World Health Organisation’s (WHO) new report on tuberculosis (TB) prevalence globally has shown that countries need to act faster to prevent, detect, and treat the disease in order to comply with global targets of eradication.

As such, last week’s news of a new treatment for drug-resistant TB patients across nine African countries that reported a success rate of 82% in a study, has been hailed as a “breakthrough” at a medical summit in Britain.

While the treatment - which consisted of seven drugs - was hailed as “a breakthrough in the fight against drug-resistant TB” by Paula I Fujiwara, scientific director of the International Union Against Tuberculosis and Lung Disease, the WHO still urges greater attention from nations for this disease.

WHO: “An uphill task” ahead

Previously, international governments have agreed on targets to eradicate the disease at both the World Health Assembly and at the United Nations General Assembly, and in-turn, these goals would fulfil the Sustainable Development Goals. The goals agreed to upon include a 90% reduction in TB deaths and an 80% reduction in TB cases by 2030, with the benchmark set at 2015.

Despite such ambitious targets, the director general of WHO Dr Margaret Chan emphasised, "… a massive scale-up of efforts [is needed], or countries will continue to run behind this deadly epidemic and these ambitious goals will be missed."

The report highlighted the state of inequalities amongst countries with respect to the access of cost-effective healthcare resources for people suffering from TB, and stressed its importance in lowering the incidence rate of TB worldwide.

Higher burden of disease worldwide than previous estimate

While lauding that current efforts to counter TB have saved more than three million lives in 2015, it also brought to light that the TB burden of disease was actually higher than previously estimated.

In 2015, there were a reported 10.4 million new cases worldwide, with six countries accounting for 60% of these cases. The countries are India, with the largest number of case, followed by Indonesia, China, Nigeria, Pakistan and South Africa.

In Singapore, the incidence rate was almost 20 per 100,000 population to date in 2016, translating to 1,103 cases, to date in 2016. In Malaysia, the rate was comparative higher, at 103 per 100,000 population in 2014

Of the 10.4 million cases reported, an estimated 1.8 million people or 17.3% have died. The number of TB deaths has fallen by 22% between 2000 and 2015, but remains one of the top ten causes of death worldwide in 2015, claiming more lives than HIV and malaria.

The report also identified the gaps in testing for TB, which stems from multiple factors, such as in countries with large unregulated private sectors. Under-diagnosis remains a major barrier for access to quality and timely treatment.

Indeed, TB is notoriously tough to diagnose due to its high transmission rate, even in Singapore, with developed healthcare systems. In a high-profile case, there were six individuals across four unrelated units who contracted the same strain of Multi Drug Resistant TB at Ang Mo Kio Avenue 3.

Doctor–patient transmission in the United States

In fact, TB is so infectious that doctors who treat TB patients might contract TB as a result. Dr. Kelly Holland is a family medicine doctor and former tuberculosis patient at the Lynn Community Health Centre in Massachusetts. In the weeks leading to the diagnosis, he had experienced night sweats and weight loss, but had thought nothing of it.

He was only concerned when he started coughing out blood clots, which led him to suspect either lung cancer, or TB.

His diagnosis opened a can of worms – public health inspectors sought to track everyone he could have infected — which in his case was mostly his patients and their family members, amounting to some 1,000 individuals. These individuals, toddlers, babies, and parents alike, as well as Dr Holland was placed on a 17 drug regiment for months.

Inspectors also had the monumental task of ensuring all those individuals took all medication religiously and completed the course of medication – failing to do so would mean that TB could acquire drug resistanceMIMS

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