World Tuberculosis Day
“We are far from controlling the epidemic”
For World Tuberculosis Day, Dr Emilie Catherinot, pulmonologist at both Necker and Foch hospitals, takes stock of the tuberculosis epidemic for the Fondation Chirac.
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In which regions do the most number of tuberculosis cases appear?
Dr Catherinot: Sub-Saharan Africa and Asia. In terms of number of patients, India and China are the hardest hit but in terms of number of cases per inhabitant, sub-Saharan Africa suffers the most from the epidemic with over 100 cases per 100 000 inhabitants per year (as opposed to 10 per year and per 1000 000 inhabitants in Europe). Today, the former republics of the Soviet Union are seeing a rise in cases. We are therefore far from controlling the disease despite progress achieved through programs run by the World Health Organization (WHO).
According to the latest WHO report on the fight against tuberculosis, Goal 6 (controlling tuberculosis by 2015) of the Millennium Development, Target 8 (bettering world health), will only be partially attained. Why is the epidemic still so virulent?
Dr Catherinot: It is a highly contagious disease. Each case left untreated leads to secondary cases; this is why the epidemic is so virulent. Furthermore, cases of multi-resistant strains of tuberculosis are on the rise and drugs created 50 years ago are today ineffective.
Therefore, the epidemic is growing due to lack of research funding rather than limited access to medication?
Dr Catherinot: Only one molecule has been discovered in the past few years, a molecule of the diarylquinoline family. It could be very promising but there is still much to do before putting it on the market. This problem is compounded with the lack of treatment in countries with high rates of HIV infection, where patients suffer from severely repressed immunity. HIV and tuberculosis create a vicious circle. From now on, fighting tuberculosis also means fighting HIV*.
Will the economic crisis curtail progress that has already been achieved?
Dr Catherinot: It is clear that countries suffering from poor social and economic conditions have less means to prevent transmission. The crisis will probably restrict prevention efforts even more.
According to the 2009 WHO report, 37% of new tuberculosis cases were not treated by the DOTS programs, and up to 96% of new multi-resistant tuberculosis cases were not diagnosed and treated according to international recommendations.
Indeed, if you take North Africa for example, the countries there are capable of intervening before the disease becomes infectious. In sub-Saharan Africa on the other had, there is no treatment until after the disease becomes contagious. The result is that in certain countries such as South Africa or Mozambique, over 20% of the population in infected.
On top of it all, there is also the problem of access to quality drugs, a cause to which the Fondation Chirac is highly committed. Tuberculosis is treated with antibiotics. If they are counterfeit or improperly dosed, they are ineffectual.
Dr Catherinot: This is exactly why even if the tuberculosis epidemic is controlled and even stamped out in some parts of the world, it is a disease that still today poses a major health threat.
