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Updated at 5:56 a.m., Thursday, March 22, 2007

Rate of new tuberculosis cases leveling off worldwide

By Bill Varner and John Lauerman
Bloomberg News

The rate of new tuberculosis cases has leveled off for the first time since the lethal disease was declared a global health emergency by the World Health Organization in 1993.

New diagnoses for every 100,000 people decreased to 1.35 in 2005, from 1.36 in 2004, the WHO, a Geneva-based arm of the United Nations, said today in a statement. There were 8.8 million TB cases in 2005, when the disease killed 1.6 million people, an average of 4,400 a day, the agency said.

Hawaii historically has had a higher than normal tuberculosis infection rate attributed primarily to people who emmigrate here from Southeast Asia and elsewhere.

The malady, after having seemed defeated, began resurging about 15 years ago, largely in concert with HIV, the virus that causes AIDS. Now countries such as China, Russia and India need to improve tuberculosis treatment to keep slowing the growth of new cases worldwide, the WHO said.

"We are currently seeing both the fruits of global action to control TB and the lethal nature of the disease's ongoing burden," UN Secretary-General Ban Ki-moon said in the statement. Almost 60 percent of TB cases worldwide are now detected, and "the vast majority" of those are cured, the official said.

The disease probably stayed at the 2005 level last year, for which figures haven't been compiled yet, the WHO said. The U.S. Centers for Disease Control and Prevention is expected to release national TB statistics later today.

Progress against the disease isn't guaranteed, for incomplete treatment of some cases threatens to breed more deadly strains that can overcome the effects of available drugs, said Paul Nunn, head of the WHO's Stop TB program, in an interview yesterday.

About 10 percent of tuberculosis infections can overcome the effects of doctors' first choices for drugs, raising treatment costs by as much as 50 times, Nunn said. An expansion of those drug-resistant cases would quickly erase the gains among new patients, he said.

`On the Cheap'

"We've been thinking and saying that we can check TB on he cheap," he said yesterday in a telephone interview. "But when we do it on the cheap, drug resistance is not addressed."

The WHO said 26 million patients have received effective TB treatments because of $2 billion in funding each year. An additional $1.1 billion is needed this year, and $56 billion during the next decade to meet the UN's goal of cutting the number of TB cases in half by 2015.

North America, South America, Southeast Asia and the Western Pacific are set to reach the UN target, while Africa, the Eastern Mediterranean and Europe are lagging behind, the WHO said.

Some 1.6 million people died from TB in 2005, the WHO reported. While new cases slowed, the number of people sick with the disease probably crept up worldwide, the agency said.

About one in three individuals on Earth is infected with tuberculosis, Nunn said; that's about two billion people.

Risk Factor

"The only risk factor for getting infected is to breathe the same air supply as someone who's infected," said Carl Nathan, the head of the microbiology and immunology department at Cornell University's Weill Medical College in New York, in a telephone interview on March 20. "Perfectly healthy people following proper social behaviors in their society are just as much at risk as someone else."

Countries such as South Africa are experiencing surges in drug-resistant TB because of high rates of HIV infection, Nunn said. More than 600 South Africans have a particularly hardy form of the germ called extensively drug-resistant, or XDR, TB. That form can cost as much as $10,000 to treat. About 4 percent of people with drug-resistant TB in the U.S. have the XDR strain.

Call for Funds

The WHO called last month for donor countries and organizations to provide $650 million to help clinics in poorer nations detect and treat drug-resistant TB. China has about 140,000 cases of drug-resistant TB annually, while India has about 80,000 cases and Russia 40,000, Nunn said.

Indonesia has cut the prevalence of tuberculosis by about 16 percent in seven years by improving access to medicines, the nation's Ministry of Health said yesterday.

The number of Indonesians who tested positive for the bacterium that causes the disease fell to 107 per 100,000 in 2005, from a rate of 128.7 in 1998, the ministry said.

Only China and India have more TB patients than Indonesia, according to estimates by the WHO.