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Sun 1 Apr 2007 06:21 PM

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WHO: TB epidemic levelling off

The global tuberculosis (TB) epidemic has levelled off for the first time since the World Health Organisation (WHO) declared TB a public health emergency in 1993.

The global tuberculosis (TB) epidemic has levelled off for the first time since the World Health Organisation (WHO) declared TB a public health emergency in 1993. The WHO's new Global Tuberculosis Control Report finds that the percentage of the world's population struck by TB peaked in 2004 and then held steady in 2005.

"We are currently seeing both the fruits of global action to control TB and the lethal nature of the disease's ongoing burden," said United Nations Secretary-General Ban Ki-moon. "Almost 60% of TB cases worldwide are now detected, and out of those, the vast majority are cured. Over the past decade, 26 million patients have been placed on effective TB treatment thanks to the efforts of governments and a wide range of partners. But the disease still kills 4400 people every day."

Although the rate at which people developed TB in 2005 was level or even declined slightly compared to 2004, the actual number of TB cases continued to rise slowly. The reason for this difference is that world population is expanding. The pace at which new TB cases developed in 2005, however, was slightly lower than global population growth. The number of cases in 2005 was 8 787 000, up from 8 718 000 in 2004. An estimated 1.6 million people died of the disease in 2005, 195 000 of them people living with HIV.

Despite signs that the epidemic may be slowing, there are major impediments to rapid progress against TB, prominent among them being uneven access to diagnosis and treatment within countries. "We need to tackle this problem as part of the larger challenge of increasing access to primary health care services. All people, no matter who they are or where they live, should have access to TB diagnosis and treatment as part of a package of general health services that bring multiple health benefits," said Dr Margaret Chan, WHO director general.

Other major barriers to progress include HIV, drug resistance and a lack of funding.

TB is a major cause of death among people living with HIV/AIDS, and HIV is the main reason for failure to meet TB control targets in high HIV settings. Collaboration between TB and HIV programmes is key to reducing the burden of TB among people living with HIV. Also, while HIV testing for TB patients is increasing rapidly in Africa, few people with HIV are being screened for TB.

The spread of extensively drug-resistant TB (XDR-TB) poses a serious threat to progress and could even reverse recent gains. "We have a clear plan on how to control XDR-TB, but countries are moving far too slowly on implementing this plan. Funding is an issue as well -- it will take an additional US$ 650 million globally to implement control of both XDR-TB and multi-drug-resistant TB (MDR-TB) in 2007 alone," said Dr Mario Raviglione, director of the WHO Stop TB Department. "Beyond that, because of the threat of XDR-TB, research to identify new diagnostics, drugs and vaccines is more vital than ever."

The Global Plan to Stop TB (2006-2015) outlines steps to treat 50 million people for TB and enrol 3 million patients who have both TB and HIV. Over 10 years, this would save 14 million lives and reduce TB levels to 1990 levels by 2015.

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