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Report outline

Report outline. 3 rd report of the WHO/IUATLD Global Project on Anti-TB drug resistance surveillance 77 settings or countries, representing 20% of new S+ cases in the world 35 in 1 st (1997), & 58 in 2 nd (2001) Two previous projects found:

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Report outline

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  1. Report outline • 3rd report of the WHO/IUATLD Global Project on Anti-TB drug resistance surveillance • 77 settings or countries, representing 20% of new S+ cases in the world • 35 in 1st (1997), & 58 in 2nd (2001) • Two previous projects found: • drug-resistant TB was present in all settings surveyed • MDR TB was identified in most settings • Good TB control practices were associated with lower or decreasing levels of resistance

  2. Report results • Magnitude & trend of anti-TB drug resistance • New cases • Previously treated cases • Drug resistance & quality of TB control • Burden of MDR • Patterns & amplification (1994-2002)

  3. Magnitude of drug resistanceNew cases • Data available for 75 settings: 55,779 patients • Prevalence of resistance to at least one drug • 0% in some Western European countries to 57.1% in Kazakhstan: (median = 10.2%) • Median prevalences of resistance to specific drugs: • SM, 6.3%; INH, 5.9%; RMP, 1.4%; and EMB, 0.8%. • MDR (median = 1.1%) • 0% in 8 countries, 14.2% in Kazakhstan & Israel • The highest prevalences of MDR were observed in: • Tomsk Oblast (13.7%), Karakalpakstan (13.2%), Estonia (12.2%), Liaoning Province (10.4%), Lithuania (9.4%), Latvia (9.3%), Henan Province (7.8%), and Ecuador (6.6%) • Significant MDR increase in Tomsk & Poland

  4. Magnitude of drug resistancePreviously treated cases • Data available for 66 countries & settings • Number of cases tested • 1 in Malta and Iceland to 668 in Poland (median = 100 cases) • Several settings reported a small number of cases tested • Any resistance among previously treated cases • The median 18.4%. • No resistance in the Gambia, Iceland, Malta and Luxembourg (small number) • Extremely high in Kazakhstan & Karakalpakstan: 82.1% & 79.4% • MDR among previously treated cases • The median 7.0%. • No MDR in 10 countries • High in Kazakhstan (56.4%) & Oman (58.3%)

  5. Drug resistance & quality of TB control • Ecological analysis of determinants of drug resistance • Prevalence of TB, HIV, GDP, NHE, etc.. • The percentage of re-treatment cases is an indicator of programme performance • Multivariate analysis showed that this percentage was significantly associated with both MDR and any drug resistance.

  6. Burden of MDR • Estimated annual incidence of MDR cases in 69 settings. • The burden can be described: • prevalence • absolute number of cases • most importantly, capacity of country to address the problem • Kazakhstan and South Africa • more than 3000 MDR cases. • Henan and Hubei Provinces of China • 1000 cases each • Estonia, Latvia, Lithuania and two oblasts in Russia • between 99 and 248 cases • Most Western and Central European countries • fewer than 10 cases each

  7. Patterns & amplification (1994-2002) • Analysis of 90,000 strains (1994-2002) confirmed that: • globally, more strains were resistant to INH than others • INH and SM resistance were more prevalent • Among previously treated cases, proportions of strains resistant to 3 or 4 drugs were significantly greater • This relationship holds globally and suggests amplification of resistance • It appears that INH and SM monoresistance are the main gateways to acquisition of additional resistance

  8. Conclusion • Drug-resistant TB was found in 74 of 77 settings • Drug-resistant TB, including MDR, in all regions • Prevalence of MDR-TB was exceptionally high in almost all former Soviet Union countries • Also high in China (Henan and Liaoning provinces), Ecuador and Israel • Percentage of re-treatment cases is an indicator of programme performance, and links with drug resistance

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