Overview
Tuberculosis (TB) is a contagious disease that spreads through airborne droplets when an infected person coughs, sneezes or breathes. About one third of the world’s population carries a latent TB infection, and around 10% of these people will develop active TB in their lifetime.
Symptoms vary depending on the affected body part. In pulmonary TB, common symptoms include a persistent cough with sputum (sometimes with blood), shortness of breath and chest pain. With early diagnosis and treatment, TB (TB disease type without resistance to rifampicin and isoniazid) can be cured using a 4- and/or 6-month antibiotic therapy regimen.
Drug-resistant TB
Drug-resistant TB (DR-TB) disease is caused by a strain of Mycobacterium tuberculosis complex that is resistant to any TB medicines. It results from incomplete or inadequate treatment of TB or poor airborne infection control in health-care facilities and congregate settings. DR-TB is more difficult to treat than drug-susceptible ones and poses a major challenge for patients, health-care workers and health-care services.
Multidrug-resistant TB
Multidrug-resistant TB (MDR-TB) is resistant to 2 of the most potent anti-TB drugs – isoniazid and rifampicin. Treating MDR-TB is more expensive and requires longer treatment, a higher pill burden and the use of medicines with a higher toxicity profile. In addition, patients may develop significant adverse events and have poorer treatment outcomes. Globally, although treatment success rates have increased, almost 15% of patients with MDR-TB/rifampicin-resistant TB die from the disease.
Several novel drugs and shorter (4- or 6-month) all-oral regimens with few side effects have emerged in recent years and are recommended by WHO for use in TB and DR-TB treatment. Significant improvements in the availability of enhanced diagnostics and more effective medicines have been made in recent years, leading to earlier detection and higher success rates.
Extensively drug-resistant TB
Extensively drug-resistant TB is resistant to the main first- and second-line TB drugs, making curative treatment extremely difficult and further limiting chances of cure.
DR-TB in the WHO European Region
DR-TB is a major public health challenge globally, particularly in the WHO European Region. The Region, especially eastern European and central Asian countries, is home to one fifth of the global number of MDR-TB cases (21%) and more than a third of pre-extensively DR-TB cases (37%). The proportions of MDR-TB cases detected among new and previously treated TB cases continue to significantly exceed the global average.
Of the 30 countries with the highest MDR-TB burden, 9 are in this Region: Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation, Tajikistan, Ukraine and Uzbekistan.
Despite progress in treatment success, current efforts remain insufficient to eliminate TB by 2030 and achieve the End TB and Sustainable Development Goals. Without urgent action, DR-TB could become even more widespread among future generations.
WHO response and the way forward
WHO/Europe is providing support to Member States in their efforts to eliminate TB. Through a Region-wide participatory consultation process, WHO/Europe has developed the Tuberculosis action plan for the WHO European Region 2023–2030, which aims to support Member States in implementing their national responses to the TB epidemic and provides strategies to enable the Region to reach the global End TB Strategy targets, and in aligning actions to WHO policies and guidance.
To effectively combat DR-TB, countries must:
- strengthen joint accountability and collaboration between health and other sectors
- systematically implement rapid molecular tests and updated WHO treatment guidelines
- expand access to new TB medicines and shorter, more effective regimens
- adopt a people-centred approach to TB care.
Accelerating these efforts can help to improve TB treatment outcomes and prevent further spread of drug-resistant strains.