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Researchers Warn of TB Epidemic

Updated:
CHICAGO (AP) — A small but alarming percentage of people worldwide have a form of tuberculosis that is resistant to the usual treatments and must be fought with stronger, more expensive drugs to prevent a health crisis comparable to AIDS, World Health Organization researchers say.

``If we don't encourage countries to do a good treatment of TB, then we will have an epidemic on our hands,'' said Dr. Marcos Espinal, who led a study published in Wednesday's Journal of the American Medical Association.

TB is a contagious respiratory disease that kills an estimated 2 million people a year. If treated correctly, most cases are curable.

The study examined 6,402 TB cases at clinics in Russia, Peru, China, South Korea and the Dominican Republic between 1994 and 1996 and found that about 5.5 percent did not respond to so-called first-line drugs.

Drugs that could effectively treat these patients are much more expensive and have to be taken for up to two years — potential barriers in some poor, developing countries.

But failing to treat these patients could have catastrophic results, particularly since TB tends to mutate into even more resistant strains when treated incorrectly, said Espinal, a doctor with WHO's communicable diseases program in Switzerland.

If more countries do not correctly treat TB, the organization estimates that nearly 1 billion people will be newly infected — and 35 million will die — in the next two decades.

In the United States from 1993 through 1998, 45 states and the District of Columbia reported at least one case each of multi-drug-resistant TB, according to the Centers for Disease Control and Prevention.

While TB more commonly afflicts people in poorer, developing countries, Espinal warned that because it is an airborne disease, ``TB can be in eight hours from Russia to New York.''

Another researcher agreed with Espinal's prognosis and called drug-resistant TB a ``public health emergency.''

``The genie of multi-drug-resistant TB is irreversibly out of the bottle,'' Dr. C. Robert Horsburgh of Boston University's Schools of Public Health and Medicine wrote in an accompanying editorial.

Espinal said 119 of the 212 WHO member countries, including the United States, have implemented or agreed to implement the organization's TB-fighting plan, which calls for treatment with the first-line drugs. Twenty-two countries representing 85 percent of all TB cases — including China, India, Brazil and Nigeria — have agreed to take part.

WHO is also calling for an expansion of the TB-fighting plan using treatments that are at least 350 more times more expensive than first-line drugs such as isoniazid and rifampicin, which cost $20 to $30.

Already, India's health secretary has said that with an annual 2 million new cases in India alone, his government cannot keep pace with the costs, estimated at $55 million this year.

WHO estimates that 16 million people worldwide have tuberculosis, and rates of infection are on the rise. WHO officials estimate there were 8 million new cases of TB in 1997 alone. The United States had 18,361 reported cases in 1998, according to the CDC.

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On the Net: World Health Organization: http://www.who.int/health-topics/tb.htm
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