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Anti-Tuberculosis Drug Resistance in The World: Please Go To The Table of Contents Page To Access The Entire Publication
Anti-Tuberculosis Drug Resistance in The World: Please Go To The Table of Contents Page To Access The Entire Publication
ANTI-TUBERCULOSIS
DRUG RESISTANCE
IN THE WORLD
Third Global Report
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Written by:
• Mohamed Abdel Aziz, M.D., M.P.H., M.B.T.Sc.,World Health Organization, Geneva,
Switzerland
• Abigail Wright, M.P.H., World Health Organization, Geneva, Switzerland
• Aimé De Muynck, Ph.D., M.D., M.P.H., M.Sc., Consultant, World Health
Organization, Geneva, Switzerland
• Adalbert Laszlo, Ph.D., World Health Organization, Geneva, Switzerland
This project was in part financially supported by the United States Agency for International
Development. The Tuberculosis Coalition for Technical Assistance (TBCTA) funded labo-
ratory training activities associated with this project. We are grateful to EuroTB for their
participation and contribution of European drug resistance surveillance data. This project
could not have succeeded without the support of national authorities and the institutions
hosting each of the national and international laboratories. A special acknowledgement is
due to Dan Bleed and Mehran Hosseini for technical support of data management.
Please click on the different underlined parts for access to the PDF files.
C ONTENTS
FOREWORD ...............................................................................................................................................13
SUMMARY ..................................................................................................................................................15
1. BACKGROUND AND METHODS ...............................................................................................15
2. RESULTS .............................................................................................................................................15
2.1 Magnitude and trends of anti-TB drug resistance ....................................................15
New cases ................................................................................................................................15
Previously treated cases .......................................................................................................16
Association of drug resistance with the quality of TB control ...................................16
2.2 MDR-TB ........................................................................................................................................16
2.3 Patterns and amplification 1994–2002 .........................................................................17
3. CONCLUSIONS ................................................................................................................................17
3.1 Scale of the epidemic of drug-resistant TB ..................................................................17
4. RECOMMENDATIONS...................................................................................................................18
4.1 Management of TB control .................................................................................................18
4.2 Surveillance of drug resistance .........................................................................................19
1. INTRODUCTION ...............................................................................................................................21
2. BACKGROUND ..................................................................................................................................23
2.1 ANTIMICROBIAL RESISTANCE AND PUBLIC HEALTH ....................................................23
2.2 MECHANISMS OF ANTI-TB DRUG RESISTANCE AND FACTORS
ASSOCIATED WITH ITS EMERGENCE.....................................................................................23
2.3 THE THREAT OF DRUG RESISTANCE FOR TB CONTROL ...............................................24
2.3.1 Increased access to drugs ...............................................................................................24
2.3.2 HIV .............................................................................................................................................25
2.3.3 Private sector ........................................................................................................................25
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ANTI -TB DRUG RESISTANCE IN THE WORLD
4. RESULTS .................................................................................................................................................43
4.1 PREVALENCE OF DRUG RESISTANCE ....................................................................................43
4.1.1 Drug resistance among new cases of tuberculosis ..............................................43
Any resistance among new cases .....................................................................................44
MDR among new cases........................................................................................................46
Resistance among new cases according to number of drugs ...................................46
Any resistance among new cases by individual drug..................................................48
New cases resistant to INH but susceptible to RMP......................................................49
4.1.2 Drug resistance among previously treated cases.................................................49
Any resistance among previously treated cases ...........................................................50
MDR among previously treated cases .............................................................................52
Resistance among previously treated cases according to number of drugs ........52
Resistance among previously treated cases by individual drug...............................54
4.1.3 Combined prevalence of drug resistance ................................................................54
Any resistance among combined cases ..........................................................................54
MDR among combined cases ............................................................................................55
Resistance among combined cases according to number of drugs .......................56
Any resistance among combined cases by individual drug ......................................56
4.2 PREVALENCE OF DRUG RESISTANCE BY REGION ............................................................57
4.2.1 Drug resistance among new cases ..............................................................................57
4.2.2 Drug resistance among previously treated cases.................................................58
4.2.3 A closer look at the European Region ........................................................................60
4.3 DYNAMICS OF DRUG RESISTANCE PREVALENCE OVER TIME (1994-2002) ........61
4.3.1 Dynamics of drug resistance among new cases....................................................62
Dynamics in settings reporting two data points ..........................................................62
Trends in settings reporting three or more data points ..............................................64
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ANTI -TB DRUG RESISTANCE IN THE WORLD
5. DISCUSSION .......................................................................................................................................83
5.1 MAGNITUDE OF RESISTANCE BY REGION ........................................................................84
African region ..................................................................................................................................84
CONTENTS
Region of the Americas................................................................................................................85
Eastern Mediterranean region..................................................................................................86
European region .............................................................................................................................87
South-east Asian region ..............................................................................................................89
Western Pacific region..................................................................................................................90
5.2 ECOLOGICAL ANALYSIS .............................................................................................................91
5.3 BURDEN OF MDR ...........................................................................................................................91
5.4 SRLN ....................................................................................................................................................92
5.5 DRUG RESISTANCE PATTERNS ...............................................................................................93
Increase in drug resistance rate .........................................................................................93
Amplification of drug resistance proportions ...............................................................94
Major drug resistance pathways.......................................................................................94
Implications ............................................................................................................................94
ANNEXES ....................................................................................................................................................95
REFERENCES.......................................................................................................................................... 133
COUNTRY PROFILES ....................................................................................................................... 141
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