INFECTION PREVENTION Worldwide efforts to tackle TB
In a bid to tackle TB globally, governments agreed on targets at the World Health Assembly and at the United Nations General Assembly within the context of the Sustainable Development Goals. The targets include a 90% reduction in TB deaths and an 80% reduction in TB cases by 2030 compared with 2015. The World Health Organization, in its 2016 Global Tuberculosis Report7
, showed
that countries need to move much faster to prevent, detect, and treat the disease if they are to meet these global targets. Dr Margaret Chan, WHO director general, commented: “There must be a massive scale-up of efforts, or countries will continue to run behind this deadly epidemic and these ambitious goals will be missed.” While efforts to respond to TB saved more than three million lives in 2015, the report showed that the TB burden is actually higher than previously estimated, reflecting new surveillance and survey data from India. In 2015, there were an estimated 10.4 million new TB cases worldwide. An estimated 1.8 million people died from TB in 2015, of whom 0.4 million were co-infected with HIV. Although global TB deaths fell by 22% between 2000 and 2015, the disease was one of the top 10 causes of death worldwide in 2015, responsible for more deaths than HIV and malaria. Gaps in testing for TB and reporting new cases remain major challenges. Of the estimated 10.4 million new cases, only 6.1
million were detected and officially notified in 2015, leaving a gap of 4.3 million. This gap is due to underreporting of TB cases especially in countries with large unregulated private sectors, and under-diagnosis in countries with major barriers to accessing care. In addition, the rate of reduction in TB cases remained static at 1.5% from 2014 to 2015. This needs to accelerate to 4–5% by 2020 to reach the first milestones of the World Health Assembly-approved ‘End TB Strategy’.
Tackling drug resistance and other challenges
Multi-drug resistant TB remains a public health crisis. WHO estimates that 480,000 people fell ill with multi-drug resistant TB in 2015. Detection and treatment gaps continue to plague the multi-drug resistant TB response. In 2015, only 1in 5 of the people newly eligible for second-line treatment were able to access it. Cure rates continue to remain low globally at 52%. “The dismal progress in the TB response is a tragedy for the millions of people suffering from this disease. To save more lives now, we must get newly recommended rapid tests, drugs and regimens to those who need them. Current actions and investments fall far short of what is needed,” said Dr Mario Raviglione, director of the WHO Global TB Programme. “The world is finally waking up to the threat of antimicrobial resistance – now is the time to accelerate the multi-drug resistant TB response.”
The migration crisis in Europe
Although rare in European countries, the risks posed by the current migrant crisis makes multi-drug resistant TB an important and urgent public health priority. A study recently published in Clinical Microbiology and Infection8
documents that the rate of
infection with multi-drug resistant TB is higher among migrants than in the general population, particularly in those born outside Europe and in those forced to leave their home country as asylum seekers and refugees.
Data reviewed by Hargreaves et al shows that 100% of the multi-drug resistant TB cases diagnosed in Austria, The Netherlands and Norway occurred in migrants to those countries. A high proportion of multi-drug resistant TB cases were also apparent in migrants to other European states – 90% in the UK, 89% in France, 87% in Italy and 94% in Germany.
Migrants are at higher risk of contracting multi-drug resistant TB both in their country of origin, because of the breakdown of their own healthcare system, and after arriving in Europe, because of destitution, homelessness, overcrowding in refugee camps or incarceration. A significant proportion of multi-drug resistant TB cases in migrants result from reactivation of latent infection.
Screening, diagnosis and treatment are available for all forms of TB, including active multi-drug resistant TB. However, this
The widest range of single use suctions.
FEBRUARY 2017
WWW.CLINICALSERVICESJOURNAL.COM I 29
t
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64
