillance, and networking have all failed till now in the task to curb TB.
The global funding for TB care and prevention has more than doubled in 2017 (US$ 6.9 billion) compared to 2006 (US$ 3.3. billion). India stood out as a country in which the budget for TB was substantially increased in 2017 (to US$ 525 million, almost double the level of 2016), following political commitment from the Prime Minister to the goal of ending TB by 2025.
The major issue we face now with TB is the emergency of multidrug resistance (MDR) and extensive drug resistance (XDR) strains of TB. In 2016, 490,000 new cases of MDR were registered and half of these were from India, China, and Russian Federation. The global treatment success rate in 2016 for drug sensitive and MDR-TB was 83% and 54%, respectively, despite the substantial increase in funding for TB.
The World Health Organization's (WHO) “End TB Strategy” and United Nations' (UN) “Sustainable Development Goals” (SDG) now share a common goal “To end the global TB epidemic.” It is good that the WHO and UN have realized the danger looming over the human race from this epidemic of TB, especially MDR-TB. The countries are now awakening to the reality that this Bacillus is not the problem of one country or one continent, but if not controlled now, it poses danger to the entire human race.
The global TB mortality and incidence are currently falling by 3% and 2% per year, respectively, but it needs to improve to 5% and 10%, respectively, to achieve the first milestone of “End TB Strategy' by 2020.” With the current pace of funding, education, and health system readiness in high-burden countries, it is unlikely that this milestone will be achieved.
Universal MDR-TB detection in new cases is recommended by the WHO, but in high-burden countries, the facilities to subject all new TB cases for drug resistance testing are not easily available. One of the North Indian centers tested 244 consecutive culture-positive TB isolates for drug resistance. They reported rifampicin resistance of 71.1% and MDR of 53.5%. These figures are alarming, though they are from a hospital-based sample.
In the fight against MDR-TB, two new drugs, namely bedaquiline and delamanid, have recently been added and at least 35 countries have introduced shorter regimens for treatment of MDR-TB. As part of efforts to improve outcomes for MDR/XDR-TB, 89 countries and territories have started using bedaquiline and 54 had used delamanid by June 2017. There are 17 drugs in various trial phases and 12 vaccine candidates in clinical trials: 3 in Phase I and 9 in Phase II or III. The shortened regimens of 9–12 months for MDR have been allowed in 2016 after sufficient evidence for effectiveness and cost efficiency. The earlier treatment regimens for MDR-TB were 20 months long.
The global community is now gearing up for a final blow to the TB, and the years 2017 and 2018 are going to be landmark ones for worldwide efforts to end TB. In November 2017, the WHO is hosting the first Global Ministerial Conference on TB in Moscow with the theme of ending TB. In the second half of 2018, this will be followed by the first UN General Assembly high-level meeting on TB, at which a multisectoral approach to ending TB and an associated multisectoral accountability framework will be discussed by heads of state.
The Bacillus has rapidly mutated taking advantage of poverty, crowding, poor health care, improper treatment, and incomplete regimens in the developing countries.
The emergence of MDR and XDR species aided by the ever-increasing socioeconomic gap is tilting the results in favor of the TB. On the other hand, gearing up of the WHO and UN to fight TB jointly with increased financing for End TB Strategy and SDG goals is the only hope for the human race in its effort to dominate this Bacillus. An epic global battle has now begun between the TB Bacillus and the human race for ultimate existence on this planet.
|1||WHO. Tuberculosis Fact Sheet Updated October, 2017. Available from: http://www.who.int/mediacentre/factsheets/fs104/en/. [Last accessed on 2017 Nov 19].|
|2||WHO: Global Tuberculosis Report. Available from: http://www.who.int/tb/publications/global_report/en/. [Last accessed on 2017 Nov 19].|
|3||Sinha P, Srivastava GN, Gupta A, Anupurba S. Association of risk factors and drug resistance pattern in tuberculosis patients in North India. J Glob Infect Dis 2017;9:22-8.|