Report Details Small Declines in TB, Calls for More Intensive Efforts

Health officials are calling for more intensive efforts to find, cure and prevent tuberculosis amid reports of slight declines in cases and deaths that are insufficient to meet global goals.

The number of new cases of tuberculosis (TB) and deaths from the disease fell by 2% and 5%, respectively in 2018, but more needs to be done to reach global goals.

Progress toward the End Tuberculosis Strategy global initiative were detailed in a recent Morbidity and Mortality Weekly Report from the US Centers for Disease Control and Prevention (CDC). It looked at data from 194 World Health Organization (WHO) member states, including overall incidence and mortality, TB among patients with HIV, TB-preventive treatment initiation, and drug-resistant TB.

“Although the annual numbers of new cases of tuberculosis (TB) and deaths from TB declined in 2018 compared to 2017, at the current rate of progress, it is unlikely that the 2035 global End TB targets will be met,” Adam MacNeil, PhD, MPH, epidemiologist in the CDC’s Division of Global HIV and TB, told Contagion®. “Initiatives to find missing TB cases; implement TB-preventive treatment (TPT) among all eligible people; provide effective treatment; support strong TB disease surveillance, laboratory and data systems; and invest in research gaps need to be accelerated and intensified. A comprehensive approach that integrates efforts to find, cure, and prevent all cases of TB is needed to meet global targets and end the public health threat of TB.”

The WHO initiative calls for the incidence of TB to decrease by 90% and deaths to decrease 95% by 2035 compared with 2015 levels. There were 10 million incident TB cases, including 862,000 patients with HIV, and 1.5 million TB deaths in 2018, according to the report. Multidrug-resistant TB was present in 3.4% of new cases and 18% of those previously treated. TPT was initiated in 1.8 million people.

Tuberculosis is the leading cause of death from a single infectious disease. The high risk of mortality for patients with HIV who are also carrying Mycobacterium tuberculosis was highlighted in a recent study that noted TB is often undiagnosed in patients with HIV.

“While the number of people living with HIV who were started on TPT nearly doubled from 2017 to 2018, the implementation of TPT among all eligible populations remains suboptimal despite strong scientific evidence and World Health Organization (WHO) guidelines,” MacNeil told Contagion®.

The most common TPT is regimen is 6 months or more of daily isoniazid, and recommendations call for TPT for all people with HIV and all household contacts of patients with confirmed pulmonary TB disease.

“Individuals at high risk for developing TB disease — which includes people living with HIV and household contacts of TB cases, especially children – can benefit greatly from TPT,” MacNeil told Contagion®. “Without implementing intensive TB screening among household contacts and other high risk-populations and providing TPT, it will be impossible to bend or break the curve of the TB epidemic. Implementing TPT at scale will help stop the onset of TB disease, prevent TB transmission, end suffering, and save lives. Additionally, individuals with multi-drug resistant TB can now benefit from treatment with all oral drug regimens, as described in WHO recommendations.”

The need to urgently accelerate the response to TB was highlighted during World Tuberculosis Day on March 24th. In 2018, southeast Asia had the highest percentage of TB cases, accounting for 44% of all TB cases. Africa also had a high incidence of TB, including 71% of all people infected with both HIV and TB. Europe saw the biggest decline in TB (15% since 2015) but the highest proportion of multi-drug resistant TB (30%).

“Strong and quality TB screening among populations at highest risk, as a part of active TB case-finding activities, supplemented with TPT for those at risk but with no TB disease, should be embraced as a more comprehensive and effective approach to end TB in our lifetime,” MacNeil told Contagion®. “Public health partners should continue efforts to find, treat, and prevent TB among all individuals affected by or at risk for TB. Investments and development efforts to create additional and improved preventive and treatment regimens and vaccines should continue."