Opinion Piece by Dr. Sarah Brode
The theme of this year’s World TB Day is that “It’s Time” to end tuberculosis. The good news is TB is preventable and it’s curable. The bad news is that it is far from eradicated.
The World Health Organization (WHO) continues to identify TB as the globe’s No. 1 infectious killer. WHO estimates that 1.6 million people died from TB in 2017. And of the estimated 10 million global TB cases, only 64 percent were actually diagnosed and notified.
And new drug-resistant strains seem to be developing faster than we can find new medications to combat them.
In 2017, approximately 558,000 people developed TB that was resistant to rifampicin, a front-line anti-tuberculosis drug, and of these, 82 percent had multidrug-resistant TB (MDR-TB). Only one in four people who needed treatment for drug-resistant TB in 2017 actually received it.
In Canada, there are about 1,500 new cases of TB diagnosed every year – not a large number comparatively. But TB has been appearing at epidemic proportions in places like Nunavut for many years, where the rate of TB is 261 cases per 100,000 people compared to the average rate in Canada of about 4/100,000.
Steps are being taken to eradicate TB in Canada’s north, Canada and the entire world by 2030.
The first-ever United Nation (UN) High-Level Meeting in the fight against tuberculosis was held in September 2018 and produced a UN political declaration on TB and the endorsement at the highest level to take the necessary steps to end the TB epidemic.
For the first time the High-Level Meeting brought together heads of state to give the leadership that is urgently needed to address this terrible disease.
Some of the commitments made were to:
• Successfully treat 40 million people for TB, including 3.5 million children and 1.5 million people with drug-resistant TB;
• Provide TB preventive therapy to 30 million people, including four million children under the age of five;
• Advance all areas of innovation needed to deliver new tools for TB prevention, diagnosis and treatment;
• Mobilise $13B US annually for TB care, and $2B US annually for TB research and development.
This unique opportunity and momentum must not be lost.
TB is an airborne disease caused by the bacteria Mycobacterium tuberculosis. Microscopic droplets of the disease can be spread from person to person when someone with active TB coughs or sneezes, but in general it takes prolonged exposure to catch it.
Symptoms of active TB can include unexplained weight loss, night sweats, fever, loss of appetite and chronic cough. TB may go unnoticed or undiagnosed because the symptoms can resemble other common illnesses such as the flu.
While it can attack any organ, about 70 per cent of cases are associated with the lungs. Pulmonary TB has been around for thousands of years and in the past was often referred to as phthisis and consumption.
West Park Healthcare Centre, started out 115 years ago as a TB sanitarium called the Toronto Free Hospital for the Consumptive Poor. Despite the name, the disease was indiscriminate and would strike princes as well as paupers.
In the 1930s as TB was at its height, West Park had more than 600 inpatient beds dedicated to tuberculosis. We now have 20. New medications in the 1940s and 50s led to a dramatic decline in the scourge across Canada and the industrialized world.
Today, we remain the only hospital in Ontario with a dedicated inpatient unit for TB, dealing with the most complex cases, including the new drug-resistant strains, and helping people get their lives back.
We need to guarantee these gains against TB are not jeopardized by ignoring the threat of drug resistant strains. We need to follow through on the UN’s commitments to battle this horrible disease. We need more investment in research, and support to other countries that are struggling with TB.
Solving the problem is not only about those who live on the other side of the globe, but it is in our best interest to expand our fight against this disease in Canada and prevent the spread of MDR-TB.
We can’t afford to be complacent. It’s time to end TB.
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Dr. Sarah Brode heads the Tuberculosis service at West Park Healthcare Centre in Toronto. She is also an Assistant Professor of Medicine at the University of Toronto and a Staff Respirologist at Toronto Western Hospital.