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Worldwide fears over drug-resistant tuberculosis

As Ireland notes record-low levels of TB, global experts have warned of an untreatable strain emerging in a number of other countries.

American philanthropist Bill Gates shows up for a photo call in support of the Global Fund to fight AIDS, Tuberculosis and Malaria at the 43rd Annual Meeting of the World Economic Forum, WEF, in Davos earlier this year.
American philanthropist Bill Gates shows up for a photo call in support of the Global Fund to fight AIDS, Tuberculosis and Malaria at the 43rd Annual Meeting of the World Economic Forum, WEF, in Davos earlier this year.
Image: Anja Niedringhaus/AP/Press Association Images

ABOUT ONE PERSON per day was diagnosed with tuberculosis (TB) in Ireland during 2012, according to the HSE Health Protection Surveillance Centre.

The 368 cases reported last year is the lowest notification rate since TB surveillance began in 1998. In the previous two years, 424 and 420 cases were treated.

During 1992, just as a global epidemic was declared by the World Health Organisation (WHO), 604 cases were reported in Ireland. In the 1950s, about 7,000 cases of TB were notified annually.

The figures were released to mark World TB Day on Sunday and while there was welcome news in Ireland, experts across the globe had more worrying data.

A series of papers in the Lancet medical journal raised concerns about the emergence of a multi-drug-resistant strain of TB (MDR TB) and an even more concerning “extensively-drug-resistant TB” (XDR TB). Researchers believe that without “concerted action” from political leaders, health policy makers and funders, health systems worldwide are at risk of being “overwhelmed by increasing numbers of patients”.

“For many decades, the response to global tuberculosis by governments in both wealthy and disease-endemic countries has been complacent and politically neglectful. A major conceptual change and visionary global leadership are needed to move away from the conventional view that tuberculosis is only a disease of poor nations.”

The widespread emergence of XDR tuberculosis could lead to virtually untreatable tuberculosis.

“With ease of international travel, and increased rates of MDR tuberculosis in eastern Europe, central Asia, and elsewhere, the threat and range of the spread of untreatable tuberculosis is very real.”

In the UK, MDR TB nearly tripled in the first decade of the millennium, with a subsequent increase of 26 per cent in 2011. Six people were treated for XDR TB during the same year.

World TB Day

World TB Day commemorates the day in 1882 when Dr Robert Koch announced his discovery of the TB bacillus which caused tuberculosis.

In a statement to mark the day, United Nations General Secretary Ban Ki-moon highlighted the fact that 1.4 million people die every year from TB, making it the deadliest infectious disease known to man.

Worldwide, about 630,000 are infected with MDR TB, inflicting new burdens on patients, families and health systems. He noted the new strains are a “major addition” to the health budget as they cost ten times more to treat. The form of the disease, which has affected more than 30 per cent of newly-diagnosed patients in parts of eastern Europe and central Asia, fails to response to two potent drugs isoniazid and rifampin.

On its website, the WHO says at least €1.2 billion is needed annually to prevent the spread of the disease.

Ireland 2013

Separately, Dr Kevin Kelleher of the HSE stressed the need for vigilance against the disease as cases of TB are still occurring in Ireland.

“It is important to be aware of the symptoms, which include fever and night sweats, cough (lasting for more than three weeks), weight loss and blood in the sputum at any time…

Anyone can get TB but those most at risk are people from countries with high incidence of TB, people with weakened immune systems due to disease or medication, people who have been in contact with a case of TB and those who for other reasons may be at high risk, for example, the homeless and intravenous drug users.”

Earlier this year, suspected outbreaks of TB were recorded in Dublin City University (DCU) and on Inis Oírr.

All residents on the smallest of the Aran Islands were offered testing in mid-February following a number of diagnoses.

More then 150 people were tested at DCU over the past six weeks after two non-contagious cases of the disease were confirmed. Those identified as being “in contact” with the infected received a letter from the Department of Public Health’s TB Unit. The HSE ensured there was “no risk to the public”, dispelling fears of an outbreak.

The most recent data from the HPSC shows that 81 cases of TB were confirmed in the first ten weeks of the year, a jump of 11 when compared to the same period of 2012.

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