Target tuberculosis in rich world as model for poor, WHO proposes

The World Health Organization launched an ambitious plan for rich countries to sharply reduce tuberculosis infections and serve as a model for harder-hit countries of Africa and Asia, where the disease still thrives.

Although the 33 targeted countries, 21 of them in Europe, have relatively low rates of infection, the disease still kills 10,000 people a year there predominantly homeless people, migrants, prisoners, drug users, heavy drinkers or people with HIV/AIDS WHO said Thursday.

• Nunavut's TB battle continues with 42 new cases this year

• TB deaths in homeless not improving: study

• Tuberculosis resurfaces in Vancouver's Downtown Eastside, CBC Digital Archives
• Tuberculosis, Old Disease, Continuing Threat, CBC Digital Archives

It is in these communities that industrialized countries including the United States could pilot approaches to a disease that is both preventable and curable that could then be transferred to poorer countries, Dr. Mario Raviglione, director of the WHO's Global TB Programme told a news briefing.

The goal is to reduce the infection rate by a factor of 10 to fewer than 10 new TB cases per million people per year by 2035 in each of the 33 countries, and to effectively eliminate it by 2050.

"We are after, really, is finding what we call trailblazers or model countries that would embark in a resolute way on this campaign against tuberculosis, proving that it is indeed possible to get to elimination level," Raviglione said.

The WHO strategy involves broader screening for both active and latent TB infections in high-risk groups, funding high-quality health services, and investing in new drugs, vaccines and diagnostic tests.

Drug resistance grows

Common symptoms of TB are coughing with sputum and blood at times, chest pains, weakness, weight loss and fever. But the disease, which is transmitted through the air, can take years to develop, and it is also vital to test as early as possible to determine if a person has a drug-resistant form.

Of the 155,000 annual new cases of tuberculosis in the target countries, about 500 are multi-drug resistant (MDR-TB), caused by an extreme superbug form of the bacterium that does not respond to the most powerful first-line drugs.

But worldwide, China, India and South Africa are among the hardest hit by TB.

The WHO estimates that 8.6 million people developed TB in 2012 and 1.3 million died. Some 450,000 fell ill with dangerous superbug strains in 2012, and up to 2 million people worldwide may be infected with drug-resistant TB by 2015, it says.

Raviglione singled out Russia for its high rates of MDR, which he called a "disaster situation" that poses a threat to Western Europe.

Standard treatment for TB usually includes a mix of four antibiotic drugs over a period of six months. MDR-TB can take 18 to 24 months to treat and cost up to $100,000 in rich countries.

But research efforts are already bearing some fruit.

Raviglione said about 12 promising vaccines were being tested, mostly by U.S. or UK companies, and some could be on the market by 2022.

The first new TB treatment in more than 40 years, Johnson & Johnson's bedaquiline, was approved in 2012 for use on drug-resistant TB, and in 2013 the European Medicines Agency recommended granting conditional marketing approval for delamanid, a treatment for MDR being developed by Japan's Otsuka .