TB Monitor International-Iran joins list of multidrug-resistant TB hot spots
'This report shows that our worst fears about MDR-TB are being confirmed'
Iran has joined a growing list of new countries where multidrug-resistant TB accounts for more than 5% of incident cases, according to the World Health Organization, which released its new report on MDR-TB "hot spots" on March 24 to mark World TB Day.
Not as surprising, other hot spots were expected to include Latvia, Delhi state in India, Estonia, Henan province in China, the Dominican Repub lic, Argentina, Ivanova oblast in the Russian Federation, and Cote D'Ivoire.
The report marks the second time WHO has surveyed global drug resistance. The first report, published in 1997, looked at incident rates in 35 countries and thus provided only a snapshot in time. The new report returns to the same 35 and surveys an additional 30 countries. More importantly, it shows trends and changes since 1997.
"Basically, this report shows that our worst fears about MDR-TB are being confirmed," says Kraig Klaudt, spokesman for WHO's Communicable Diseases Cluster. "The drug resistance we've seen in New York City, in Russia, and in Eastern Europe is emerging elsewhere in the world." The good news, Klaudt adds, is that wherever directly observed therapy, short-course (DOTS) is being used, "MDR-TB is being prevented" — though not, some might add, as efficiently as WHO presumably would like. Peru, for example, with an exemplary DOTS program, still has an annual incidence of 11.9 cases per 100,000.
To galvanize more political will around increasing DOTS coverage, WHO convened a ministerial conference March 22-24 in Amsterdam. At the conference, ministers of finance rubbed shoulders and talked about TB incidence rates with ministers of health, thereby illustrating the conference theme that TB afflicts national economic well-being in addition to public health.
The invited ministers represented 18 of 20 "high-burden" countries in the world. Though World Bank president James Wolfensohn disappointed conference sponsors by deciding not to attend the event as originally planned, high-level politicos were still in good supply. U.S. Secretary of Health and Human Services Donna Shalala was expected to join vice-premiers from China, Vietnam, and Ethiopia, among others. Their appearances show "people are starting to take the threat of TB very, very seriously," Klaudt says.
The assembly was expected to draft a declaration of intent, in which they vowed to expand implementation of DOTS and to work to meet DOTS targets within the next five years.
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