Tuberculosis (TB) concerns us all

There are almost half a million TB patients in the European Region, and each year over 40 000 people die from the disease. Early diagnosis, better treatment and care are vital to stop the disease. 24 March is World TB Day.

Anyone can catch TB

Over 1000 people are estimated to fall sick with tuberculosis (TB) every day across Europe, or over 380 000 yearly.

TB is an infectious disease caused by “Mycobacterium tuberculosis” that spreads through the air by very small aerosols. It has a thick cell wall.

Once “M. tuberculosis” reaches the lungs, it can cause infection. Fortunately people’s immune system can usually contain bacteria. If this system is weakened – particularly in young children or older people, or due to HIV infection or diabetes – bacteria can spread and cause disease.

If TB goes untreated, each person with active disease can infect, on average, 10–15 others every year.

TB: touching more than just health

TB has not only specific symptoms (coughing, blood in sputum, shortness of breath and chest pain) but also general ones (fever, night sweats, loss of weight, loss of appetite, fatigue and general weakness). Beyond these, it affects people’s lives in many other ways.

Social stigma and the length of treatment (up to two years for drug-resistant forms) often isolate patients from their families and friends.

The cost of being unable to work during treatment can leave people with an impossible choice: finishing treatment and getting well, or stopping treatment to support their families.

Disproportionate effect on the most vulnerable

TB can affect anyone, but it hits the poorest hardest. The disease is linked to social determinants of health: the conditions in which people live and work.

Poor living conditions, poor nutrition, and overcrowding are all risk factors for the disease. This means that TB rates are higher in big cities, where these problems are more common.

Migrants, prisoners and socially marginalized people are particularly vulnerable.

Evidence indicates that TB is seen most often among young adults in the eastern part of the WHO European Region and among migrants and native elderly people in western countries.

Drug-resistant TB: a growing problem

The Region shows a worrying trend: the increasing proportion of cases of multidrug-resistant and extensively drug-resistant TB (M/XDR-TB).
In MDR-TB, the disease is resistant to at least two of the most potent anti-TB drugs. With XDR-TB, the disease is resistant to both first- and second-line drugs, and therefore almost impossible to cure.

This is a man-made problem, the result of inadequate TB treatment and/or poor airborne infection control. The result is greater numbers of cases that are more difficult and much more expensive to treat, with more frequent and severe adverse events.

Better diagnosis, treatment and care needed

In 2011, WHO approved a revolutionary new diagnostic test for TB, which will speed up diagnosis of M/XDR-TB. The challenge is to ensure that it is available in all the countries that need it. At present, the detection rate is estimated to be about 40%; WHO’s goal is raise it to 85% by 2015.

A vital objective of TB control is to shorten treatment times, to help patients complete their treatment, beat the disease and return to active life. At present, less than 50% of patients with M/XDR-TB are treated successfully, but WHO aims to increase this rate to 75% by 2015.

In sum, health systems must become more people focused, to ensure that services for TB diagnosis, treatment and care are available free of charge to all, when and where they are needed. New and more effective medicines and vaccines, and evidence-based approaches to prophylactic treatment, are also needed.