HEALTH-ASIA: Tuberculosis Could Make a Comeback – Experts

By Marwaan Macan-Markar Reprint | | Print |

Marwaan Macan-Markar

BANGKOK, Feb 24 2002 (IPS) - The increasing number of tuberculosis (TB) patients being detected among the elderly in Japan and Singapore has triggered an alarm within the public health community in East Asia.

Some health experts see this pattern as an ominous sign of the deadly lung disease — that spreads through the air — having the potential of making “a dramatic comeback”, consequently infecting more people across the region.

Japan’s TB rate is “six times higher” than developed countries like Australia and Sweden, states the World Health Organisation (WHO). In 2000, there were 33 TB cases reported for every 100,000 people in Japan, as opposed to Australia and Sweden having five reported cases of TB for every 100,000 of their population.

Singapore’s rate, the WHO said, is “seven times more” than Jordan’s, which lags behind the city-state in terms of quality of life offered its citizens. Singapore had reported 43 TB cases for every 100,000 people in 2000 while Jordan had six reported cases of this infectious disease per 100,000 people.

What’s more, another Asian country with a relatively impressive development record – Malaysia – has also been singled out by the UN health agency for the number of TB patients among its elderly.

“Malaysia’s rate is nearly seven times Cuba’s and four-fold that of Egypt and Mexico — countries with far lower GDPs (gross domestic product,” the Geneva-based health body reveals.

“The numbers may seem relatively small, but they’re a potential hotbed for growth,” says Dr. Shigeru Omi, regional director for WHO’s Western Pacific Office. “TB could stage a dramatic comeback given the right conditions. The situation here cannot be ignored or taken lightly.”

“These countries need to be more alert,” adds Dr. Dongil Ahn, the WHO’s Western Pacific advisor for its Stop TB drive. “TB is particularly a problem in urban settings.”

Moreover, says Dr. Ahn, many of the elderly in these nations were infected with TB “when young, when the disease was a huge epidemic in these countries”.

In the 1950s, for instance, close to half of all Japanese adolescents were infected with TB, the WHO states, quoting a study done by Japan’s Research Institute of Tuberculosis (RIT). “TB was known as the ‘national disease’ with about half a million new TB cases every year.”

Other East Asian countries had equally bad TB infection rates during that period, according to the health agency. Britain, by contrast, had only 33,000 TB cases in 1957.

But TB rates began falling in the 1960s in Japan due to a combination of two factors: better TB control measures and development. “TB rates during the 1990s remained at a plateau in Brunei, Hong Kong, Japan, Malaysia and Singapore, although substantial declines had been seen in previous decades,” states the WHO.

Now, public health experts have a reason to feel worried about these achievements being reversed in countries that have advanced health systems. “The drugs are available and health centres are there in countries such as Japan, Singapore, Malaysia and Brunei,” says Dr. Ahn.

At a regional health conference in Osaka, Japan last week, public health experts urged the governments in these countries to fund the “sustained programmes needed to stop TB spreading”.

Currently, the WHO-recommended Directly Observed Treatment Short-course (or DOTS) is considered the most effective form of TB control. Under DOTS, health workers and public health systems are called to play a significant role in achieving a cure, rather than the onus being completely borne by the patients.

For health workers, that means having to conduct diagnosis through “sputum smear microscopy,” and once a TB patient has been identified, ensuring an adequate drug supply, and thereafter providing “standardised short-course chemotherapy by directly-observed treatment.”

However, this remedy is being challenged by a “deadly form of TB resistant to drugs,” states the WHO. “This type of TB is becoming more common and can cost up to 250,000 dollars per case to treat in developed nations. It can even be incurable.”

According to the WHO, the infection with TB germs — known as bacilli — does not cause sickness immediately. Those infected might fall ill years later, when their immune systems weaken, “which is why people with AIDS or the elderly are more likely to fall sick with TB”, it adds.

The WHO’s concern over the increasing presence of TB in East Asia’s developed nations comes at a time when the region has still to show dramatic progress in combating this infectious disease in the developing countries, like Cambodia, Vietnam and the Philippines.

Currently, close to two million people fall sick with TB every year in the region, a number that the WHO feels has the potential of increasing to three million new TB patients annually if the deadly disease is not curbed.

“TB remains one of the most deadly health problems in East Asia, causing more deaths than any other infectious disease, including AIDS,” a WHO press release adds. Every day, the WHO estimates that 1,000 people die of TB in East Asia and the Pacific.

“Some of the countries with the greatest TB burden worldwide lie in the region — China, Cambodia, the Philippines and Vietnam,” it states. “In China, TB accounts for 80 percent of infectious diseases — far more than AIDS and about 16 times more deaths than Hepatitis B or C.”

At the recent Osaka health conference, the WHO warned governments against complacency towards tuberculosis in the region, since it is a deadly disease that “knows no borders”.