Text: Overview on March 24 World Tuberculosis Day

21 March 2001

Text: Overview on March 24 World Tuberculosis Day

U.S. joins World Health Organization to eliminate disease

The U.S. Centers for Disease Control and Prevention (CDC) joins the World Health Organization (WHO) and other prominent health organizations in recognition of World Tuberculosis Day March 24.

A disease of the lungs, tuberculosis (TB) is the world's second most serious infectious disease, killing two million people worldwide as compared to the three million who die each year from AIDS. WHO reports that about 2,000 million people carry the TB virus, which can be spread from person-to-person through merely a cough or sneeze.

A WHO statement says the theme for World Tuberculosis Day 2001 is the advocacy of Directly Observed Treatment Short-Course or DOTS. "'DOTS: TB cure for all' calls for equitable access to TB services for anyone who has the disease, free from discrimination -- rich or poor, man or woman, adult or child, imprisoned or free, and including other vulnerable groups such as people with HIV or drug resistant TB."

Following are texts of CDC and WHO statements and fact sheets:

(begin CDC Statement)

World TB Day, March 24, 2001

TB Elimination: Now Is the Time

"Now is the time to grasp a vision. A vision of coming together on World TB Day in the near future to celebrate the elimination of tuberculosis in this country."

Dr. Kenneth G. Castro
Director of CDC's
Division of TB Elimination

(end CDC Statement)

(begin CDC Fact Sheet)

TB Is Not a Disease of the Past...At Least Not Yet

Many people think that tuberculosis (TB) is a disease of the past - an illness, like smallpox, that no longer threatens us today. One reason for this belief is that, in the United States, we are currently seeing a decline in TB, and we are at an all-time low in the number of new cases. However, that very success makes us vulnerable to the complacency and neglect that come with declining numbers of visible persons suffering with TB. But it also gives us an opportunity to eliminate TB in this country. Now is the time to take decisive actions, beyond our current efforts, that will ensure that we reach this attainable goal.

The Price of Neglect

In the 1970s and early 1980s, the nation let its guard down and TB control efforts were neglected. The country became complacent about TB, and many states and cities redirected TB prevention and control funds to other programs.

Consequently, the trend toward elimination was reversed and the nation experienced a resurgence of TB, with a 20% increase in TB cases reported between 1985 and 1992. Many of these were persons with difficult-to- treat drug-resistant TB.

Back on Track Toward Elimination

The nation's mobilization of additional resources in the 1990s has paid off; 1999 represented the 7th consecutive year of decline and an all-time low in reported TB cases.

In 1999, there were 17,531 cases of TB disease reported in the United States, declining 5% from 18,361 cases in 1998. This recent recovery has put us back on track toward TB elimination.

TB Continues to Lurk Below the Surface

TB is caused by an organism called Mycobacterium tuberculosis. When a person with infectious TB disease (TB that can be spread) coughs or sneezes, tiny particles containing M. tuberculosis may be expelled into the air. If another person inhales air that contains these particles, transmission from one person to another may occur.

Persons exposed to TB disease may develop latent TB infection (LTBI). There are an estimated 10 to 15 million persons in the United States with LTBI, and about 10% of these infected individuals will develop TB disease at some point in their lives. A much higher proportion develop TB disease if coinfected with HIV, the virus that causes AIDS.

TB Poses Greater Challenges Today Than Ever Before

--The increasing proportion of cases in the U.S. among people born outside the U.S.

--Cases among foreign-born individuals increased from 22% of the national total in 1986 to 43% in 1999.

--Estimates suggest that more than half of U.S. cases may occur in foreign-born individuals by 2002.

These changes reflect the global magnitude of TB as an important health problem

--The continued threat of multidrug-resistant TB (MDR TB)

--If people with TB disease do not complete therapy for at least 6 months, they can develop and spread strains of TB that are resistant to available drugs.

--One case of MDR TB can cost up to $1 million to treat.

--Forty-five states and the District of Columbia have reported diagnosing and caring for persons with MDR TB.

The impact of declining TB cases on TB control and prevention

Some areas are having increasing difficulty in assuring proficiency among health care providers in diagnosing and treating TB disease and LTBI.

Diagnosis of infectious cases may be delayed because of their lack of experience, resulting in unnecessary transmission to others.

The interaction between HIV and TB

People coinfected with HIV and TB are up to 800 times more likely to develop active TB disease during their lifetime than people without HIV infection.

Approximately 10%-15% of the national total of TB cases are reported among people living with HIV.

Finishing the Job

Over 17, 000 cases of TB occurred in 1999, and every case is a potential outbreak if not promptly recognized and treated. The 50 states and District of Columbia continue to report TB cases each year. We must finish the job by:

--Maintaining Control: By strengthening current TB control, treatment, and prevention systems, we ensure the critical interruption of the transmission of TB and prevent the emergence of MDR TB.

--Accelerating the Decline: By finding better methods of identifying and treating LTBI and improving strategies to reach at-risk populations, we will speed our progress toward elimination.

--Developing New Tools for Diagnosis, Treatment, and Prevention: Through research to develop more effective methods of screening for LTBI, better drugs to treat LTBI, and an effective TB vaccine, we will find vital ways to stop the progression from latent infection to contagious disease.

--Engaging in Global TB Prevention and Control: In providing leadership, contributing technical support, and forming international partnerships, we improve global health; worldwide control of TB is in the Nation's self-interest.

--Mobilizing Support for TB Elimination: By reaching leaders of high-risk groups, we can offer hope that a disease that burdens their community can be eliminated.

--Monitoring Progress: By assessing the impact of our elimination efforts, we can continually monitor our progress and identify and address any lapses in our efforts.

(end CDC Fact Sheet)

(begin WHO statement)

World TB Day - 24 March 2001 "DOTS: TB cure for all"

"We have heard Ministers agree that no one should be denied access to DOTS. This means that DOTS should be available to all who need it, wherever they live, whether they are young or old, man or woman, homeless or housed, jailed or free."

Dr Gro Harlem Brundtland, Director-General, World Health Organization Ministerial Conference on TB and Sustainable Development, Amsterdam, 24 March 2000

The theme for World TB Day 2001, "DOTS: TB cure for all", calls for equitable access to TB services for anyone who has TB, free from discrimination-rich or poor, man or woman, adult or child, imprisoned or free, and including other vulnerable groups such as people with HIV or drug resistant TB. TB cure for all contributes to the fulfilment of everyone's right to the enjoyment of the highest attainable standard of health.

The two main objectives of this year's campaign are:

1) To mobilize political leaders and decision-makers around the world about the situation of TB sufferers, the implications of TB for human development, and the fact that there is no excuse for inaction in the face of an available, cost-effective cure.

2) To raise awareness that a cure for TB is available and that accessing and completing TB treatment, without stigma and discrimination, is an important step in realizing one's right to the highest attainable standard of health and well-being.

The theme, "DOTS: TB cure for all", promotes the principles of the Amsterdam Declaration to Stop TB. Through the Declaration, countries committed themselves on World TB Day 2000 to expand DOTS coverage with the goal of making DOTS accessible to all who need it. They noted "with grave concern that the magnitude of the suffering and death caused by TB is both alarming and unacceptable". The Declaration further states that:

Access to life-saving tuberculosis control programmes providing safe, high-quality drugs opens doors to life's opportunities by getting people back to work and school. Effective treatment and cure of tuberculosis is one of the most tangible interventions available to extend the life of persons with HIV/AIDS.

"DOTS: TB cure for all" reflects the important role of governments and the private sector in providing TB drugs and services. It points to the need for health services to be patient-centred and non-discriminatory. It challenges DOTS providers to continue to reach out and adapt DOTS to the needs of their TB patients. It highlights the crucial role of DOTS workers and the community in ensuring that the right to health for each patient becomes a reality, even in remote communities and among minority populations. It is a call to civil society to provide an environment that encourages everyone with TB to seek treatment and cure. DOTS is used here in its broadest sense as an umbrella term for all DOTS-based strategies, including DOTS plus for multidrug-resistant TB and TB/HIV.

"TB Treatment for All" was also the theme of a 2000 campaign (www.iuatld.org) launched by the International Union Against TB and Lung Disease (IUATLD), inspired by Archbishop Desmond Tutu. Archbishop Tutu made a moving and passionate declaration to attract the world's attention to the fact that despite the existence of a powerful and inexpensive tool to combat the disease, fewer than 25% of TB sufferers worldwide have access to affordable and effective treatment strategy.

Desmond Tutu spoke on behalf of tuberculosis patients everywhere urging that governments, the United Nations and development agencies the world over, take this responsibility seriously and make TB treatment and cure available to everybody who needs it to stop the TB epidemic. "Every person with TB has the right to be treated for his or her disease. TB can be cured, this scourge can be defeated. So let us stop denying them this basic human right".

(end WHO statement)

(begin WHO TB Fact Sheet)

World TB Day, March 24, 2001

World TB Day 2001

Global Fact Sheet: The Impact of Tuberculosis Worldwide

The History of World TB Day

In the late 19th century, tuberculosis (TB) killed one out of every seven people living in the United States and Europe. In Berlin on March 24, 1882, Dr. Robert Koch announced the discovery of the TB bacillus. At the time, his discovery was the most important step taken towards the control and elimination of the deadly disease.

In 1982, a century after Dr. Koch's announcement, the first World TB Day was sponsored by the World Health Organization (WHO) and the International Union Against TB and Lung Disease (IUATLD). The event was intended to raise awareness about the devastating health and economic consequences of TB, its impact on developing countries, and its continued threat to global health.

World TB Day

Today among infectious diseases, TB remains the second leading killer in the world, with 2 million TB-related deaths each year. Therefore, today's World TB Day is by no means a celebration. Instead, World TB Day is an occasion for countries around the world to raise awareness about the international health threat presented by TB. It is a day to recognize the collaborative efforts of all countries involved in fighting TB and for all countries to spread the word that TB can be cured and, with diligent efforts and resources, eventually eliminated.

TB -- Not a Disease of the Past

TB is an ancient disease, but it is not a disease of the past. Worldwide, an estimated 2 billion people are infected with the bacteria that causes TB. TB is spread through the air from one person to another, usually when a person with TB in the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected. Many people who have latent TB infection never develop TB disease. In these people, the TB bacteria can remain inactive for a lifetime without causing disease. But in other people, especially people who have weak immune systems, the bacteria can become active and cause TB disease.

We have medications that can prevent latent TB infection from becoming active TB disease, as well as cure people that are sick with TB disease. Many countries worldwide are also implementing highly effective TB control strategies in collaboration with the World Health Organization.

Global Facts about TB

While TB is an ancient disease, it is also one of the world's deadliest:

Each year, there are 2 million TB-related deaths worldwide.

A disproportionate number of people who become sick with TB are the most vulnerable in any society: children, the elderly, the poor, the homeless, racial/ethnic minorities, and people infected with HIV.

TB is the leading killer of people who are HIV-infected, accounting for one third of AIDS deaths worldwide.

In most of the developing world, TB is the most common single opportunistic infection (OI) for people living with HIV/AIDS.

TB causes more deaths among women worldwide than all causes of maternal mortality combined.

Someone in the world is newly infected with TB every second.

Nearly one percent of the world's population is newly infected with TB each year.

Overall, one third of the world's population is infected with the TB bacillus.

Each year, 8 million people around the world become sick with TB.

Every day, 20,000 people develop TB disease and 5,000 die from it.

TB accounts for more than one quarter of all preventable adult deaths in developing countries.

One person dies of TB every ten seconds.

Global Tuberculosis Control: WHO Report, 2000

(end WHO TB Fact Sheet)