DRUG-RESISTANT TB JUMPS IN GERMANY, DENMARK, NEW ZEALAND|
By JOHN DONNELLY|

 WASHINGTON — Deadly drug-resistant tuberculosis, a highly infectious disease, is spreading more rapidly from poor nations to rich ones, raising a new health concern for the Western world, researchers say.  The infection rate, though still low, jumped 50 percent in one year in Germany and Denmark, and it doubled in New Zealand, according to a report being released Friday in Amsterdam by the World Health Organization and the International Union Against TB & Lung Disease.  ‘‘It’s a warning to the developed world,’’ said Nils Daulaire, president of Global Health Council, an alliance of global health-care advocates. ‘‘There are hot spots nowdeveloping and if we don’t deal with it immediately, it’s only going to get much worse.’’  While drug-resistant tuberculosis has taken root in many of the world’s poorest countries, global health experts believe the fight against TB will not fully begin until it spreads to the wealthiest countries — and those nations see it as a national security threat, and begin spending billions of dollars to defeat it everywhere.  Tuberculosis, which spreads through the air when an infected person coughs, sneezes or spits, kills about 1.5 million people a year, 98 percent of them in developing countries. The Mycobacertium tuberculosis bug develops immunities to the most common drugs if the treatment isn’t completed or is improperly administered.  But even as reports in recent years circulated about frightening epidemics of drug-resistant TB in Russian prisons and slums in every continent, no one knew the rate at which the infectious disease was growing, or whether treatment was helping.  For the first time, the 117-page report establishes the beginnings of a baseline of information about the drug-resistant TB bug, comparing data from 1994 to 1999, and it showed that proper treatment had slowed the spread of drug-resistant TB.
 Yet, several areas reported alarming increases in drug-resistant TB, including Estonia; the Henan and Zhejiang provinces of China; the Tamil Nadu region in India; Iran; Mozambique; and Russia. Other countries reporting that drug-resistant TB accounts for more than 6 percent of all TB cases were Israel, Italy and Mexico.  The United States has reported only a handful of cases, and almost all of them are transmitted by foreign travelers, officials said. The numbers of cases in wealthy countries still remains relatively small — Germany has about 100 people infected with drug-resistant TB — but only a few years ago there were no cases.  WHO’s recommendation will be to increase by threefold a program treating people with easily curable TB. The program is called directly observed treatment, or DOTS. The organization also supports several pilot projects to treat those with drug-resistant TB.  

Only a few years ago, the WHO said in a report that those who contract drug-resistant TB in poor countries would almost surely die because of the high cost of drugs.  In response, a Cambridge, Mass. group called Partners in Health started a project in Lima, Peru, in which it cured more than 100 people in the Carabayllo slum who had drug-resistant TB. The cost per patient then was up to $10,000. Now, according to Jim Yong Kim, the group’s executive director, the price of the drugs should drop to about $500 per patient as a result of negotiations with the pharmaceutical industry — and WHO’s reversal to a position that poor people with the illness could be cured, which created a market for the drugs.  Kim, in a telephone interview from Amsterdam, where he is attending a TB conference, applauded the WHO report, saying it ‘‘marks a real change in its policy’’ that DOTS alone cannot solve the TB epidemic.  Tuberculosis is dormant in most people, activated almost always when a person’s immune system weakens. TB kills large numbers of people with HIV even in countries such as Botswana that have good anti-TB programs.

NYT-03-23-00 2008EST