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CDC in Action - World TB Day 2017 - Global HIV TB

TB and Miners

Deep in the mines of South Africa, men and women are hard at work extracting the precious minerals that place the country near the top of the list of the world’s biggest exporters; however, the job does not come without risks. Miners regularly find themselves facing dangerous situations that put them at risk of injury and/or illness. One of these risks is tuberculosis (TB).

Underground mines are one of the highest risk environments for TB transmission, and miners experience some of the highest rates of TB disease across any population. The living and working conditions that miners face make them highly susceptible to contracting the disease, as well as the high concentration of mining communities in countries already battling high rates of TB. In South Africa, the rate of TB among miners is 15 times higher when compared to the rest of the South African population, and a staggering 2,000 times higher than the rate of TB in the United States.

One-third of all TB cases in the entire South African region are a result of exposure to TB within the mines. Ensuring a miner diagnosed with TB completes the recommended TB treatment is an additional challenge, since many miners have no medical home and cross borders for work for months at a time. This puts those close to them, often their families, at risk of contracting TB when they return home. The lack of timely diagnoses, as well as adequate and complete treatment for those sick with TB, has created a perfect storm for the development and transmission of drug-resistant TB in mines and mining communities in southern Africa.

In order to address this issue, CDC is collaborating with the World Bank and local government partners from four African countries on a five-year effort to increase access to diagnosis and treatment for miners, their families, and communities. As a part of this effort, CDC scientists are working on the ground in Lesotho, Zambia, and Mozambique to help map and target hot spots within affected communities; develop new models for active TB case finding, diagnosis, and treatment; and scale up universal TB screening with a focus on miners and their families.

To reduce the spread of TB among mining communities, their families, and the broader population, we must continue our efforts to screen, diagnose, and effectively treat miners for TB. This will reduce the burden of TB worldwide and move us closer to eradicating the disease.

 

Video:

For more information, check out a CDC-supported feature film and documentary on the devastating effects of TB on the South African mining community.

 

Drug resistant TB

In 1882, Dr. Robert Koch made a revolutionary discovery that changed the way that the world understood a disease that had been plaguing populations for centuries. The discovery of the tubercle baccilus was the first step in addressing tuberculosis (TB), a disease that was the leading cause of death from any illness for much of modern history. However, it has only been in the past 70 years that effective anti-TB drugs have been developed to treat the over 10 million people around the world who still fall sick to this disease annually.

Over the years, TB has become a wily intruder that can outwit the drugs used to combat it in the body, leading to drug-resistant forms of the disease. These forms of TB are resistant to our best and most potent drugs, threatening the decades of progress CDC and the global health community has made against the disease. Drug resistant TB (DR TB) is more difficult to diagnose, involves longer and more costly treatments, can cause serious and permanent side effects, and significantly increases the risk of death.

Drug-resistant forms are often classified into two categories: Multidrug-Resistant TB (MDR TB) and Extensively Drug-resistant TB (XDR TB). TB can become resistant to anti-TB drugs when patients are inadequately treated or are unable to complete their full treatment regimen.  Also, drug-resistant forms of the disease can be transmitted directly through the air from person-to-person.

In 2015, there were nearly 500,000 cases of MDR TB, which is resistant to at least two of the first-line anti-TB drugs. This form of TB is now found in every country in the world, with only 1 in 5 people receiving the drugs they need to combat the disease, and of that small fraction, less than half are cured.  

Extensively drug-resistant tuberculosis (XDR TB) is the deadliest and most dangerous form of TB and is resistant to at least four of the best anti-TB drugs. Now in more than 105 countries worldwide, XDR TB is at least 20 times more costly to treat than drug-susceptible forms of TB and takes more than 2 years to cure. In most places, less than half of all patients treated are cured, with death rates as high as 80 percent.

Missed opportunities to identify and appropriately treat DR TB early on have led to hundreds of thousands of preventable deaths worldwide.

At CDC, we are on the frontlines in some of the world’s highest burden regions, working to understand what is driving the spread of DR TB and how to stop it. Since TB is an airborne disease, it can be transmitted easily across borders. That is why CDC is fighting this disease on two fronts – at home and abroad – to ensure a safer America and a safer world.

For example, in 2016, CDC helped lead a five-year study in Kwazulu-Natal, South Africa, which provided new evidence that direct transmission, not just inadequate treatment, is driving the spread of XDR-TB.  In India, CDC is working with local partners in Mumbai to stop transmission of drug resistant TB in health care facilities, find more cases, and improve cure rates in one of the highest burden cities in the world. Additionally, in countries across the globe, DGHT experts are working to identify better treatment approaches that cure patients faster.

But more needs to be done. Recent modeling suggests that if left unchecked, eventually TB may no longer be curable and we could see a global resurgence in TB deaths.

To break the cycle of transmission of drug-resistant TB, it is critical that we increase our focus on infection control efforts, while continuing to strengthen global programs in order to quickly detect and effectively treat all people with TB, including TB/HIV co-infection, childhood TB, and all forms of drug-resistant TB.

 

Video:

Click here for a compelling video about a healthcare worker in South Africa who contracted MDR TB and was left fighting for her life.

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