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Last Updated: Tuesday, 16 March, 2004, 01:38 GMT
Drug-resistant TB 'threatens EU'
TB bacterium
Drug-resistant strains of TB are prevalent in Eastern Europe.
Multi-drug resistant tuberculosis poses a major threat to the European Union, a World Health Organization report says.

Researchers found rates of MDR-TB are very high in several former Soviet republics. China is another blackspot.

The report estimates there are 300,000 cases world-wide - and warns that no country is safe.

It says increased funding for TB treatment programmes in badly affected areas is the only effective way to tackle the problem.

Attempts to contain the disease by beefing up border controls are unlikely to have much effect in an era of mass population movement.

We worry about multi-drug resistance because untreated it's a death sentence.
Dr Paul Nunn, Stop TB, WHO

In the largest study on drug-resistant TB to date, the WHO looked at 63 countries and 64,184 patients worldwide.

It found multi-drug resistance rates were up to ten times the average in the Russian Federation, Kazakhstan, Uzbekistan, Estonia, Lithuania, Latvia.

Other blackspots included Ecuador, South Africa, Israel and regions in China.

Central Europe and Africa were found to have the lowest levels of drug resistance.

Investing in TB

Dr Paul Nunn, in the Stop TB Department at WHO, said in regions that have not been surveyed, rates could even be higher.

Graph showing prevalence of multi-drug resistant tuberculosis
"We worry about multi-drug resistance because untreated it's a death sentence," he said.

The results coincide with areas where HIV infection rates are spiralling out of control.

Dr Mario Raviglione, director of WHO's Stop TB department said: "The response to this situation has to be global.

"It is in the interest of every country to support rapid scale-up of TB control if we are to overcome MDR-TB.

"Passport control will not halt drug resistance; investment in global TB prevention will."

The report also calls for greater funding specialised WHO treatment programmes, focusing both on the use of drugs and close patient surveillance.

Multi-drug resistance - where a patient has a form of the disease that is resistant to two or more drugs - often occurs through poor drug management.

People can also be infected directly by drug-resistant strains of TB. In Uzbekistan, one of the worst affected areas, drug resistance was found in 14% of new cases.

In addition, almost 80% of MDR-TB cases are now superstrains, meaning the patient is resistant to at least three of the four drugs.

The WHO DOTS plus programme uses a combination of one or more of the four main 'first line' drugs, with 'second line' ones. These are generally less powerful and more toxic, with more severe side effects.

DOTS plus treatment also lasts up to two years and is up to 100 times more costly.

But the report found DOTS plus has so far been extremely effective.

In Latvia, Peru, the Philippines and the Russian Federation, success rates of up to 82% have been recorded in preliminary project pilots where DOTS plus is being used.

Currently there are only 15 DOTS plus pilots running, covering South America and parts of Eastern Europe.

There are plans underway for 20 more, meaning in total 20,000 patients with MDR-TB could be treated. This is still less than 7% of the total who could potentially benefit.

A UK problem?

Paul Sommerfield, chair of TB Alert, a UK awareness charity, said: "This is a global problem, and Britain is only a small reflection.

"Rates of MDR-TB are at around 1% - 1.5% of all TB cases in Britain, which translates to around 40-50 cases a year."

Passport control will not halt drug resistance; investment in global TB prevention will.
Dr Mario Raviglione, director, Stop TB department, WHO
Mr Sommerfield said it was important that the problem of drug resistance was tackled at a global level and that the UK played its part.

However, he said the UK should treble its current investment.

Screening at ports of entry only pick up three or four cases a year, he said.

A spokesperson for the Department of Health said the government has developed a new TB strategy, which will be released in due course.

Shadow Health Minister, Andrew Murrison accused the government of dragging its feet. He said ministers had pledged to put a TB action plan in place by early 2003.

"In the face of concerns that the public's health will be seriously under threat after 1 May, when our borders are opened to countries like Estonia, Latvia, and Lithuania which are three of the top ten global hotspots, the absence of this promised action plan will not inspire confidence."




WATCH AND LISTEN
The BBC's Karen Allen
"Doctors are having to turn to more toxic medicines to treat the disease"



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