Tuberculosis Surge Abruptly Reversed by Better Therapy

By Price, Joyce | The Washington Times (Washington, DC), March 20, 1997 | Go to article overview

Tuberculosis Surge Abruptly Reversed by Better Therapy


Price, Joyce, The Washington Times (Washington, DC)


A "breakthrough" in tuberculosis control has "virtually stopped" the global surge of the TB epidemic and is likely to save millions of lives and sharply reduce the threat of drug-resistant strains, the World Health Organization announced yesterday.

"[This] is the biggest health breakthrough of this decade," Dr. Hiroshi Nakajima, director-general of the WHO, said in a statement. "We anticipate that at least 10 million deaths from tuberculosis will be prevented in the next 10 years."

TB is the world's leading fatal infectious disease. WHO said a treatment program called DOTS, or Directly Observed Treatment Short-course, is causing the worldwide TB epidemic to level off for the first time in years. It has an average cure rate of 85 percent.

Under DOTS, a patient takes four drugs daily for six months as part of a health-management system. WHO says this approach is "nearly certain" to cure every TB patient treated, except for those with infections that are resistant to several or all medications. Ordinarily, a major impediment to TB control is patients not finishing the entire treatment sequence, so they often are not cured and thus can still spread the disease. And the TB germs from these patients often are more virulent because they survived the initial doses of medication.

Under DOTS, though, "patient observers" watch TB patients swallow each dose of medicine over the entire six months.

Before the use of "patient observers," health officials said, the unsupervised use of TB drugs led to outbreaks of virtually incurable multidrug-resistant strains of TB.

WHO yesterday made its call for the "immediate and widespread use" of DOTS, in anticipation of World TB Day Monday.

On Monday, the federal Centers for Disease Control and Prevention will release data expected to show that TB cases dropped in the United States in 1996 for the fourth straight year. DOTS has been a factor in that decline, federal officials said.

While the annual number of TB cases has dropped dramatically in North America, Japan and Europe, it has risen substantially in the rest of the world.

"Up until the development of DOTS, we had no hope of stopping this global trend," said Dr. Jaap Broekmans, director of the Royal Netherlands TB Association, in a statement released by WHO.

"This past year, however, we have seen compelling evidence that where DOTS is used, cure rates nearly double, and the TB epidemic can eventually be sent into reverse," he said.

The WHO report singled out Russia as an area of special concern among 13 countries that have about three-fourths of the world's TB cases. The other 12 are India, Indonesia, China, Brazil, Bangladesh, Mexico, Ethiopia, Pakistan, the Philippines, South Africa, Thailand and Zaire. …

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