Drug resistant strains could become the dominant form of TB in Europe: it’s time to end TB
If the current situation continues, the majority of tuberculosis (TB) patients in the next generation could be suffering from drug resistant forms of the disease. The latest WHO/European Centre for Disease Prevention and Control (ECDC) report, “Tuberculosis surveillance and monitoring in Europe 2019 (2017 data)”, shows that the European Region is struggling to make sufficient progress to finally end TB. Challenges in timely detection, which result in ongoing transmission, and inadequate treatment are driving resistance. Despite an overall decline in cases, TB remains a major public health issue that is causing patients suffering and perpetuating poverty.
With 30 people diagnosed with TB every hour in the European Region, both patients and health systems are paying a high price. The eastern part of the Region has become the world’s drug-resistant TB hot spot. Of the 275 000 new diagnoses and relapsed cases, an estimated 77 000 patients are suffering from difficult-to-treat multidrug-resistant TB (MDR-TB). Almost 7000 patients are battling extensively drug-resistant TB (XDR-TB), an even more extreme form of the disease.
For 16-year-old Arman in Armenia, the outlook seemed particularly bleak when he received his diagnosis of XDR-TB. A misdiagnosis of pneumonia meant his treatment was delayed by 2 months, but his luck changed when he was referred to the National Centre for Tuberculosis Control in Armenia under the care of Dr Lusine Yeghiazaryan. Arman’s recovery began in the laboratory, where staff were able to conduct rapid tests that established 2 facts that determined his care and probably saved his life. Firstly, it was discovered that Arman had XDR-TB, so no more time was wasted trying to treat him with drugs that would not be effective. Secondly, they were able to determine the few drugs that would work and prescribe them along with bedaquiline, a new medicine which WHO recommends for treatment of these forms of drug-resistant TB. The first phase of Arman’s treatment took place in hospital, but after a few months he was no longer infectious and was allowed to continue his treatment at home, and began to get back to his normal life.
“TB can affect anyone but typically the most vulnerable suffer the most. European countries’ efforts are reducing the number of people falling sick with TB every year, but progress in addressing drug resistance has been too slow. We need to scale up early diagnosis and more effective treatment for all forms of TB as soon as possible. If we don’t, drug resistant TB will take over and ending TB will remain a dream,” warned Dr Masoud Dara, Coordinator for Communicable Diseases and Programme Manager for the Joint Tuberculosis, HIV and Vital Hepatitis Programme, WHO/Europe.
New hope for treatment of drug-resistant TB
Up until now, a diagnosis of drug-resistant TB spelled the start of a gruelling treatment plan for patients, lasting up to 2 years. New WHO recommendations for treatment of MDR-TB involve safer and more effective drugs, with reduced chances of severe side effects, and a new treatment regimen for increased effectiveness. On average, only 57% of MDR-TB and 35% of XDR-TB patients are successfully treated in Europe as a whole. In European Union/European Economic Area countries, the average treatment success rate is just 47% for MDR-TB, and 28% for XDR-TB.
Rapid testing is vital
Proper and fast diagnosis of TB is essential. The faster a patient is diagnosed, the sooner their treatment can begin, lessening suffering and further disease transmission. The new report indicates that just over half of newly notified TB patients were reported as having been tested using WHO recommended rapid diagnostic tests. To improve diagnoses and ensure appropriate treatment approaches, it is also important to have the capacity at country level to rapidly detect drug-resistant TB.
Overall, the situation in the European Region is improving too slowly to end TB by 2030 and achieve the Sustainable Development Goal target for the disease. New intersectoral approaches are needed, current tools need to be more fully implemented and a people-centred approach to care is paramount. The United Nations High-Level Meeting on TB, held in September 2018, brought hope to the world, as global leaders stepped up their commitment to end TB by 2030. This political commitment now needs to translate into action to end TB.