Tuberculosis TB eradication

TB eradication

TB numbers from the WHO

There are many facts about tuberculosis (TB) that would startle most people. TB is often thought of as a problem of the past, or a problem faced in other countries or by other people. However, TB continues to be a huge burden globally, including in most countries in Asia-Pacific. Consider the following…

0

Lives saved

It is estimated that 58 million lives were saved through TB diagnosis and treatment between 2000 and 20181

0

People in the Asia Pacific region with latent TB infection

WHO global estimates that 25% of the world population has LTBI2

0

People became sick with TB

In 2018, 10 million people became sick with TB1

0

People died from active TB disease

In 2018, approximately 1.3 million people died from the disease worldwide3

0%

People living with LTBI

About 25% of the world’s population has LTBI1

0%

TB cases due to untreated LTBI

More than 80% of TB cases in the US are a result of longstanding, untreated LTBI4

0$

Cost of treating active TB disease

The average cost of treating active TB disease is $19,000 per patient5

0$

Cost of treating LTBI

The average cost of treating LTBI is $600 per patient5

TB disproportionately affects minorities:6

  • The rate is 31 times higher for Asians than it is for whites
  • The rate is 8 times higher for African Americans and Hispanics/Latinos than it is for whites

TB. To find it is to fight it.

It is easy for people not to think of TB as the problem it truly is worldwide: the second leading cause of death from a single infectious agent.7

In high TB burden areas, active TB disease has been the main focus in the fight to eradicate TB regionally. However, the WHO has recently identified LTBI as an important target in their End TB strategy. LTBI can be harder to recognize because patients are asymptomatic. However it’s estimated that 5-15% of patients will progress from LTBI to active TB disease over their lifetime, so if we do not find ways to screen and treat patients for LTBI, in addition to active TB diease, TB will be much harder to eradicate.

BCG vaccine

The bacille Calmette-Guérin (BCG) is a vaccine for active TB disease. It is often given to infants and children in countries with high TB rates. It offers limited protection from the disease.

  • The BCG vaccine can cause a false positive tuberculin skin test (TST) result
  • Interferon-gamma release assays (IGRAs) are not affected by previous BCG vaccination status
BCG Vaccine T-SPOT.TB

The global fight to end TB

On September 26, 2018, the United Nations (UN) General Assembly convened their first ever meeting on TB. The theme of the meeting was, “United to end tuberculosis: an urgent global response to a global epidemic.” The meeting endorsed a declaration aimed at accelerating the pace of the global fight to end TB. The declaration was adopted by the General Assembly on October 10, 2018. Read the declaration here and see below for the main points of the strategy:

The End TB strategy:10

  • Vision:
    A world free of TB. Zero deaths, disease and suffering due to TB
  • Goal:
    End the global tuberculosis epidemic
  • Indicators:
    • 95% reduction by 2035 in number of TB deaths compared with 2015
    • 90% reduction by 2035 in TB incidence rate compared with 2015
    • Zero TB-affected families facing catastrophic costs due to TB by 2035

Progress towards 2020 End TB milestones is falling short (WHO annual report)11

The WHO’s annual report on the status of global efforts to End TB notes that, at the present trajectory, most WHO regions and individual countries will fall significantly short of the End TB 2020 milestones:

2015-20182020 milestone2030 target
Reduction in TB incidence rate6.3% 20% 80%
Reduction in TB deaths11% 35% 90%
  • Areas on track to meet the 2020 milestones for both incidence rates and deaths include the WHO European Region, as well as Kenya, Lesotho, Myanmar, the Russian Federation, South Africa, Tanzania and Zimbabwe
  • A new, more effective vaccine could help reduce TB rates; however, the most promising vaccine (M72/AS01E) is not expected to be available until 2028 at the earliest, which is very close to the End TB target year of 2030