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Spread of Resistance: Global Emergency

The Word Health Organization (WHO) reported two million deaths and a global emergency in 1993 resulting from the spread of TB. Of the eight million patients who contracted the disease annually, 95% were in developing countries (Asia, Africa, Latin America), where the threat continues to increase. Attributed to poverty and slum-living conditions, TB is exacerbated by poor economic conditions. Despite the availability of vaccines (for limited groups) and antimicrobial therapy, the cost is prohibitive for the patients in these developing regions. In 1991, in an effort to curb the spreading pandemic, the WHO instituted the Direct-Observed Treatment Short Course (DOTS), the first solution to treating non-compliance by monitoring patients' adherence to drug therapy. Staffing was increased to implement DOTS, but many of the patients (homeless, IV drug abusers) were already living in a situation primed to precipitate further drug resistance that was difficult to access.
Emergence of extensively drug-resistant tuberculosis (XDR-TB)
By 2006, a threat greater than multidrug-resistant tuberculosis (MDR-TB) appeared, known as XDR-TB, which is untreatable by both first- and some second-line anti-tuberculosis drugs. The organism first appeared in India, then Africa in 2007, and later was confirmed by laboratories to include 48 countries, where 20% of the cases were MDR-TB and 10% were XDR-TB.
Control measures
As a result of the advancing statistics, global health efforts by the WHO were again activated to set targets for eradicating all strains of TB by enhancing every available measure:
  • Increased DOTS, with focus on HIV/AIDS patients with MDR- or XDR-TB (most effective measure)
  • Development of new vaccines and new molecular diagnostic methods
  • Patient advocacy, communication, and social mobilization
The effort continued with much success in developed countries. However, less fortunate developing countries continued to suffer the scourge of this ancient, unrelenting disease. In 2007, the cost of treatment for antibiotic susceptible cases in India was not unreasonable ($10 for six months), but the cost to treat resistant cases ($2,000 for two years) was markedly prohibitive.