MDR-Tuberculosis on the rise around the world

October 12, 2010 - 4:48:18 am

Due to frequent travel by some residents from TB endemic areas in the world, most countries are susceptible to increased incidence rates of MDR-TB ((Multi-Drug Resistant Tuberculosis). For example: China, India and Russia all report increases. WHO (World Health Organization) estimates 440,000 cases of MDR-TB (2008) worldwide. So where does that leave Qatar? What about its huge multinational workforce coming and going on annual leaves, business trips and holidays?

Dr. Faraj Al-Alousi, Consultant Infectious Diseases at Hamad Medical Corporation (HMC), in an interview with me stated, “TB incidence in Qatari nationals is very low, in the range of 5 cases per 100,000 persons per year. But, among the immigrant population in Qatar, it is much higher, averaging 40-45 cases per 100,000 persons per year.” The 2010 World Health Organization (WHO) report on MDR-TB indicates MDR-TB cases are on the rise in many regions of the world.

Tuberculosis is an infectious disease caused by Mycobacterium Tuberculosis bacteria. Airborne infected droplets enter the air when an infected person sneezes, coughs or spits. Then, people nearby, e.g. in an aircraft or tight-living quarters, inhale the bacteria into their lungs. MDR-TB is caused by bacteria that are resistant to the anti-TB drugs Isoniazid and Rifampicin. XDR-TB (extensively drug resistant) is caused by bacteria that are resistant to MDR-TB drugs as well as Fluoroquinolone and the second line of anti-TB injectable drugs (Amkiacin, Kanamycin or Capreomycin).

Ok, but why specifically is the rate of MDR-TB and XDR-TB increasing? It is mainly due to the fact that many people begin treatment, but for a variety of reasons, do not complete the full prescribed period of treatment. This allows the drug to mutate and become resistant to the standard first-line TB drugs. According to Al-Alousi: “Often the patient begins to feel better after a few months and does not recognize the importance of completing the full period of treatment, which can then result in MDR-TB and XDR-TB.”

The WHO DOT (Directly Observed Therapy) programme was developed to address this noncompliance on the part of patients. Al-Alousi explained: DOT requires the patient to come into a health centre near his residence to be observed while taking the medicine. This ensures the treatment is not discontinued before the prescribed length of treatment is completed. The mutation of TB into more resistant strains puts the entire community at risk for the more dangerous forms of TB. Al-Alousi also mentioned that DOT is available free of charge to all persons living in Qatar, including medications.

Al-Alousi views this progressive approach adopted by Qatar as the only real solution to the problem. Poverty is a common reason in many cases of noncompliance in countries that do not have the DOT programme and where the medications are expensive to obtain.

When asked if the WHO’s goal of complete eradication of the disease by 2050 was realistic, Al-Alousi responded: “Poverty, housing issues and poor ventilation are a tall order to tackle in that time frame, and when you factor in the reoccurrence of war in these regions, it is not likely to happen.”

Therefore, early detection, compliance to the prescribed drug regimen and duration are the key to successful treatment of this dangerous and deadly disease. For the sake of everyone in the community, anyone infected with TB has a responsibility to comply. And here in Qatar, there is no excuse not to!

So, until next week, “Here’s to your health!” tHE PENINSULA