Israel, Kazakhstan lead in drug-resistant tuberculosis cases

Israel and Kazakhstan share first place in a list of countries where the germ that causes tuberculosis has developed strains that are resistant to drugs, according to a special report published yesterday by the World Health Organization (WHO).

According to the report, the chances that a person suffering from tuberculosis in an Eastern European or Central Asian country is 10 times more likely to develop resistance to drugs than in the rest of the world. The authors of the report suggest that the reason for this is that diseases develop drug-resistant strains in cases where patient supervision is poor and where there is a large proportion of migration between those countries where drug-resistant tuberculosis is common.

The WHO collated data from 67,657 TB patients in 77 countries and regions between 2000 and 2002. According to the findings, six of the 10 countries in which TB is most likely to be drug-resistant are in eastern Europe: Estonia, Latvia, Lithuania, Uzbekistan and parts of the Russian Federation. Some 14 percent of TB cases in these countries develop strains that are resistant to drugs. Other countries where there was a significant percentage of drug-resistant TB cases were China, Ecuador and South Africa. But topping the list were Israel and Kazakhstan, each with 14.2 percent of TB cases showing signs of resistance to drugs in 2001. In the Israeli case, 36 of the 253 patients tested showed signs of resistance.

The WHO estimates there are 300,000 new cases per year of multiple-drug-resistant TB around the world. WHO defines multiple-drug-resistant TB (MDR-TB) as any strain of the disease which is not affected by two or more of the main drugs usually used to treat it: isoniazid and rifampicin. Close to 80 percent of all the cases of MDR-TB cases are now considered a superstrain, resistant to three or four drugs.

Tuberculosis is primarily a disease of the respiratory system, and is spread by coughing and sneezing. Each year 2 million people die from this curable disease.

According to WHO, curing `normal' TB is cheap and effective: a six month course of medicines costs $10. Treating drug-resistant TB is a hundred times more expensive, however, and even then a cure is not guaranteed.

"Tuberculosis remains a major public health problem globally," Dr Paul Nunn, of the WHO, told a news conference yesterday.

"The response to this situation has to be global," Dr Mario Raviglione, director of WHO's Stop TB Department, said at the launch of the report.

"It is in the interest of every country to support rapid scale-up of TB control if we are to overcome MDR-TB. Passport control will not halt drug resistance; investment in global TB prevention will," he added.

The head of the Health Ministry's TB and AIDS unit, Dr. Zohar Mor, said yesterday that there had been a consistent drop in the number of new TB patients in Israel who went on to develop MDR-TB.

According to Dr. Mor, most of the cases of MDR-TB in Israel are "imported" from Eastern Europe. "We take every care to ensure that people who contract TB take their medicine," Mor told Haaretz yesterday. "For those suffering from MDR-TB, we are even more diligent."