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Tuberculosis - still a major killer

The WHO has classified tuberculosis as a full-blown epidemic which affects all countries, both developing and developed

Not long ago, tuberculosis was considered something belonging to a bygone age. But as the international community marks World TB Day 2001 on Saturday, the grim statistics prove that the disease is currently one of the most serious worldwide medical problems.

Tuberculosis is a contagious air-borne bacterial disease, which spreads like the common cold or flu. It is the biggest infectious killer of young people and adults.

One third of the world’s population is currently infected or “TB-positive”. Eight million people are now ill with TB. Two million of them will die in the next year, and 30 million could die in the next 10 years.

TB is currently the number-one infectious killer of HIV-positive people, because TB is a so-called “opportunistic disease” that thrives when the body’s immune system is weak. A recent study showed that 70 per cent of the world’s TB patients are also HIV-positive.

The Geneva-based World Health Organization now classifies tuberculosis as a full-blown epidemic which affects all countries, both developing and developed. There are now 1.5 million cases a year in sub-Saharan Africa, three million in southeast Asia, and a quarter of a million in eastern Europe.

“Whether on Wall Street or the Great Wall of China, anyone who breathes air must be concerned about the risk”, is the way a WHO slogan puts it.

Nonetheless tuberculosis can be successfully treated and cured in 95 per cent of cases. Despite some instances of drug-resistance, especially in eastern Europe, there is an adequate range of medication available, at least in the West.

The WHO has a prescription for dealing with TB which it calls DOTS (Directly Observed Treatment, Short-Course). The main feature of the strategy is concerted government commitment to assure detection of new cases, and supervised treatment for a period of six to eight months.

Curing tuberculosis in a developing country can cost as little as US$ 10-15 per patient. Even so, according to the WHO’s Dr Ian Smith, the biggest hurdle in effective control of TB in poor countries is still lack of funds and medical infrastructure.

But even rich nations have failed in the past to pay enough attention to the TB threat, and have been caught off-guard. Poorly managed anti-TB control and treatment programmes have also been a major problem in some countries.

The WHO considers protection against tuberculosis to be a human right. For that reason, it is spearheading a global drive to contain and treat the disease. The WHO’s global “Stop TB Initiative” seeks to coordinate the efforts of all agencies, public and private, with the aim of treating a total of 10 million sufferers within five years.

Despite the gravity of the global situation, it would be wrong to paint a picture of universal gloom and doom.

In contrast to the WHO’s worldwide view, the situation in Switzerland, for example, looks much better. Dr Peter Helbling of the Swiss federal health office describes Switzerland -along with other highly developed nations - as having “low TB incidence”.

Among the native population of Switzerland, there are five cases per 100,000. Most of the native TB patients in Switzerland are elderly people who became infected before the advent of antibiotics. Other cases involve immigrants who became infected in their home countries.

Estimated at between five and 10 per cent, the number of people with TB who are also HIV-positive is also considered low, says Helbling.

Two per cent of TB cases show varying degrees of resistance to drug therapy. However, in highly-developed medical care systems, such as that in Switzerland, these patients can be treated, albeit at very great cost.

Although the Swiss federal health office considers the WHO’s DOTS have merit, even in highly-developed countries, it is not possible to fully implement in Switzerland since health is a cantonal and not a federal matter. This notwithstanding, says Helbling, the tuberculosis situation in Switzerland is under control.

by Bob Zanotti


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