In 2015, there were 10.4 million cases of tuberculosis (TB) worldwide and 1.8 million deaths from the disease. And no… that’s not a typo.
To further emphasise just how deadly the disease actually is: tuberculosis continues to kill around 4,000 people globally each day. No, that’s not a typo either…. that’s 4,000 people every day!
Most people living in Australia have no idea how devastating this disease actually is, largely because death from TB is extremely rare here.
Despite this, there are Australian researchers working together with their international counterparts in a mammoth effort to eradicate tuberculosis by 2035.
One such researcher is Professor Guy Marks, Chief Researcher at the Respiratory Medicine Department at the Ingham Institute and President of the International Union Against Tuberculosis and Lung Disease. His research has focused on identifying how to implement existing and new tools to eliminate tuberculosis.
But first a bit about tuberculosis.
There are very few deaths due to tuberculosis in Australia, US, UK and Europe. However, if you live in Vietnam, India, China, Philippines and Cambodia, your chance of developing TB (and in many cases, dying from it) is extremely high. This is despite the fact that the disease is almost 100% treatable and curable.
“We have had drugs that effectively treat and cure this disease for nearly 70 years,” Professor Marks explains. Yet, it still kills thousands of people worldwide every day.
“This inequality is a huge failure on the part of the political and health system that we can eliminate TB in some countries and not in others.”
Professor Marks explains that TB is a complex disease which can manifest as active disease at any time or lay dormant until triggered at a later point in life.
“People inhale the organism and acquire an infection which causes an immune response which may progress to active TB. Active TB usually occurs in the lungs but can also occur in the lymph nodes in the neck, heart, brain, gut, bones and urinary tract. Of these forms of disease, only pulmonary (lung) TB is infectious. Therefore, it is this type of disease is that causes the epidemic to continue and is the major cause of concern for the community.”
One of the important ways to prevent TB is to prevent people from getting infected in the first place. The best way to do this is to find and treat all the people with the infectious, pulmonary forms of the disease. In some countries with a high burden of TB as many as one in 300 to one in 100 people have active TB. As long as they have untreated pulmonary TB, they are spreading the disease to others. A key strategy for eliminating TB is to find and treat all these people.
Professor Marks has just completed a study to test the effect of doing just this, finding and treating all cases of active TB in the community. The study took place in Ca Mau, a Mekong River delta province in Vietnam.
For the first three years, people aged 15 years and over in the intervention group received yearly screening for active TB. Those found to have TB, were placed on treatment for tuberculosis by the local health service. In contrast, the control group were not screened and only those presenting to the health service with active symptoms received treatment. This is normally the case in Vietnam and most other countries.
In the fourth year, both groups were screened for TB and it was found that the intervention group had significantly lower rates of pulmonary tuberculosis than the control group. Furthermore, children in the intervention group (who were not, themselves, screened for TB), had a lower rate of TB infection: indicating that the intervention had prevented the spread of infection.
“The ACT3 trial has shown that a community-wide active case-finding intervention was effective in reducing the prevalence of tuberculosis and the transmission of tuberculosis infection,” Professor Marks explains.
While the project was successful as a proof-of-concept study, Professor Marks explains that they now need to, not only look at how to implement this on a larger scale, but also how to fund these interventions globally.
“It’s not the end of the story. More work needs to be done.”
Tuberculosis is not currently a major problem in Australia but that doesn’t mean it shouldn’t concern us. With 4,000 deaths occurring every day, we should not turn our backs on the most vulnerable. Thankfully, researchers like Professor Marks haven’t turned their backs but are continuing to work hard to eliminate the disease by 2035.