title: Drug-resistant TB: deadly, costly and in need of a vaccine.
abstract: TB is an underappreciated public health threat in developed nations. In 2014, an estimated 9.6 million TB cases and 1.5 million deaths occurred worldwide; 3.3% of these cases resulted from multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) strains. These figures underestimate the economic burden associated with MDR-TB and XDR-TB, as the cost of treating disease caused by these strains can be 9-25 times higher than treating drug-susceptible TB. Developing new drugs, improved diagnostics and new TB vaccines are critical components of a strategy to combat TB in general, and drug-resistant TB in particular. Because Mycobacterium tuberculosis (MTB) has demonstrated a capacity to develop resistance to drugs developed to combat it, it is unlikely that drug-resistant MTB would be 'resistant' to vaccines capable of preventing disease or established infection with drug-sensitive MTB strains. Accordingly, the development of TB vaccines represents an important long-term investment in preventing the spread of drug-resistant TB and achieving WHO's goal of ending the global TB epidemic by 2035. Our current understanding of the epidemiology of drug-resistant TB and the interventions needed to limit its spread, reviewed in this article, illustrates the need for increased financial support for developing new TB drugs, diagnostics and vaccines to meet the WHO goal of TB elimination by 2035.
authors.affiliation: Epidemiology, Site Feasibility & Utilization, Aeras, Rockville, MD 20850 USA jmanjelievskaia@mail.usciences.edu.
authors.forename: Janna
authors.initials: J
authors.lastname: Manjelievskaia
authors.affiliation: External Affairs, Aeras, Rockville, MD 20850 USA.
authors.forename: Dara
authors.initials: D
authors.lastname: Erck
authors.affiliation: External Affairs, Aeras, Rockville, MD 20850 USA.
authors.forename: Samina
authors.initials: S
authors.lastname: Piracha
authors.affiliation: Scientific Affairs, Aeras, Rockville, MD 20850 USA.
authors.forename: Lewis
authors.initials: L
authors.lastname: Schrager
mesh_terms: D060740:Disease Eradication / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D032581:Tuberculosis Vaccines / Q000191:economics / Q000627:therapeutic use*; D018088:Tuberculosis, Multidrug-Resistant / Q000191:economics / Q000517:prevention & control*
chemical_list: D032581:Tuberculosis Vaccines
keywords: Extensively drug-resistant TB; Multidrug-resistant TB; Public health; Tuberculosis; Vaccines