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  • Title: Tuberculosis control and research strategies for the 1990s: memorandum from a WHO meeting.
    Journal: Bull World Health Organ; 1992; 70(1):17-21. PubMed ID: 1568278.
    Abstract:
    Tuberculosis is the largest cause of death from a single infectious agent in the world, killing nearly 3 million people every year. This death toll represents 25% of avoidable adult deaths in developing countries. It imposes a heavy burden on the 8 million new individuals who contract the disease each year, and on their households; morbidity and mortality are concentrated in young adults. The association of tuberculosis and HIV infection will significantly exacerbate the situation in developed and developing countries, making the need for action all the more pressing. Effective control measures are available. Broad action is therefore warranted and should be aimed at introducing the effective strategies on as wide a scale as possible to reach the targets of 70% case detection and 85% cure of smear-positive patients, by the year 2000. Research is needed to implement these strategies throughout the world and to ensure that effective tools will remain available for controlling tuberculosis despite emerging problems such as resistance to the major drugs currently available. To make a real impact on the tuberculosis problem, a focused global programme must be created, under the leadership of WHO, to bring tuberculosis to the world's attention, to mobilize support on a major scale, and to provide direct guidance and support to national programmes. The impact of tuberculosis, the leading cause of death from a single infectious agent in the world, warrants a global control program. Every year, some 8 million people worldwide contract tuberculosis. Some 3 million die from it. It is estimated that 1/4 of all avoidable adult (15-59 years) deaths in the developing world each year are due to tuberculosis, meaning that the diseases represents one of greatest impediments to social and economic development. 2 recent developments have aggravated the tuberculosis problem: 1) the epidemic of HIV infection, which increases the risk that a tuberculosis infection will progress to disease; and 2) the appearance of strains that are resistent the major drugs used for the treatment of tuberculosis (isoniazid and rifampicin). Nonetheless, there currently exist effective tools for controlling tuberculosis, including the BCG vaccine and chemotherapy. Highly cost-effective, a well-managed chemotherapy treatment can cure almost any patient rapidly and render sputum-positive cases noninfectious, thereby reducing the transmission of the infection. Despite the existence of effective and cost-effective treatment methods, most countries have made little progress in combating the disease and the international community has given scant support. Given the magnitude of the problem, a global program for the control of tuberculosis is needed. Such a program should include advocacy, research, and capacity building, and should set as its target goal a 70% detection rate of all new cases and an 85% cure rate by the year 2000. Such a program would cost approximately $200 million a year, but would represent one of the most advantageous health investments possible.
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