Treatment for multidrug resistant TB fails in a quarter of cases in Europe, says WHO

The World Health Organization’s Europe regional office has launched an action plan to contain the spread of drug resistant tuberculosis, with the aim to achieve universal access to prevention, diagnosis, and treatment in all European member states by 2015.

WHO says that in western Europe treatment fails in 23% of patients, 26% are lost to follow-up, 19% die, and only 32% are successfully treated.

Zsuzsanna Jakab, WHO’s regional director for Europe, said that the region has the world’s highest rate of multidrug resistant tuberculosis, which, she said, “speaks of the failure of health systems to treat TB effectively.”

She said, “TB is an old disease that never went away, and now it is evolving with a vengeance. We have to find new weapons to fight it.”

Although people infected with HIV, migrants, prisoners, and other vulnerable groups are most at risk, Ms Jakab said, “TB can infect anyone.” Despite the availability of new diagnostic techniques, “only one third of estimated MDR-TB [multidrug resistant tuberculosis] cases are diagnosed,” she said, and only two thirds of those people are reported as receiving adequate treatment.

“Our region has the lowest treatment success rate of pulmonary TB patients, and this contributes to the further spread of MDR-TB. We cannot let this continue,” she said.

The new plan calls for “expanding country capacity” to scale up the management of drug resistant TB, with “patient centred models of care and tailored services for specific populations such as migrants, drug addicts, or prisoners” and “collaboration on more effective drugs, vaccines, and testing.”

If fully implemented, the plan envisages “the prevention of the emergence of 250 000 new MDR-TB patients and 13 000 XDR-TB [extensively drug resistant] patients, the diagnosis of an estimated 225 000 MDR-TB patients and successful treatment of at least 127 000 of them.”

WHO says that in countries outside western Europe “diagnostic and susceptibility test services are extremely limited” and so cannot reflect the whole picture, but the officially reported number of cases of extensively drug resistant TB rose “more than sixfold between 2008 and 2009” in eastern Europe and the countries of the former Soviet Union.

However, it warns that tuberculosis “also affects western Europe.” London has the highest incidence of any capital city in western Europe: nearly 3500 cases a year, a rise of about 30% in the past 10 years. The incidence of multidrug resistant TB in London doubled from 2005 to 2009.

Ibrahim Abubakar of the UK Health Protection Agency told the BMJ that “drug resistance is definitely an issue of concern for the UK.” The latest data, for 2009, showed 58 cases of multidrug resistant disease, twice the 28 cases in 2000.

Treating patients with multidrug resistant TB takes up to two years, using second line drugs or surgery, making it particularly difficult to treat patients in the “hard to reach” groups that include the people most at risk in more developed countries.

“Because some patients’ circumstances do not facilitate treatment,” WHO says, the success rate among patients with multidrug resistant TB in some western European countries “is under half that of countries in eastern Europe and central Asia.”

WHO says that only 32% are successfully treated in western Europe, while the success rate in eastern Europe and central Asia is estimated to be 65%.

Hans Kluge, WHO Europe’s representative on drug resistant tuberculosis, said, “This problem is a man-made phenomenon resulting from inadequate treatment or poor airborne infection control, and we need wide involvement to tackle the damage that humankind has done.”