Tag Archives: drug-resistant TB

So you think TB doesn’t affect people in Europe?

Jessica Kuehne, Health Advocacy Officer at RESULTS, presents some key facts about the scale of the TB epidemic in Europe and what RESULTS and partners are doing to help get rates down.

We talk a lot about how many people think TB is a disease of the past when in fact it still kills 1.3 million people every year. Yes, more than 90 percent of all the people who get sick with TB live in developing countries. But – Europe is not immune from the one disease that has killed more people than any other in history.

Here are a  facts about TB in Europe that might surprise you. They are:

  • TB is the top infectious disease killer in Europe. Of all deaths caused by communicable diseases (diseases caused by viruses, bacteria, parasites etc.), more than 40 percent are still due to TB.
  • Europe is a hot bed for drug-resistant TB. Although the European region only accounts for 13 percent of the world’s population, it makes up nearly a quarter of all drug-resistant TB cases.
  • The European Union has some of the worst treatment outcomes for drug-resistant TB. Of all people who are diagnosed with multidrug-resistant TB worldwide, only about half are able to successfully complete their treatment. In the EU this number is even lower – only one third of patients with multidrug-resistant TB successfully complete their treatment.

So the answer is yes, TB does still matter. And with drug resistance on the rise, TB in Europe REALLY matters.

Treatment for drug-resistant TB is tough – patients have to have daily injections at the start of treatment followed by two years of swallowing fists full of pills. On top of this come the side effects – vomiting, diarrhoea, headaches, depression, suicidal thoughts and even deafness.

Credit: Tom Maguire/RESULTS UK

Credit: Tom Maguire/RESULTS UK

Want to know what it’s like to have to go through that treatment? Read Marina’s account of going through TB diagnosis and treatment in three different EU countries.

Marina said that during those two years, one of the things that kept her going was a quote by Martin Luther King who said:

“If you can’t fly then run, if you can’t run then walk, if you can’t walk then crawl, but whatever you do you have to keep moving forward.”

Marina said she tried to focus on whatever she could to take her forward.

TB is often forgotten in Europe. Even amongst the TB community, little attention is paid to a region where people think TB isn’t actually a problem or, when it comes to Eastern Europe and Central Asia, people don’t know very much about.

But it’s not all bleak news. Last week, the TB Europe Coalition brought together 24 TB advocates from 13 countries across Eastern Europe and Central Asia to build a network of individuals raising the issue of TB and to work out ways of getting Governments to allocate more funding for TB in the region. RESULTS is supporting the coalition to build stronger ties in the region and find ways advocates can support each other and work together to respond to TB in Europe.

It was also encouraging to see that Public Health England, when welcoming the World Health Organisation’s new report on antimicrobial resistance, specifically identified TB as an area of antibiotic resistance we need to be paying attention to.

TB still kills an estimated 40,000 people in the European region every year, and the rise in drug resistance is nothing to be scoffed at. This is a disease we should be responding to with a global approach. And when I say global, that includes Europe, too.

Photo story: Drug-resistant TB in Romania

The fifth and final blog in our World TB Day series comes from Tom Maguire in the form of a photo story from his recent trip to Romania.  During two weeks in December, Tom visited hospitals, sanatoriums and prisons to meet with drug-resistant TB patients and the doctors and nurses assisting them with their treatments. These photos of some of the people he met visualise both the severity of the treatment and the loneliness and isolation that many patients feel being away from their loved ones whilst completing treatment that can last up to 2 years.

First ever debate on rising rates of drug-resistant tuberculosis held in Parliament

Global Fund image for websiteOn Tuesday 4th June, All-Party Parliamentary Group on Global Tuberculosis member Jim Fitzpatrick MP (Labour, Popular and Limehouse) secured a debate on the rising rates of drug-resistant (DR) TB in developing countries. This was the first time that a debate had been held specifically on the infectious disease that, despite being curable, continues to kill 1.4 million people each year.

There are estimated to be almost nine million cases of TB each year, just over six hundred thousand of which are the more extreme drug-resistant strain of the disease.

The numbers will come as a shock to many, given the perception that TB was confined to the history books long ago. Unfortunately that is not the case. Even here in the UK rates of the disease have been rising since the 1980’s with around nine thousand new cases each year.

TB has been around for a long time, it is the greatest infectious killer in human history eclipsing all other pandemics, and is now evolving into an even tougher advisory. Drug-resistant (DR-TB) forms of the disease can take four times as long to treat as ‘normal’ TB cases and cost up to 450 times more in developing countries. So while DR-TB cases account for less than 10% of the global burden of the disease, the cost to treat it is, quite frankly astounding.

If this was not bad enough, very few people who contract DR-TB have access to diagnosis or treatment, meaning that the disease continues to spread.  It can be passed from person to person as it is often airborne.

In a globalised world it is clear that this problem requires a global response. Mr Fitzpatrick sought to raise exactly this point and highlighted a number of key recommendations from the recent APPG TB report Drug-Resistant Tuberculosis: Old Disease – New Threat which highlighted steps the UK could take to meet this new threat. Continue reading

Guest Blog: A Call For History Makers

Todays guest blog post is brought to you by Endalkachew Demmiss, author of ‘The Mystery of God’s will’.

In 2004, I was a bed-ridden multidrug-resistant tuberculosis (MDR-TB) patient and missed class for more than two years. Before 2008, the medications were not available in Ethiopia. During those days, patients like myself were isolated in small rooms, waiting for their death due to the lack of access to expensive of anti-tuberculosis drugs. That was my fate. Fortunately I was able to get the life-saving drugs miraculously from a charitable organization, like the programs now supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria. After two years of suffering from the drug’s side effects I got the opportunity to go back to school and pursue my career as a pharmacist and global health advocate.

Credit: Claire Moodie

Credit: Claire Moodie

Our world can be a safe place to her inhabitants, but only if we win the fight against epidemics, which have showed time and again throughout history to be one of the greatest threats to our global brothers and sisters. Epidemics like the black plague, smallpox, measles and today, AIDS, TB and malaria have dealt devastating impacts for human kind.

Can you imagine if there weren’t scientists, committed political leaders or health professionals standing in the gap during these challenging times? My existence would have been threatened without these heroes. They have given us tools through modern science, political will and effective partnerships like the Global Fund, to make staggering advances in global health in the short space of just over a decade.

In developing countries, HIV/AIDS, TB, and malaria continue to kill at an alarming rate, more effectively than war. These major global health threats cause substantial morbidity, mortality, negative socioeconomic impact, and human suffering. Disease-specific interventions have had a considerable impact on improving health systems. However, we still need more resources, more research and attention from the global community to get tangible results on prevention, treatment and patient care. It’s time for the Big Push to defeat these diseases and we need champions and heroes now more than ever.

During the time of my fight against MDR-TB, we faced dramatic challenges, but now because of the effective interventions financed by the Global Fund and its partners, people can have a chance to get the medications freely. The Global Fund stands between life and death of millions and needs donors’ commitment for increased and sustained funding.

This is my call — from a poor nation to history makers — to be the generation who can change the course of history. Let’s march mercilessly against TB, HIV and malaria. In an age of vaccines, antibiotics and dramatic scientific progress, these diseases can be brought under control.

This post is part of a series produced by The Huffington Post, The Global Fund, and its partners as part of The Big Push campaign. For more information on The Global Fund, click here. To read more posts about The Big Push — The Global Fund and its partners efforts to eradicate HIV/AIDS, malaria and tuberculosis — click here.

APPG on Global Tuberculosis launches report on drug-resistant tuberculosis

This week in parliament, the APPG on Global Tuberculosis (TB) launched a major new report that calls on the UK Government to take a two-fold approach to tackling the increasing public health threat of TB in the UK and worldwide.

‘Drug-Resistant Tuberculosis: Old Disease, New Threat’ identifies the main challenges facing the UK and the world and outlines a series of recommendations for swift action where the biggest impact can be made.

The report highlights concerns about drug-resistant TB  (DR-TB). Both developed and developing countries are witnessing a rise in DR-TB. Fifteen of the 27 highest burden countries are in the WHO European region, while in the UK DR-TB has doubled in the last decade. This is of great concern, not only because DR-TB is much more difficult to treat but also because, compared to ‘normal’ TB, it is much more expensive. The reports highlights that:

In the UK, treating a single case of DR-TB is at least £50,000 and in developing countries it can cost close to £6,000. This is compared to £5,000 (UK) and £15 (developing countries) for ‘normal’ TB cases.

In the report’s foreward, Andrew George MP (Chair of the APPG TB) made note of the fact that many consider TB to be a disease that has been consigned to the history books. The report reinforces the message that this is not the case. As Andrew George MP goes on to say:

The fight against TB needs a new sense of urgency and innovation; combined with sufficient funding – both in the UK and internationally – if we are to effectively tackle the ‘TB time bomb’.

Now is not the time to loosen the reigns in the fight against TB. We must do all we can to ensure that 1.4 million people per year do not continue to die of this preventable and treatable disease. In the report MPs make a number of recommendations to the UK Government which include calling for;

  • A comprehensive strategy to combat TB in the UK;
  • At least a doubling of the UK’s contribution to the Global Fund to Fight AIDS, TB and Malaria to address the threat of DR-TB in low- and middle-income countries;
  • Continued investment in TB research and development (R&D) into new drugs, diagnostics and vaccines.

Visionary political leadership and increased investments into TB control programmes are exactly what is needed to fight the disease and tackle DR-TB; the report makes this clear. We hope the UK Government and leaders worldwide take note and do all they can to help save millions of lives.

We urge to you read the report. You can access the summary version here and the full version here.

TB in TIME Magazine

TIME Cover, Credit: James Nachtwey

In a blogpost last week we discussed the increased media attention on tuberculosis in recent weeks. A study, reported on in The New York Times and Al Jazeera, highlighted that many developing countries are awash with falsified and substandard TB drugs. This was encouraging the spread of drug-resistant forms of TB (DR-TB), something that was also said to be the case in a Wall Street Journal article discussing India’s counter-productive TB strategy.

Following from these, this week TIME Magazine declares “Contagion: Why drug-resistant TB threatens us all”. Worryingly, the article points out that despite estimates “there will be over 2 million new cases of MDR TB from 2011 to 2015, yet today only 10% of new MDR cases get proper treatment”. Continue reading

In Romania, politics allows drug resistant TB to flourish

Last week RESULTS UK and TB Alert, both members of the TB Europe Coalition, travelled to Romania to help facilitate an advocacy training and planning session for the Stop TB Romania Partnership. As part of the visit, Jess Kuehne, our European Health Advocacy Officer, visited a hospital that treats patients with drug-resistant TB.  Jess tells her first-hand account of the visit:

What’s it like to look a 20-year-old girl in the face and know that there is a good chance she will not overcome the extremely drug-resistant bacteria that have taken over her lungs? I was able to find out last week when I travelled to Bucharest as part of the TB Europe Coalition to help the Stop TB Romania Partnership develop an advocacy strategy.

RESULTS’ collaboration with NGOs in Romania began last year when we searched for patient stories for our report ‘Tuberculosis: Voices in the fight against the European epidemic’. During that time I was put in touch with Jonathan Stillo, a medical anthropologist who has been researching TB in Romania since 2006 and provided us with Iulian’s powerful story.

During my time in Bucharest, I, along with Jon, Paul Sommerfeld from TB Alert and Misu Stefan from Romanian Angel Appeal, visited a hospital that treats patients with drug-resistant TB. Jon has documented the significant challenges Romania faces in dealing with drug-resistant TB, and my visit to the hospital further demonstrated the plight that TB patients face.

At the hospital, we were given face masks before entering the hospital’s drug-resistant TB ward. The face masks were uncomfortable and made it awkward to speak to patients, not just because they made us look like a little like Bane from Batman, but because the masks also made it impossible to give a friendly smile. Yet our discomfort paled in comparison to the experiences of the patients we were about to meet.

We had the opportunity to speak with two young girls, Katalina and Alexandra*, both in their early 20s, both appearing otherwise healthy, but both battling strains of drug-resistant TB. Continue reading

The EU must act now to tackle escalating HIV and TB epidemics

RESULTS UK, in collaboration with leading non-governmental health organisations,  has released a report that highlights how the Global Fund funding shortfall and changes in eligibility criteria risk undermining momentous achievements that have been made in the fight against TB and HIV in the Eastern European and Central Asian (EECA) region.

The report outlines how the lack of available funds to the region means that the crucial scaling up of programmes tackling TB and HIV will simply not be able to go ahead. The report calls upon the leadership of the European Union (EU) to ensure that the needs of those living in the EECA countries are addressed and lives are saved. RESULTS calls on the EU  to demonstrate leadership and to help fill the funding gap.

Highlighting the necessity for action, the report states,

“The European region is home to the highest rates of MDR-TB (multidrug-resistant TB) in the world and, with 81,000 MDR-TB cases in 2010 alone, accounts for nearly 20 percent of the global burden.”

Continue reading

Wall Street Journal article highlights woman’s struggle to survive drug-resistant TB

Image courtesy of World Lung Foundation

A compelling article published in the Wall Street Journal last weekend tells the story of TB patient Rahima Sheikh, detailing a six-year journey that has resulted in Sheikh having one of India’s first documented cases of TB that is resistant to virtually all medicines available.

Sheikh, who was diagnosed with TB in 2006, spent the past six-years journeying throughout India in search of a cure for her illness. It has been a journey that has forced her to mortgage her family’s rice fields, spend her father and brother’s life savings, as well as causing her considerable physical and mental anguish. Despite these sacrifices, Sheikh still has no guarantee that she will survive her illness.

Treating TB ordinarily requires a six to nine month course of treatment, and, therefore, it may seem strange that Sheikh has been on this six-year journey. However, if TB cases are mismanaged, if doses aren’t correctly prescribed or  if treatment is taken incorrectly or inconsistently, the TB bacteria can re-emerge and become resistant to medication.

In the case of Sheikh, it is suggested drug-resistant strains of TB were able to emerge because she was prescribed the wrong treatment on the basis of a misdiagnosis when she first sought treatment. Continue reading

New study reveals shocking levels of extremely drug resistant tuberculosis

A study published yesterday by the Lancet has found much higher rates of drug resistant TB than previously estimated in eight countries around the world. The study found that among patients with multi-drug resistant TB (MDR-TB), 43 percent of cases were resistant to at least one second-line drug used to treat MDR-TB.

TB patients are treated with a six to nine month course of treatment that costs as little as $20 in the developing world. However, if drugs are taken incorrectly or stopped prematurely, the TB bacteria can re-emerge and become resistant to medication. Drug resistant strains are much more costly and difficult –sometimes even impossible – to cure. Drug resistant TB strains often develop in areas where case management is weak and where there is poor TB control.

MDR-TB is a drug resistant form of TB that does not respond to the standard treatment using first-line drugs. Extensively drug-resistant TB (XDR-TB) occurs when resistance to second-line drugs develops on top of MDR-TB.

The Lancet study enrolled 1,278 MDR-TB patients in Estonia, Latvia, Peru, Philippines, Russia, South Africa, South Korea and Thailand and tested them to see how many were resistant to second-line drugs. Among all patients, 43.7 percent were resistant to at least one second-line drug and 6.7 percent had XDR-TB. Continue reading