* WHO says many TB cases in marginalised groups are missed

* Contagious disease spreads easily but is hard to treat

* Care, treatment for drug resistant TB under-resourced

* $7 to $8 bln a year needed to get TB under control by 2015 (Adds quotes, details of drug pipeline)

By Kate Kelland

LONDON, Oct 23 (Reuters) - The number of people infected with tuberculosis (TB) or dying from it fell in 2012, but global progress on controlling the contagious lung disease is at risk from growing drug resistance.

In its annual TB report, the Geneva-based World Health Organisation (WHO) said the world is on track to meet U.N. goals for 2015 of reversing TB incidence and cutting the death rate by 50 percent compared to 1990.

Yet around 3 million people with TB are being missed by health systems, and "superbug" drug-resistant strains of the bacterial infection are putting progress at risk.

"Far too many people are still missing out on care and are suffering as a result," Mario Raviglione, the WHO's director of the Global TB Programme, told reporters in London.

"And still the death toll from TB - a disease that is preventable and curable - is far too high," he said.

TB is often seen as a disease of the past, but the emergence over the past decade of strains that cannot be treated with existing drugs has turned it into one of the world's most pressing health problems.

Of all infectious diseases, only the human immunodeficiency virus (HIV) that causes AIDS kills more people than TB.

In 2012, an estimated 8.6 million people developed TB and 1.3 million died from the disease, including 320,000 deaths among HIV-positive people, according to Wednesday's WHO report, down from 8.7 million cases and 1.4 million deaths in 2011.

The WHO says $7-8 billion a year is needed for a full response to the global TB epidemic by 2015, and there is a funding shortfall of some $2 billion a year.

Raviglione said insufficient resources for TB were the biggest hurdle to further progress, but welcomed advances in the development of rapid diagnostic tools that allow patients to be quickly tested for drug-resistant TB strains.

He also praised success in the development of potential drugs and vaccines to combat TB, noting that 10 new or re-purposed anti-TB drugs are now in clinical trials.


Still, on the frontline in poorer countries, many TB programmes lack the capacity to find and care for people in hard-to-reach groups - such as the homeless and marginalised, who often live outside any formal or state health system.

Weak links in what health experts call the "TB chain" -connecting proper detection and diagnoses to quality treatment and care - lead to people in these groups being missed.

The WHO estimates that 75 percent of the 3 million missed TB cases are in just 12 countries, with South Africa, Bangladesh, India and Pakistan among them.

On the issue of multi-drug resistant TB (MDR-TB), the WHO report said the problem was not only that the links in the chain were weak, but that links were not even there.

The U.N. health agency estimates that 450,000 people fell ill with MDR-TB in 2012 alone, with China, India and Russia worst affected, followed by another 24 other countries.

More worrying, about 16,000 MDR-TB cases reported to WHO in 2012 were not treated, with long waiting lists a growing problem. Raviglione said it was unacceptable that increased diagnosis rates were not matched by more access to MDR-TB care.

"We have patients diagnosed but not enough drug supplies or trained people to treat them," he said.

Grania Brigden, a TB adviser for the international medical charity Medecins Sans Frontieres, said the failure to improve rates of diagnosis and treatment for drug-resistant TB costs lives.

"The horrific scale of preventable suffering and death caused by the spiralling drug-resistant TB crisis must spur governments, donors and WHO to mobilise the political will and secure the funding ... to tackle this deadly epidemic head-on," she said.

The WHO's report is based on data from 197 countries and territories that together have more than 99 percent of the world's TB cases. (Editing by Alistair Lyon)

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  • Bubonic Plague

    Yes, the black plague -- responsible for <a href="http://www.smithsonianmag.com/people-places/mall_aug99.html?c=y&page=2" target="_hplink">killing 56 million people in Europe the 14th century</a> -- is still around, but it isn't as deadly or prevalent as it was in Medieval times. Dr. Robert Gaynes, an infectious disease expert at Emory University and author of the book <a href="http://estore.asm.org/viewItemDetails.asp?ItemID=1036" target="_hplink">Germ Theory: Medical Pioneers in Infectious Diseases</a>, said that people contract the disease when they gain access to previously undistrubed ecosystems, thereby making "these types of diseases become evident as a result of animal contact." These days, the disease is most commonly spread by bites from fleas that are infected with Yersinia pestis. When the bacteria enters into a person's skin, it leads to headache, chills, and <a href="http://www.bt.cdc.gov/agent/plague/factsheet.asp" target="_hplink">swollen lymph glands</a>, according to the CDC. Early <a href="http://www.bt.cdc.gov/agent/plague/factsheet.asp" target="_hplink">treatment with antibiotics</a> is essential for survival, as the disease can cause respiratory failure and shock if left untreated. Every year, about 1,000 to 3,000 <a href="http://healthland.time.com/2011/05/10/first-case-of-bubonic-plague-in-2011-appears-in-new-mexico/" target="_hplink">bubonic plague cases</a> occur around the world, with 10 to 20 of those cases in the United States, <em>TIME</em> reported. The first 2011 case of bubonic plague was confirmed in May in a New Mexico man. The reason is murky for why black plague seems to be less deadly today than in the Medieval times, Weinberg said, but it probably has to do with more rats and unclean living conditions back then, as well as a lack of appropriate medicines. In addition, the bacteria back then may be different from the current form, he added.

  • Scarlet Fever

    <a href="http://www.medicinenet.com/scarlet_fever/article.htm#history" target="_hplink">Scarlet fever</a> was among the rash of diseases that commonly afflicted people in the 19th century (alongside yellow fever, rubella and measles), according to MedicineNet. Scarlet fever most often afflicts children, causing rash and fever. Fortunately, scarlet fever is a lot less common today than it was centuries ago, but it still can be deadly. Today, we now know that scarlet fever is just a form of group A streptococcus (strep), Weinberg said. But instead of just turning into a regular case of strep throat, scarlet fever manifests as a red skin rash. With antibiotics, the disease is easily treated, though complications can occur that <a href="http://www.medicinenet.com/scarlet_fever/article.htm#history" target="_hplink">can lead to sepsis</a> (bacteria in the blood, tissue or bone), according to MedicineNet. Just this summer, Reuters reported that a Hong Kong kindergarten was closed after tests revealed that a child there may have <a href="http://www.reuters.com/article/2011/06/21/us-scarletfever-china-idUSTRE75K14Q20110621" target="_hplink">died from scarlet fever</a>. Scarlet fever is relatively common in that part of the world, but this year a Hong Kong health department spokesman told Reuters that there seem to be more cases of it this year than in past years.

  • Whooping Cough

    <a href="http://articles.sfgate.com/2011-09-20/bay-area/30178479_1_whooping-cough-booster-shots-childhood-vaccine" target="_hplink">Whooping cough</a>, caused by the Bordetella pertussis bacteria, was a common illness among children in the early 1900s, according to HealthCentral. However, when the vaccine for whooping cough was introduced in the 1940s, cases dropped. But while whooping cough cases are still dramatically lower than 50 years ago, there are still cases that persist today possibly because the vaccine against the disease doesn't provide lasting protection later in life, Weinberg said. Another reason is that older people seem to be able to carry whooping cough in their throats without actually getting sick (due to being vaccinated at a younger age), but that whooping cough is then passed on to infants who haven't yet been vaccinated against the disease, Gaynes said. "This problem has led to a recent recommendation by [the] CDC to have adults get TDAP once as adults (it contains pertussis in the vaccine) and not just a tetanus booster, which is needed every ten years," Gaynes told HuffPost. Recent research presented just last month shows that the <a href="http://articles.sfgate.com/2011-09-20/bay-area/30178479_1_whooping-cough-booster-shots-childhood-vaccine" target="_hplink">protection from the whooping cough vaccine</a> is decreased dramatically once a child reaches age 8 or 9, the <em>San Francisco Chronicle</em> reported. <a href="http://www.cdc.gov/features/pertussis/" target="_hplink">Whooping cough is very contagious</a> -- spread by cough and sneezing -- and is so named because of the sound people who have it make when they cough. Last year, 27,550 people had whooping cough in the United States, according to the CDC. The disease is the deadliest for babies, as it can lead to pneumonia, convulsions and even death.

  • Polio

    Polio, the paralysis-causing disease that afflicted former president Franklin D. Roosevelt, isn't completely gone from the world today. However, it has been eliminated from the western world, Weinberg said. The Mayo Clinic reports that the last known <a href="http://www.mayoclinic.com/health/polio/DS00572" target="_hplink">case of polio in the U.S.</a> was in 1979. Polio is still present in <a href="http://www.who.int/mediacentre/factsheets/fs114/en/" target="_hplink">Afghanistan, Pakistan, India and Nigeria</a>, where unrest and dangerous conditions can make it more difficult to get everyone vaccinated against the disease, according to the World Health Organization. Recently, the WHO reported that a dangerous strain of polio -- called wild poliovirus type 1 -- had <a href="http://www.huffingtonpost.com/2011/09/20/polio-china-pakistan_n_971787.html" target="_hplink">made its way from Pakistan to China</a>. Polio<a href="http://www.mayoclinic.com/health/polio/DS00572" target="_hplink"> causes paralysis</a> and can make it hard to breathe, the Mayo Clinic reported. It can even lead to death.

  • Gout

    Gout has been known throughout history as the "<a href="http://www.bl.uk/learning/langlit/booksforcooks/1700s/1700sfood.html" target="_hplink">disease of kings</a>" and the "rich man's disease," as it was most commonly seem among the gluttonous rich in the 1700 and 1800s, according to the British Library. Gout is considered an ancient form of <a href="http://www.cdc.gov/arthritis/basics/gout.htm" target="_hplink">inflammatory arthritis</a>, and is caused by metabolic disorder that has not been properly controlled. It occurs when uric acid crystals build up in tissues and fluids, thereby leading to a red, swollen joint that is very painful, according to the Centers for Disease Control and Prevention. The condition is most common in overweight men and women who have gone through menopause. Gout rates have <a href="http://arthritis.webmd.com/news/20101110/gout-cases-on-the-rise-in-u-s" target="_hplink">been on the rise</a> since the 1960s, with cases doubling between 1960 and 1990 and then continuing to rise through 2008, according to WebMD. More than 8 million Americans currently have gout. WebMD reported that the <a href="http://arthritis.webmd.com/news/20101110/gout-cases-on-the-rise-in-u-s" target="_hplink">rise in gout cases</a> may be due to people living longer, as the condition is seen in women only after they have passed menopause. In addition, "you can go years with hyperuricemia and no symptoms. But at some point, enough uric acid accumulates to have a flare-up of gout, so if you're living longer you are more likely to reach that threshold," gout expert Dr. John S. Sundy told WebMD. In addition, Gaynes speculated that it may not even be that gout rates are actually rising -- rather, detection and diagnosis may have improved throughout the years.