Tuberculosis (TB) is a major global disease that is caused by a bacterium called Mycobacterium tuberculosis (MTB). TB can manifest either as active disease or latent infection. Worldwide, tuberculosis is one of the leading causes of death: the WHO reported 1.4 million¹ deaths from it in 2019.
For more than 25 years, Dokumeds has been committed to supporting research against infectious diseases. Since 2007 our team has been continuously working in clinical studies for treatments aiming to bring tuberculosis infections to low rates.
Over 90% of TB cases occur in low and middle-income countries. Without comprehensive health care infrastructure, appropriate care and monitoring are especially difficult.
The WHO notes a drop in TB cases as a result of social distancing measures put in place to prevent the spread of COVID-19. However, they also describe that this drop is certainly temporary, stating that it is “crucial” to strengthen our defense against TB in the years to come. Research indicates that the COVID-19 pandemic could cause an additional 6.3 million cases of TB between 2020 and 2025.
Since two of the key determinants of TB incidence are GDP per capita and undernutrition, modelling suggests that the economic impact of the pandemic will be a rise of 1 million cases per year from 2020-2025.
This is especially difficult to think about when we consider the impact that COVID-19 has had on pushing back TB research. We must work harder to fight this disease whilst suppressing and overcoming the pandemic.
The WHO identified a list of 30 countries with high numbers of TB. Two thirds of these cases occurred in eight countries. This list indicates the % of people who developed TB in 2020 across a number of countries:
2.5% of global cases were in the WHO European Region (2.9%) and WHO Region of the Americas (3%).
(Source Data: Global tuberculosis report 2020 published by WHO)
The most common form of active TB is lung disease. Typical symptoms of active TB are coughing, chest pain, weakness, weight loss, fever, chills and sweating at night. The bacterium is transmitted by people infected with pulmonary (lung) TB through coughing, sneezing or spitting into the air. When TB invades other organs (for example, the kidney, spine, brain, or lymph nodes), it is called "Extrapulmonary TB."
Miliary TB is a rare form of active TB. In this case the TB bacteria find their way into the bloodstream and quickly spread all over the body.
As per WHO data, one third of the world’s population carry the disease but don’t have any symptoms. However, 10% of these people will likely develop active disease during their lifetime and then become capable of transmitting the bacterium.
In order to treat active TB diseases, patients need to join a treatment program. Today, several effective medications are available, and the chances are good that a patient with TB can be cured. However, the issue is that patients need to fully cooperate with the therapy program.
TB infections are treated with various antibacterial drugs. These only work when the bacteria are actively dividing. Because the TB bacteria grow very slowly, therapy takes up to 24 months. Moreover, this is a disease that must be treated aggressively and patients may have to start treatment therapy with a hospital stay. While latent TB infection can be treated with only one anti-tuberculosis drug, active TB disease is treated with many anti-tuberculosis drugs at one time.
The biggest challenge with this TB therapy is that patients do not take prescribed anti-tuberculosis drugs on schedule. This gives bacteria the opportunity to develop resistance to the drugs, including the infamous multi-drug resistant TB (MDR-TB). As a result, the disease becomes more difficult to treat.
MDR-TB remains a public health crisis and a health security threat. About half of the global burden of MDR-TB is in 3 countries – India, China and the Russian Federation.
It is crucial that patients take all their drugs as instructed, on time and without interruptions. Most treatment programs run under the supervision of a physician or a healthcare professional.
Currently, Bacillus Calmette-Guérin (BCG) remains the only TB vaccine licensed for human use against Miliary Tuberculosis. This TB vaccine is effective in protecting children against severe miliary TB but offers variable protective efficacy in adults.
New and more effective vaccines and drugs are needed to overcome this serious disease. WHO and the US, European CDCs, jointly aim to eliminate the global TB epidemic by 2035, by reducing 90% of TB cases (compared to the 2015 baseline).
With the “End TB Strategy” the focus is on the 30 high-burden countries. The strategy is aiming to ensure that people with TB worldwide have access to high-quality diagnosis, treatment, and prevention services.
WHO announced that despite of challenges, progress in the research and development pipeline for TB has been made in recent years. Currently, 22 drugs and 14 vaccine candidates are in Phase I, II or III clinical trials. Also in 2020, WHO launched an implementation research toolkit to support greater use of digital technologies across the TB continuum of care. The team of specialists at Dokumeds are proud to play a part in the fight against TB. In the past 12 years, Dokumeds supported the development of new medicines and treatment regimes, including a recent addition to anti-TB therapies - delamanid.
Dokumeds conducts clinical studies in Europe and Africa, contributing to the search for a new TB treatment regime therapy against multi-drug resistant TB (MDR-TB). A shorter therapy period would help ensure that patients take all required drugs as instructed, without interruptions.
Dokumeds has extensive expertise in the field of tuberculosis and holds deep knowledge about various international requirements in all regions of the world in which TB occurs. To find out more about Dokumeds involvement with the fight against TB, book a call with us here.