MDR-TB: Just As Lethal as Ebola
By Sandy K. Johnson

Quick, name this disease. It’s easily spread, kills half its victims and afflicts thousands. Not Ebola. Drug-resistant tuberculosis.

Dr. Ignacio Monedero, a TB consultant for the International Union Against Tuberculosis and Lung Disease, used the analogy of a lunar eclipse to compare Ebola and MDR-TB.

“There is something that is eclipsing my patients. It is Ebola. With this outbreak, funding for MDR-TB is now going to Ebola. Ebola is killing 5,000 people in Africa, and it’s really painful. But more than 300,000 Africans are dying because of TB. Please do not lose perspective,” he said.

When TB patients stop taking medicine, the TB in the body develops resistance to the drugs themselves. Those germs continue to multiply and the patient can continue to spread the disease through the air – but now he or she is spreading drug-resistant TB. When that happens it is called MDR-TB – Multi-Drug-Resistant TB.

“MDR-TB is out of control,” Monedero said, during the National Press Foundation’s J2J lung health training for journalists. “No one really cares about this massive disease.”

In 2013, 480,000 people developed MDR-TB. About a third of those are in three nations: 62,000 in India; 54,000 in China; and 41,000 in Russia.

The drug regimen is costly ($9,235 in low-income countries, according to WHO), must be taken daily for 24 months and has persistent side effects, such as nausea and vomiting and even hearing loss.

The cure rate for MDR-TB is 50 percent – which just happens to be the same as Ebola, although the numbers are significantly higher for MDR-TB than Ebola.

“What is going on? Something that should be curable is not getting cured,” Monedero said.

Even the availability of physicians to treat TB is not a guarantee of success. Monedero said even experienced doctors might not get the drug regimen right. “Whenever you are not trained, you are prone to errors.” As a result, patients “are not cured but they are not dead. They are able to transmit the disease to others. Bad treatment is worse than no treatment at all. Do you think we are doing a good job with a 50 percent cure rate? No.”

There are new drugs becoming available, most notably Bedaquiline and Delamanid. These drugs are cheaper and may shrink the treatment period to as little as nine months, in combination with older drugs.

While TB itself is on a slow decline, the drug-resistant strains are on the rise.

 “Every person with MDR-TB that is undiagnosed and not put onto treatment will infect up to 15 people every year,” said Dr. Lucica Ditiu, executive secretary of STOP TB Partnership.

“I will dare to say that the world will pay the price sooner or later on MDR-TB. Just to give an example, in South Africa alone there are 5,000 (people with) TB dying a month.”

Thinking outside the box can be effective. Eli Lilly shared its expertise and technology about two medicines – capreomycin and cycloserine – with seven manufacturers in order to ensure a large supply as MDR-TB multiplied. Over the last decade, Lilly’s technology transfer helped make the two antibiotics available in MDR-TB hotspots like China, India, Russia and South Africa.

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