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…
It is estimated that 58 million lives were saved through TB diagnosis and treatment between 2000 and 20181
People in the Asia Pacific region with latent TB infection
WHO global estimates that 25% of the world population has LTBI2
People became sick with TB
In 2018, 10 million people became sick with TB1
People died from active TB disease
In 2018, approximately 1.3 million people died from the disease worldwide3
People living with LTBI
About 25% of the world’s population has LTBI1
TB cases due to untreated LTBI
More than 80% of TB cases in the US are a result of longstanding, untreated LTBI4
Cost of treating active TB disease
The average cost of treating active TB disease is $19,000 per patient5
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.
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
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
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:
Reduction in TB incidence rate
Reduction in TB deaths
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
World Health Organization. Global Tuberculosis Report 2019 Fact Sheet.
World Health Organization. Global tuberculosis report 2019. License: CC BY-NC-SA 3.0 IGO
Latent TB Infection in the United States – Published Estimates. Centers for Disease Control and Prevention. CDC Latent TB Infection in the United States – Published Estimates. Accessed February 29, 2020.
Take on Latent TB Infection. Centers for Disease Control and Prevention. CDC Latent TB Infection Infographic. Accessed February 29, 2020.
TB in Specific Populations. Centers for Disease Control and Prevention. CDC TB in Specific Populations. Accessed March 3, 2020.
Global Health Observatory Data: Tuberculosis. World Health Organization. WHO Tuberculosis Observatory Data. Accessed March 11, 2020.
Covey, E. Latent TB Rates Likely Higher Than Previously Thought. Infectious Disease Special Edition. Latent TB Rates Likely Higher Than Previously Thought. Published October 24, 2019. Accessed January 9, 2020.
Vaccines. Centers for Disease Control and Prevention. CDC Tuberculosis Vaccines. Published March 15, 2016. Accessed February 20, 2020.
WHO End TB Strategy. World Health Organization. WHO End TB Strategy. Published September 8, 2015. Accessed January 9, 2020.
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