WHO and drug-resistant TB

World Health
Organization’s (WHO) new plan for controlling drug resistant Tuberculosis (TB)


The WHO has presented a new plan for the prevention of and dealing
with multi-drug resistant and extensively drug resistant TB in the WHO’s European
region relating to the period  2011-2015
for discussion at a session of the International Forum, ‘Millennium Development
Goals – 6’.


The plan had been approved by the WHO’s European Regional Committee
on 15 September at a session in Baku.on 15 September. The director of the WHO’s
European regional office, Zhuzhanna Yakab, said that its implementation would
help to forestall 250,000 cases of multi-drug resistant TB and 13,000 cases of
extensively resistant TB; and, also, to identify around 225,000 patients who
are not receptive to anti-TB medicinal preparations, successfully treating at
least 127,000 of these. The WHO estimates that if the spread of drug resistant
TB can be stopped, it will save 120,000 lives and the sum of $12 billion.


The plan envisages the application of the latest diagnostic
techniques and service models designed to take account of the needs and
requirements of actual groups of people. The basic targets to be attained by
the end of 2015 include a decrease in the number of cases of multi-drug
resistant TB amongst patients who had formerly been treated by 20% and also
successful treatment of at least  75% of
the total number of registered patients who are not receptive to anti-TB


The text covers cooperation in developing more effective
preparations, vaccines and diagnostic tests. The special representative of the
regional director dealing with multi-drug resistant TB and extensively drug
resistant TB in the WHO’s European regional office, Hans Klyuge, said that
countries in the region needed to begin by submitting grant applications to the
WHO. The Global Fund for Combating AIDS, TB and Malaria would consider these
and then take a decision about finance. He went on to say: ‘The Global Fund is
prepared to provide financial assistance to governments that for their part
will also increase the level of finance allocated to the resolution of the


The director of the Central Scientific Research Institute into TB,
Vladislav Erokhin, told the ASI correspondent that the situation in Russia
regarding drug resistant TB was really alarming. Recent years had seen an
upswing in the number of cases of multi-drug resistant TB both amongst those
who were first time patients and those who had been treated previously.
115-117,000 patients were diagnosed annually, of whom 13% suffered from
multi-drug resistant TB.


Mr Erokhin said that there were reckoned to be over 30,000 patients
with multi-drug resistance in Russia. If the spread of multi-drug resistant TB
was to be stopped, it was important to have available preparations which could
serve as a second line of defence in its treatment. Furthermore, these should
always be available in institutions dealing with TB since interruptions in
treatment because of the shortage of these or other preparations lowered their
effectiveness. ‘Such preparations should be sourced centrally in both federal
and regional medical institutions’, observed Mr Erokhin. He also stressed the
necessity of finding methods of expediting diagnosis of TB in the laboratory
and establishing the sensitivity of its pathogens to various preparations. ‘The
quicker we establish to which preparations the bacteria involved remain
sensitive, the more effective will be the treatment plans that we formulate.’,
the expert asserted. He predicted that at least two suitable tools for the
purpose should become available within the next three years.


The expert went on to explain that the main reason for the existence
of multi-drug resistant TB was poor organisation of chemotherapy when the
patient was first diagnosed (inappropriate choice of treatment type,
interruptions in administration of therapy, and patient irresponsibility). As a
result strains of TB bacteria were appearing that were resistant to the
preparations that are administered. 
Furthermore, drug resistant bacteria may also be transmitted to other
people resulting in their becoming infected with forms of the disease that are
resistant to preparations.


Mr Erokhin took the view that the main task was to find an effective
way of treating new patients. Therapy for patients suffering from multi-drug
resistant forms of TB lasted longer than usual (up to 24 months) and cost the
government more. He also mentioned that a new Dioskin test had been devised
which in contrast to the Mantoux test allowed it to be determined whether
reaction to a test is consistent with the presence of infection or is simply a
‘vaccination’ allergy.








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