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Tuberculosis or TB, as it is also commonly known, is the world’s second-deadliest infectious disease, killing approximately 1.3 million people a year, according to the World Health Organization (WHO). While treatment is readily available, much of the world lacks accessibility and funding to effectively administer it. WHO has stated an additional $1.6 billion a year is needed to successfully fight the disease on a global scale. Without the funding, WHO has predicted that TB could elevate the future costs of treatment and further spread the multidrug-resistant form of the disease, which is known as MDR-TB. Here are some facts about tuberculosis and awareness of the global threat posed by the disease.
The symptoms of tuberculosis include coughing, fatigue, fever, weight loss, night sweats, and loss of appetite. When an individual with active TB, which is characterized by active bacteria replication, engages in any activity that releases droplets containing Mycobacterium tuberculosis (M. tuberculosis) into the air, the disease can be transmitted. If the resulting droplets are inhaled by other people, they may develop the disease. However, not everyone who inhales the droplets will become sick or infected with the disease.
There are two forms of TB that exist–latent TB infection and active TB disease. Without treatment, individuals with active TB disease will infect several people annually. Whereas individuals with latent tuberculosis, which is characterized by non-dividing bacteria, are often asymptomatic and unable to infect others. However, these individuals remain at risk of developing active TB disease if not properly treated. It is estimated that one-third of the world’s population currently has latent TB infection. Moreover, as many as 10 percent of those affected with latent TB infection will develop active TB disease at some point during their lives. However, people with compromised immune systems and other co-morbidity factors, due to HIV, AIDS, diabetes, tobacco use, or those who are malnourished, have a much higher risk of becoming ill with the disease.
Understanding the facts about tuberculosis and developing an awareness of the global threat TB poses is key to the successful treatment of the disease, as well as its prevention from becoming a global epidemic. Significant progress has been made in the fight against TB since WHO declared the disease a public health emergency in 1993. Over the past 20 years, nearly 60 million people have been successfully treated for TB, with more than 20 million lives saved. Moreover, the incidence of global TB has decreased and TB mortality rates have dropped nearly 50 percent since 1990. As a result, the Stop TB Partnership’s target to cut TB deaths in half by the year 2015 is now within reach.
In 2014, the Stop TB Partnership, which is an international collaboration of governmental and non-governmental organizations, adopted the “Reach the 3 million” slogan for World TB Day. The slogan refers to the 3 million people with TB missed by the global healthcare community each year. However, there is still much work to be done in order to eliminate the global threat of TB. There are still an estimated 7.5 million new TB cases and 1.4 million TB deaths reported every year. Moreover, TB is the third-leading cause of death for women worldwide and kills approximately 75,000 children every year.
When examining the facts about tuberculosis and developing an awareness of the global threat the disease poses, the influence of other co-morbidity factors must be explored and understood. For instance, those individuals who suffer from both TB and HIV infection pose a significant threat to HIV and TB control efforts. The two diseases form a lethal combination, as each disease accelerates the other’s progression. TB is the leading cause of death for HIV-positive people, and it is estimated to be responsible for one in five deaths among this population group. Moreover, people who have both HIV and latent TB infection are up to 50 times more likely to develop active TB disease than HIV-negative people. In 2012, there were over 1 million new cases and 320,000 deaths due to TB and HIV co-infection. Furthermore, TB testing rates among HIV patients and the use of anti-retroviral (ARV) medications in TB and HIV co-infected individuals remained low.
Other factors that are strongly linked to TB incidence rates include socioeconomic considerations, with over 95 percent of deaths from the disease occurring in low and middle-income countries. Contributing factors to the global variations in TB incidence rates include lack of accessibility to health care services, poor health information systems, lack of community, and inadequate attention to relevant social determinants of health that can fuel the epidemic. These social determinants of health include factors such as economic inequalities, cultural and religious beliefs regarding treatment, lack of education, rapid urbanization, and stigma surrounding the disease.
The facts about tuberculosis and developing an awareness of the global threat the disease poses is only part of the equation. Developing effective treatment and containment protocols to eliminate the threat of a global epidemic is also of utmost importance in battling the disease. One successful approach to reducing TB has been Directly Observed Treatment, Short-Course (DOTS), which is a multi-tiered tuberculosis control strategy. DOTS is best-known for using community workers to deliver and supervise the administration of TB therapy. This strategy has a cure rate of greater than 80 percent and has been ranked as one of the “most cost-effective of all health interventions” by the World Bank.
In May 2014, the WHO released its global strategy for containing the tuberculosis epidemic. The strategy seeks to accelerate the current two percent decline in new TB infections each year to a 10 percent annual decline rate. The WHO global strategy included the following target areas for successful completion by 2025–75 percent reduction in TB deaths compared with 2015, the TB incidence rate cut in half compared with 2015, as well as affected families not enduring financial ruin due to TB.
In July 2014, the WHO also established an action framework to eradicate TB in low-incidence countries. The framework included several priority recommendations as listed in the report, which included funding and stewardship for high-quality planning and services; outreach to the most vulnerable and hard-to-reach groups; screening for active TB disease and latent TB infection in high-risk groups and providing appropriate treatment, as well as the management of associated outbreaks; work to optimize multidrug-resistant form (MDR-TB) prevention and care; facilitate continued surveillance, program oversight, and evaluation; more investment in new TB research and protocols, as well as support for global TB control.
While understanding the facts about tuberculosis and developing an awareness of the global threat TB poses is key to the successful treatment of the disease, there are many components that play a role in the effective treatment and containment protocols necessary to eliminate the threat of a global epidemic in battling the disease. Massive funding gaps lie at the root of this continued global TB threat. While treatment is readily available, much of the world lacks accessibility and funding to effectively administer it. Without the funding and intervention needed to battle the disease on a global scale, TB could drastically increase the future costs of treatment and further spread the MDR-TB form of the disease. Moreover, tuberculosis will continue to devastate lives and communities around the world.
By Leigh Haugh