India leads the world in TB burden

India leads the world in the burden of tuberculosis (TB) according to the new report of the World Health Organization (WHO) on the disease.

According to the WHO’s 2018 Global TB Report, released in the United Nations (UN) headquarters in New York,  two of the primary routes to reducing TB incidence and death are diagnosis and treatment, areas where "large and persistent" gaps remain. Of the 10 million new and relapsed cases in 2017, only 6.4 million (64 per cent) were officially reported to national authorities and the WHO. Ten countries accounted for 80 per cent of the 3.6 million gap, led by India (26 per cent), Indonesia (11 per cent), Nigeria (9 per cent). The gap is suspected to be caused by a combination of under-diagnosis and under-reporting.

India also led in cases of Multi-Drug Resistant TB (MDR-TB). Nearly half of the world's MDR-TB cases are in India (24 per cent), China (13 per cent), and Russia (10 per cent).

Overall, the report revealed that while the number of new TB cases continued to decline in 2017, and fewer people died from the disease, efforts to make the world's deadliest infectious disease a "disease of the past" needed to be ramped up.

While an estimated 54 million deaths have been averted since 2000, the burden of TB remains high in many low- and middle-income countries, and WHO officials say ending TB as a major global health problem by 2030 will require countries to pick up the pace.

The report estimates that 10 million people developed the disease in 2017, including 5.8 million men, 3.2 million women, and 1 million children. That is down from 10.4 million in 2016. Globally, the TB incidence rate is falling by roughly 2 per cent a year, with annual reductions of 5 per cent and 4 per cent in Europe and Africa, respectively.

But the global incidence rate needs to be falling by 4-5 per cent every year to meet the first milestone of the “End TB” strategy—a 20 per cent reduction by 2020 (compared with 2015). The strategy aims to cut TB incidence by 80 per cent by 2030.

Another case in point is case-fatality rate. The number of estimated TB deaths dropped from 1.7 million in 2016 to 1.6 million in 2017. Of those, 300,000 were among HIV-positive people. Since 2000, the number of TB deaths among HIV-negative people has fallen by 29 per cent, while the number of deaths among HIV-positive people has dropped by 44 per cent. The case-fatality rate dropped from 23 per cent in 2000 to 16 per cent in 2017, but needs to fall to 10 per cent by 2020 under the “End TB” strategy, which aims for a 90 per cent reduction in deaths by 2030.

Drug-resistant TB

Another big challenge is MDR-TB and drug-resistant TB (XDR-TB). WHO estimates that 558,000 people in 2017 developed TB that was resistant to rifampicin, the most effective first-line TB drug; 82 per cent of these cases were MDR-TB, and 8.5 per cent were XDR-TB. The report says that efforts to address MDR-TB continue to be hampered by poor detection and treatment.

However, the report expresses hope that the recently updated MDR-TB treatment recommendations from the WHO will boost the success rate. The recommendations, issued in August, prioritise newer antibiotics like bedaquiline and oral drugs over injectables, which are less effective and have been associated with severe adverse effects. Data shows that the newer drugs have greater treatment success and lower mortality rates. 

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