Overview and epidemiological assessment of the current global tuberculosis situation: with an emphasis on tuberculosis control in developing countries.
This paper reviews the global epidemiological situation to tuberculosis, with an emphasis on the disappointing tuberculosis control achievements in developing countries over the last three decades. It is concluded tht in low prevalence developed countries it will take at least 35-40 years to eliminate tuberculosis because of endogenous exacerbation in subjects remotely infected. In developing countries most of the estimated 4 million new smear-positive and 4 million new smear-negative and extra-pulmonary cases with some 2-3 million deaths from tuberculosis occur each year. It is evident that a low cure rate is the most important reason for failure of tuberculosis control programmes in poor developing countries. Canetti stressed the urgent need to develop chemotherapeutic methods adapted to the conditions prevailing in developing countries. Based on a 9-year experience in IUATLD-assisted national tuberculosis programmes in 10 developing countries, it became apparent that the basic chemotherapeutic regimen consisting of Thiazina (combined tablet of isoniazid and thiacetazone) for 12 months supplemented by streptomycin for the first 2 months is not suitable for achieving a high cure rate in those countries. A high cure rate (90%) under routine conditions can be achieved with an inexpensive 8-month short-course regimen with a 2-month strictly supervised initial intensive phase with daily isoniazid, rifampicin, pyrazinamide and streptomycin, followed by 6 months of self-administered Thiazina daily. A substantial decrease in the risk of tuberculous infection in developing countries is essential, since we are facing their serious problems concerning tuberculosis with the increasing number of AIDS patients. BCG vaccination alone at least with the present type of vaccine, cannot substantially influence the epidemiological situation. It goes without saying that it should be applies to children to prevent tuberculosis whenever its use is justified for its purpose.
Styblo
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International Tuberculosis Surveillance Center, The Hague, Netherlands.
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D000349:Africa / Q000453:epidemiology; D001210:Asia, Southeastern / Q000453:epidemiology; D003906:Developing Countries; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control