TB Now Ranks With AIDS as a Leading Cause of Death Worldwide

Medscape Medical News

Troy Brown, RN

October 29, 2015

The tuberculosis (TB) rate has fallen by nearly half (47%) since 1990, according to the World Health Organization (WHO). Still, 1.5 million people succumbed to the disease in 2014, and it ranks alongside HIV/AIDS as the leading cause of infectious disease deaths worldwide.

The WHO released its Global Tuberculosis Report 2015 yesterday.

"The report shows that TB control has had a tremendous impact in terms of lives saved and patients cured," WHO Director-General Margaret Chan, MD, said in a WHO news release. "These advances are heartening, but if the world is to end this epidemic, it needs to scale up services and, critically, invest in research."

Much of the improvement has occurred since 2000, when the Millennium Development Goals were established. Since then, effective diagnosis and treatment have prevented 43 million deaths, and global TB incidence has dropped by 18%, with a 1.5% reduction each year.

The world has largely met the Millennium Development Goal that called for stopping and reversing TB incidence by 2015; the goal has been met globally and in 16 of the 22 high-burden countries that together account for 80% of cases.

"Far From Sufficient"

"Despite the gains, the progress made against TB is far from sufficient," Mario Raviglione, MD, director of WHO's Global TB Programme, said in the news release. "We are still facing a burden of 4,400 people dying every day, which is unacceptable in an era when you can diagnose and cure nearly every person with TB."

In 2014, 890,000 men, 480,000 women, and 140,000 children died from TB, for a total of 1,510,000 deaths. Of those, 400,000 deaths were in individuals coinfected with HIV. The total number of deaths from HIV that year was approximately 1.2 million, including the 400,000 patients with TB.

Global totals for new TB cases (9.6 million) were higher in this year's report, but this is probably the result of "increased and improved national data and in-depth studies," as opposed to any rise in the spread of TB, according to the WHO news release.

Some 54% of new cases were in China, India, Indonesia, Nigeria, and Pakistan. An estimated 3.3% of those individuals are infected with multidrug-resistant TB (MDR-TB), and this level has remained steady in recent years.

Detection, Treatment Gaps Significant

More than one third (37.5%) of the 9.6 million cases of TB that occurred in 2014 were undiagnosed or not reported to national authorities.  These gaps are particularly serious for those with MDR-TB, which is a public health crisis. Only one quarter (123,000) of the 480,000 cases were found and reported to national authorities. The largest numbers of these cases were in China, India, and the Russian Federation.

Treatment initiation for individuals diagnosed with MDR-TB rose substantially, and most individuals diagnosed with MDR-TB in 2014 began treatment. Cure rates for patients with MDR-TB were more than 75% in 43 countries. Worldwide, the average cure rate for patients who were treated for MDR-TB is only 50%.

Progress is occurring: 77% of patients identified with both HIV and TB received antiviral medications in 2014. In addition, almost 1 million patients with HIV received TB preventive therapy in 2014, an increase of approximately 60% from 2013. More than half (59%) of these patients live in South Africa.

Financing Shortfalls Impede Progress

The report identifies significant gaps in funding for the implementation of interventions ($1.4 billion gap) and research and development of new diagnostic tests, drugs, and vaccines ($1.3 billion).

"The [American Thoracic Society (ATS)] reiterates its call to the international community to fully fund TB control and research and development programs," Dean Schraufnagel, MD, from the University of Illinois Hospital and Health Sciences System in Chicago, said in an ATS news release.

"In its report, the WHO describes insufficient funding as the key obstacle to battling TB. This includes the urgent need to develop new diagnostic, treatment and prevention tools. President Obama will shortly be releasing an ambitious National Action Plan to Combat Multi-Drug Resistant Tuberculosis globally and in the US," he said.

"We urge the Administration and Congress to fully implement and fund this important global health initiative through the [Centers for Disease Control and Prevention], [US Agency for International Development], and TB research through the National Institutes of Health. We simply must step up our efforts to combat TB, now the leading global infectious disease killer alongside HIV/AIDS, and this new plan will provide the guidance for doing so," Dr Schraufnagel, past president of the ATS, said.

Starting in 2016, the global focus will be more on ending the global TB epidemic as opposed to simply controlling TB. The End TB Strategy, adopted by all WHO member states, will aim to decrease TB incidence by 80%, reduce TB deaths by 90%, and "eliminate catastrophic costs for TB-affected households by 2030," according to the WHO news release.

"Ending the TB epidemic is now part of the Sustainable Development Goal agenda," Eric Goosby, MD, UN Special Envoy on Tuberculosis, said in the WHO news release. "If we want to achieve it, we'll need far more investment — at a level befitting such a global threat. We'll also need progress on universal health coverage and poverty alleviation. We want the most vulnerable communities worldwide to gain first, not last, in our efforts."

"The ATS, originally founded as the American Sanitorium Association in 1905, and its more than 15,000 worldwide members pledge to continue our work to eliminate TB. In collaboration with the WHO and other partners, we have produced international standards of care and are providing technical assistance in implementing those standards and other TB control, treatment and prevention strategies in over 23 countries," Dr Schraufnagel said in the ATS news release.

"Global Tuberculosis Report 2015." WHO. Published online October 28, 2015.  View report