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Is Tuberculosis Still a Threat?

Tuberculosis (TB) is a terrible and cruel disease that leaves its victims wasting away, coughing blood and at risk of infecting carers and loved ones. A few years ago, it looked like mankind was about to conquer TB once and for all – yet it is making a deadly comeback. One in three people in the world are infected with dormant TB germs and these can be made active in a variety of ways when a person’s immunity is reduced, by ageing, by contracting HIV or some other medical conditions.

This is made more serious by the resistance the germs now have to drugs, assisted by the extensive use of antibiotics around the world. This new form of Extremely Drug Resistant Tuberculosis (XDR-TB) is now emerging around ASEAN, with the announcement yesterday that 17 cases of the disease have been found in Thailand among a total of 15,000 cases nationwide. No more than 30% of patients with XDR-TB can be cured, and the proportion may be lower in cases when the disease is resistant to multiple drugs and depending on the overall state of the patient’s health.

The World Health Organisation (WHO) lists 22 high burden countries in terms of TB, with six ASEAN countries among them: Cambodia, Indonesia, Myanmar, Philippines, Thailand and Vietnam. In Cambodia, success has been achieved in implementing the WHO’s global anti-TB strategy (DOTS) in many local health centres but the government suffers from the lack of skilled workers and technical capacity. The country is also facing increasing prevalence of HIV/AIDS and its related impact on TB. Indonesia ranks third in the list of most at risk countries and, although progress has been made there too, there is still a shortfall in extending detection and treatment throughout the whole of the far-flung archipelago. In Vietnam, which is portrayed as a model of DOTS implementation in Asia, incidence rates continue to rise, driven by the increased rates of infection among young men. Even the recalcitrant government of Myanmar has co-operated with the WHO, although there remain some shortfalls in providing funding and there remain problems with patients dropping out of medical care. The data from both Thailand and the Philippines indicate persistently high incidence rates, notwithstanding compliance with DOTS to a reasonably high level.

In the last year for which figures are available, 80% of the total of 9 million new cases of TB lived either in Sub-Saharan Africa or in Asia. TB killed 2 million people in that year and infections continue to rise. In the 22 high burden countries, the cost of fighting TB is rising to US $2 billion, which is clearly far beyond the ability of many of the poorer ASEAN governments to meet. This leads to a shortfall which is being met by international organisations. It will be important to ensure that spending is maintained in future years as much as is possible. Employers may wish to consider the impact of disease upon their workforce and the implications the XDR-TB has on international labour migration.

More details on XDR-TB may be found at the website of the World Health Organisation:

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