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24 March

Pathogens and Global Health: The danger of drug-resistant TB (Revised 29/03/2012)

24 March marks World TB Day which commemorates the day in 1882 when Dr Robert Koch announced that he had discovered the cause of tuberculosis, the TB bacillus. 130 years later TB is still spreading at a rapid rate. The first issue of Pathogens and Global Health highlights the grave threat that this disease still poses to public health.

According to a World Health Organisation (WHO) report last year, TB in Europe, particularly multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), is spreading at an ‘alarming rate’. It is thought that one fifth of all cases of MDR-TB worldwide now occur in Europe.

Issue 1 of Pathogens and Global Health, the re-launched journal that supersedes Annals of Tropical Medicine & Parasitology, takes a closer look at the existing topics affecting Europe today. The issue’s contributors, Dr Mario Raviglione, Professor Ajit Lalvani and Dr Manish Pareek, recommend ways to better control the growing incidence rates, proposing a unified strategy and a greater cooperation between national government agencies, active targeting of vulnerable populations, and the need for European states to comply with international health agencies’ recommendations.

Dr Mario Raviglione, Director of the WHO Stop TB Department, comments in an interview on the scale of the problem worldwide: of infectious diseases, TB is the number one killer in the world. He says “if one counts together the number of deaths, including those related to HIV, but dying because of TB, the figure comes to around 1.7 million per year”. Although this morbidity rate, as well as prevalence rates of TB, is declining, incidence rates remain high across the world.

In the 1990s, the WHO set up new policies and new standards to address these issues and to help control TB, but in the case of many countries it was difficult to convince governments to change the notification system or use certain definitions, and particularly to implement the treatment outcome monitoring.

Nevertheless, for most Western European nations, TB incidence rates have dropped significantly, but the UK is particularly unusual in that these rates have remained stable, and slightly increased in recent years. London has become the ‘capital of TB’ in Western Europe, owing to high immigration but also, according to Professor Ajit Lalvani and Dr Manish Pareek,"an up-to-date evidence-based co-ordinated national strategy predicated on close cooperation between the UK Department of Health, UK Border Agency, primary care organisations and TB services" is required.

In their report, Lalvani and Pareek outline the “missed opportunity” that is the UK’s policy to screen newly arriving immigrants for active, rather than latent TB, despite the evidence that a cost-effective screening of new immigrants from intermediate-to-high incidence countries could reduce the overall incidence rate.

Such recommendations could significantly reduce the TB incident rate in the UK and see it compare with other Western European nations, although TB will persist. “We will not see an elimination of cases of TB in the UK in the foreseeable future until it is under control globally” says Dr Raviglione. To this end, he reports on the development of two, possibly three, new drugs for TB – the first to be developed in forty years – two of which could be ready by the end of this year.

The interview and article discussed above are available in PDF format as a preview to issue 1 of Pathogens and Global Health which will be published later this month at Follow the links below to access the special preview versions of the interview and article:

> INTERVIEW: Dr Mario Raviglione, Director of the Stop TB Department, World Health Organization

> REVIEW ARTICLE: Immigrant screening for TB: a missed opportunity to improve TB control in the United Kingdom

Pathogens and Global Health is a journal of infectious disease and public health that focuses on the translation of molecular, immunological, genomics and epidemiological knowledge into control measures for global health threat.