The White Plague


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The 24th March is World Tuberculosis day, and therefore, a moment to raise awareness as well as advocate and accelerate the efforts to eliminate this disease that still causes the deaths of nearly 1.7 MILLION people each year, mostly in developing countries 8.

 

In the late 1800’s, Dr. Robert Koch announced that he had discovered the bacteria (Mycobacterium tuberculosis) that causes Tuberculosis (TB)1,2. This opened the way towards diagnosis and cure of this epidemic disease, once known as the white plague.  TB’s history has had many ups and downs since. By the 1980s, tuberculosis had dropped from its status as a top international priority to that of a largely forgotten disease. This opened a window to the resurgence of TB disease in the early 1990’s which led to the publication of “Ending Neglect” in 2000 by the Institute of Medicine 3. It outlined steps needed to eliminate TB in the United States and for the World Health Organization (WHO) to declare the epidemic a global emergency, with deaths from TB higher than any previous year in recorded history 3. The fight against TB became a harder struggle with co-infection with HIV and the emergence of drug-resistant strains.

 

According to WHO 8, in 2016, approximately 10.5 million people fell ill with TB, and 1.7 million people lose their lives to this preventable and curable disease every day. TB is also the major cause of deaths related to antimicrobial resistance and the leading killer of people with HIV 8. TB along with HIV are the leading causes of death among infectious diseases worldwide 9. HIV and TB form a lethal combination, each speeding the other’s progress. About 40% of deaths among HIV-positive people were due to TB in 2016 8. The social and economic impacts are devastating and include stigma and discrimination.

 

Ending the TB epidemic by 2030 is among the health targets of the newly adopted Sustainable Development Goals 4,5. In May 2014, WHO has gone one step further and launched an ambitious strategy to end TB by 2035 setting a target of 95% reduction in deaths and a 90% decline in TB incidence by 2035 – similar to current levels in low TB incidence countries today 5.

Despite these goals, the EU/EEA TB notification rate of TB is still declining only by around 4% each year, when a decline of at least 10% is needed to reach the Sustainable Development Goals and global End TB Strategy targets 10.

 

Due to the presence of difficult-to-treat drug-resistant TB and increased population mobility, negligence of TB can be dangerous, even in low-incidence settings, and this, political commitment is high on the agenda ahead of World TB Day 2018. Many are calling for stronger leadership to end TB. This year’s World TB Day focuses on building commitment to end TB at all levels from political leaders to people affected by TB, civil society advocates, health workers, NGOs and other partners 6.  WHO and the Stop TB Partnership have joined hands to rally their forces behind the theme for the 2018 campaign: “Wanted: Leaders for a TB Free World. Make History. End TB.” 6. All can be leaders of efforts to end TB in their own work or terrain, YOU included. So let’s join this campaign today and advocate for TB end!

Campaign materials:  World TB Day 2018 Campaign, Adcovacy and Communication Toolkit 7.

 

About Tuberculosis:

TB is spread from person to person through air droplets, and when a person with lung TB cough, sneeze or spit, the person propels the TB germs into the air. To be infected, a person needs to inhale only a few of these germs 8.

People infected with TB bacteria have a 5–15% lifetime risk of falling ill with TB. Persons with conditions that impair the immune systems (e.g. people living with HIV, malnourished, diabetics, or tobacco smokers), have a significantly higher risk of falling ill. The first symptoms of TB (e.g. a cough, fever, night sweats, or weight loss) may be mild for many months, which can lead to delays in seeking care and results in the transmission of the bacteria to others 8.

Fortunately, TB is a treatable and curable disease, and the majority of TB cases can be cured when medicines are provided and taken properly. Support, such as information and supervision by a health worker is given so that the treatment adherence is guaranteed 8. However, many countries still rely on a long-used method called sputum smear microscopy to diagnose TB. Unfortunately, microscopy detects only half the number of TB cases and does not detect drug-resistance 8.

In 2010, WHO recommended using the rapid Xpert MTB/RIF® test, and since then the use of the test has expanded substantially. The test detects TB and resistance to rifampicin, which is the most effective first-line TB medicine. In 2016, WHO recommended four new diagnostic tests: a rapid molecular test, which can be used to detect TB at peripheral health centers where Xpert MTB/RIF cannot be used, and another three tests, which can be used to detect resistance to first- and second-line TB medicines 8.

 

WorldTBDay_Picture

 

References:

  1. Cambau, E. & M. Drancourt (2014). Steps towards to discovery of Mycobacterium tuberculosis by Robert Koch. Clinical Microbiology and Infection, 20(3), 196-201.
  2. Berberis, I., Bragazzi, N.L., Galluzzo, L. & Martini, M. (2017). The history of tuberculosis: from the first historical records to the isolation of Koch’s bacillus. Journal of Preventive Medicine and Hygiene, 58(1), E9-E12.
  3. Institute of Medicine (2000). Ending Neglect: The Elimination of Tuberculosis in the United States. Washington, DC: The National Academies Press
  4. United Nations. Sustainable Developmental Goals: Available at: <http://www.un.org/sustainabledevelopment/sustainable-development-goals/>
  5. World Health Organization (2014). The END TB Strategy. Global strategy and targets for tuberculosis prevention, care and control after 2015. Available at: <http://www.who.int/tb/strategy/End_TB_Strategy.pdf>
  6. World Tuberculosis Day on WHO Website. Available at: <http://www.who.int/campaigns/tb-day/2018/en/>
  7. StopTB Partnership & World Health Organization (2018). World TB Day 2018 Campaign Advocacy & Communication Toolkit. Available at: <http://www.who.int/campaigns/tb-day/2018/STBP_WHO_WTBD2018_ACToolkit.pdf>
  8. World Health Organization (2018). Tuberculosis. Available at: <http://www.who.int/mediacentre/factsheets/fs104/en/>
  9. World Health Organization (2017). Global tuberculosis report 2017. Available at:
  10. http://www.who.int/tb/publications/global_report/en/
  11. European Center for Disease Prevention and Control (ECDC) (2018).World Tuberculosis Day 2018. Available at: <https://ecdc.europa.eu/en/news-events/world-tuberculosis-day-2018>

 

Cover picture: Stop TB Partnership (2018). Campaign materials. Available at: <http://www.stoptb.org/events/world_tb_day/2018/materials.asp>

 

Want to know more?

  1. World Health Organization, Global Tuberculosis Reports (from 1997). Available at: <http://www.who.int/tb/publications/global_report/archive/en/>
  2. World Health Organization, Tuberculosis, Country Profiles. Available at: <http://www.who.int/tb/country/data/profiles/en/>
  3. World Health Organization (2016). On the road to ending tb highlights from the 30 highest TB burden Countries. World Health Organization Global TB Programme. Available at: <http://apps.who.int/iris/bitstream/10665/204662/1/WHO_HTM_TB_2016.06_eng.pdf?ua=1>
  4. Stop TB Partnership Website. Available at: <http://www.stoptb.org/global/plan/>
  5. World TB Day on WHO Website. Available at: <http://www.who.int/campaigns/tb-day/2018/en/>

 

GHNG_Bio_Gisela

Gisela Leiras is a medical doctor in Portugal. She graduated from Faculty of Medicine, University of Lisbon, and is currently doing her Public Health specialization in Coimbra. She concluded her Information Management and Business Intelligence in Health post-graduation this year. Her main interests in global health include infectious disease, health inequities, health economics and innovation in health and data analysis tools.

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