While most college students spent the past weekend hanging out with their friends, catching up on some homework, or brooding over the fact that the warm Boston weather was short-lived, much of the rest of the world, especially those in the international health field, was commemorating World Tuberculosis Day 2012. The World Health Organization sponsored the first World TB Day, after Dr Robert Koch announced the discovery of Mycobacterium tuberculosis, the bacteria that cause tuberculosis (TB) in 1882. While World TB Day will not be a celebration until TB is fully controlled, it is a good opportunity to spread awareness to the public and thus take one step closer to stopping the spread of this devastating disease. According to the The Global Fund, “Since 2006 the total number of TB cases worldwide has been falling. Calculated from a 1990 baseline, global TB mortality rates have fallen by a third by 2010.” While TB is mostly known as a disease associated with poverty and developing countries, people might be shocked to know that TB is still be rampant in parts of the developed world.
Drug-resistant “White Plague” Lurks Among Rich and Poor, written by Kate Kelland, opens with a story about Anna Watterson who had just been diagnosed with TB. She had been losing weight, suffering from fevers, night sweats, and shortness of breath and was finally diagnosed with multi-drug resistant TB (MDR-TB) after the regular TB treatment showed no effect. But the here’s the catch: Anna Watterson lives in London. In the western world, TB is known as a disease of bygone eras, but what is scary is that the disease is still lurking – and drug-resistant TB is rising rapidly. According to Kelland’s article, “London has been dubbed the “tuberculosis capital of Europe”, and a startling recent study documenting new cases of so-called “totally drug resistant” TB (TDR-TB) in India suggests the modern-day tale of this disease could get a lot worse” (Kelland, 2012).
TB is a bacterial infection that destroys patients’ lung tissue, making them cough and sneeze, thereby spreading germs through the air. Anyone with active TB can easily infect another 10 to 15 people a year. For a disease that has not plagued the western world in years, why is it resurfacing? And why isn’t it being controlled in other countries? Like any other bacteria, the TB bacteria multiply and therefore, mutate. Drug resistant TB is on the rise and it frustrates many WHO professionals because it is completely man-made – “It came about because patients were treated badly — either with poor quality drugs, or not enough drugs, or with insufficient observation so the patient didn’t finish the treatment course” (Kelland, 2012). If a patient doesn’t finish his course of medication, not all of the bacteria are killed off, and this gives the surviving bacteria the opportunity to mutate and gain immunity to the current drugs. These mutated TB bacteria then multiply and create a new strain of TB that is resistant to the drugs that didn’t kill them off. Because of this, TB now has different forms: regular TB, multi-drug resistant TB (MDR-TB), extremely-drug resistant TB (XD-TB), and totally-drug resistant TB (TDR-TB). Each form mutates into the other, and it is a significant problem. We currently do not have the drugs or medication to combat these drug resistant forms of TB. Furthermore, the fact that TB can be spread rapidly has caused the failure of TB eradication regimes. And thus here we are, 130 years after Dr Koch discovered the TB bacteria, acknowledging World TB Day 2012.
Like many college students in America, I hardly think about TB as a threat to our society. I knew my grandfather had it when he emigrated from Hong Kong to America in the late 1950s, but that was 50 years ago. I have read about MDR-TB in Tracy Kidder’s Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World, but the story took place in Haiti, one of the poorest developing countries today. This is the first time I have heard of XDR-TB and TDR-TB and it actually surprises, and scares me, that TB is and can make a comeback in a form that is even deadlier and nastier than the one my grandfather had contracted.
Bacteria are stronger and more resilient than we think they are. That just means we have to be stronger. In order to combat TB, people have to be given the right kinds of medicine in the right dosages – if not, the bacteria can evolve and affect countries where TB was thought to be long gone. Yet, what has limited many countries, as with almost every other eradication attempt, is limited funding and lack of research. TB has to be put under control, and that will only come from more funding, research and hard work. When the day we can say we have successfully eliminated TB, World TB Day will finally become a celebration.
Kelland, Kate. 2012. “Drug-resistant “white plague” lurks among rich and poor”. Thomson Reuters.
The Global Fund. 2012. “World TB Day 2012”. http://www.theglobalfund.org/en/events/2012_World_TB_Day/
Centers for Disease Control and Prevention. 2012. “World TB Day 2012”.