Multidrug and extensively drug-resistant TB (M/XDR-TB): problems and solutions

Area of Science:

• Public Health
• Infectious Diseases
• Epidemiology

Background:

• Multi Drug Resistant Tuberculosis (MDR-TB) and Extensively Drug Resistant Tuberculosis (XDR-TB) represent significant challenges to global tuberculosis control efforts.
• Global surveillance data since 1994 indicate a concerning prevalence of drug-resistant TB strains, with an estimated 489,139 MDR-TB cases emerging in 2006, disproportionately affecting China and India.

Purpose of the Study:

• To analyze the global trends and burden of MDR-TB and XDR-TB based on WHO-IUATLD surveillance data.
• To highlight the man-made nature of M/XDR-TB and emphasize preventive strategies.
• To underscore the importance of strengthening laboratory services and programmatic management for M/XDR-TB control.

Main Methods:

• Analysis of data from multiple WHO-IUATLD global drug resistance surveillance rounds conducted between 1994 and 2007.
• Estimation of MDR-TB prevalence in countries without survey data.
• Inclusion of data on XDR-TB from 35 countries and two SARs in 2006.

Main Results:

• The global burden of MDR-TB is substantial, with an estimated 440,000 incident cases in 2008, leading to approximately 150,000 deaths.
• XDR-TB is present in 5.4% of MDR-TB cases, with confirmed cases reported in 58 countries to date.
• MDR-TB and XDR-TB are preventable through prompt diagnosis and appropriate use of first-line and second-line anti-TB drugs.

Conclusions:

• M/XDR-TB is a preventable public health crisis requiring urgent global attention and intervention.
• Strengthening laboratory diagnostic capacity and scaling up programmatic management are essential for controlling M/XDR-TB.
• Effective infection control measures and research into new diagnostics, drugs, and vaccines are vital for combating M/XDR-TB.