The good news is that COVID-19 is no longer the world’s biggest infectious killer, with the rate of deaths internationally down to under 2,500 a day, as of October 24th. The bad news is that according to experts, tuberculosis, which had never gone away, has regained its place as the biggest infectious cause of human death.
Speaking to news agency AFP, Mel Spigelman, president of the charity TB Alliance, said that the development of vaccines, tests and treatments for COVID-19 had effectively “reined it in”. But he raised the question of why similar efforts have not been put into fighting lung disease tuberculosis, which had before and now has again “the dubious distinction [of being the world’s biggest infectious killer].”
Spigelman pointed out that the comparison between COVID-19 and TB is pretty stark. Tuberculosis deaths have grown since 2020, and it now kills 1.5 million people worldwide every year, working out at 4,109 a day. He puts this down partly to the COVID-19 pandemic hampering efforts to treat tuberculosis, with TB hospitals taken over for COVID care. Spigelman said, ”We went from what I honestly consider to be unbelievably slow progress, but at least progress, to a reversal. It has been a major setback.”
WHO
Warnings about a resurgence in TB go back to October 2021, when the World Health Organisation (WHO) reported that the COVID-19 pandemic had severely impacted the progress made in fighting the TB pandemic, estimating that in 2020, more than 40 percent of the estimated 9.9 million people who fell ill from TB were neither diagnosed nor treated.
Part of the problem is that active TB must be treated with a combination of up to four drugs, over a period of four months, so it can be difficult to keep treatment routines going when services are disrupted. Now the WHO estimates that 1.5 million people died of TB in 2020, and this could be a low estimate due to difficulties gathering data.
A further complication is that drug-resistant TB can develops when the long, complex, decades-old TB drug regimen is improperly administered, or when people contract TB from others who have the drug-resistant disease.
Burden
In 2020, the 30 highest TB burden countries accounted for 86% of new cases. Eight countries account for two thirds of the total, with India leading the count, followed by China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa.
Globally, TB incidence had been falling at about 2% per year, and between 2015 and 2020 the cumulative reduction was 11%. This was over half way to the End TB Strategy milestone of 20% reduction between 2015 and 2020. An estimated 66 million lives were saved through TB diagnosis and treatment between 2000 and 2020. But the WHO says that there was an 8.7% decline in spending on TB between 2019 and 2020 (from US$ 5.8 billion to US$ 5.3 billion), with TB funding in 2020 back to the level of 2016.
Ending the TB epidemic by 2030 is among the health targets of the United Nations Sustainable Development Goals (SDGs). The condition is both curable and preventable; it’s caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs, and is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.
About a quarter of the world’s population has a TB infection, which means people have been infected by TB bacteria but are not (yet) ill with the disease and cannot (yet) transmit it.
People infected with TB bacteria have a 5–10% lifetime risk of falling ill with TB. Those with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a higher risk of falling ill.
When a person develops active TB disease, the symptoms (such as cough, fever, night sweats, or weight loss) may be mild for many months. This can lead to delays in seeking care, and results in transmission of the bacteria to others. People with active TB can infect 5–15 other people through close contact over the course of a year. Without proper treatment, 45% of HIV-negative people with TB on average and nearly all HIV-positive people with TB will die.
Trend
The WHO says that US$ 13 billion is needed annually for TB prevention, diagnosis, treatment and care to achieve global targets agreed on at UN high level-TB meetings.
In England, in 2020, 4,125 people were notified with TB, with a rate of 7.3 per 100,000 population. People born outside of the UK accounted for 72.8% of 2020 notifications. This rate was a 13.1% decline compared to 2019, and remains below the 10 per 100,000 WHO definition of a low incidence country, but in March 2022, the UK Health Security Agency (UKHSA) called on the public and healthcare professionals to help reverse an upward trend in TB cases.
Dr Jenny Harries, the CEO of UKHSA, said: “Tuberculosis develops slowly, and it may take several weeks, months or even years after you were infected before you notice you’re unwell. Contact your GP if you think you could be at risk so you can get tested and treated.”
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