What is MDR TB?
MDR TB is a particular type of drug resistant TB. It means that the TB bacteria that a person is infected with are resistant to two of the most important TB drugs, isoniazid (INH) and rifampicin (RMP). If bacteria are resistant to certain TB drugs this means that the drugs don’t work. Other drugs then need to be taken by the person if they are to be cured of TB.
MDR TB is also known as Multi Drug Resistant TB.
What is RR TB?
People with RR TB are resistant to rifampicin. They may or may not have resistance to other drugs. MDR/RR TB means patients with MDR TB as well as patients with TB resistant to rifampicin.
For many years MDR TB has been the most basic form of drug resistant TB, and the type of TB for which many statistics were collected. Then in 2016 RR TB started to become more widely discussed because many people are now being diagnosed with TB using the Genexpert test. The Genexpert test detects resistance to rifampicin as well as resistance to isoniazid
How do you get MDR TB or RR TB?
There are two main ways that you can get them. Firstly you can get them if you don’t take your drugs exactly as you have been instructed to by your health care provider. You may also get MDR TB if you are not taking the correct drugs. This could possibly be because your bacteria are resistant to more drugs than your health care provider realised. Maybe you have undiagnosed XDR TB. This is referred to as acquired TB.
You can also get them if you get TB bacteria from another person who already has MDR or RR TB. This is known as primary TB. It used to be believed that most people have acquired TB. But it is now realised that many more people than were previously realised have primary TB.
How many people have MDR TB?
Globally in 2016 about 490,000 people are estimated to have become ill with MDR-TB. In addition there were an estimated 110,000 people who had rifampicin resistant TB (RR TB). So the number of people estimated to have had MDR TB or RR TB in 2016 was 600,000. Almost half of these cases (47%) were in India, China or the Russian Federation. There is more about TB in India and TB in China.
MDR TB accounts for about 4.1% of new TB cases. Also, in 2016 about 19% of previously treated TB cases were estimated to have either rifampicin or multi drug resistant TB.
About 6.2% of MDR TB cases in 2016 had additional drug resistance, which means that they may have had what is known as extensively drug resistant TB (XDR-TB). This is lower than the figures for previous years (9.5% in 2015, 9.7% in 2014). This decrease is most likely due to improved measurements, rather than an actual decrease.
Can MDR TB cause people to die?
In 2016 MDR TB and RR TB caused approximately 240,000 deaths. This is similar to the best estimate for 2015.
It is estimated that there is a large pool of undiagnosed drug resistant infection in children. It is considered by some people that this may be as high as 2 million children. Of the estimated 850,000 children that developed TB in 2014, 25,000 probably had MDR TB. 1Dodd,P “Global burden of drug-resistant tuberculosis in children: a mathematical modelling study”, the Lancet, 2016,
www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30132-3/abstract There is more about TB in Children.
Reported (notified) numbers of people with MDR TB
The number of people actually reported (notified) to the World Health Organisation (WHO) as having MDR TB or RR TB was 26% of the people estimated to have become ill. This was about 153,119.
Among MDR/RR TB patients notified in 2016, 39% were tested for resistance to both fluoroquinolones and second line injectable drugs, a slight increase from 36% in 2015. Coverage varied widely among countries.
The notification numbers among different WHO regions for 2016 are shown in the table below.
Regional notification TB statistics
|Region||Total notified TB cases||MDR TB & RR TB cases notified|
If there is a "plus sign" clicking on it will show more columns.
There are some more TB statistics
Treatment of MDR TB
In May 2016 the WHO recommended that there should be a major change to the treatment for drug resistant TB with shorter regimens being made available for many patients.
Previously treatment for drug resistant TB had often required a large number of drugs to be taken taken for up to two years. Also the drugs often caused severe side effects in patients. So various efforts were being made to develop shorter regimens which were easier to take.
The first shorter and easier to tolerate regimen is known as the Bangladesh regimen. It appears to have a higher cure rate than “standard” MDR TB regimens.
There is more about the treatment of drug resistant TB.
A family with MDR TB
Danon and four of his family members were all treated for MDR TB in Benin as part of an observational study led by the International Union against Tuberculosis and Lung disease.
“My whole family got sick - there were five of us in total from the same home, all with MDR TB. My older brother and several of his children - all of us together. And we’re all cured thanks to this treatment.”
Timothé, his brother Evariste, and Evariste’s three sons, Florantain, Geraldo and Fresnel, were all treated and cured, using the shortened nine month treatment regimen, the Bangladesh regimen. This new regimen cuts the treatment time for MDR TB patients from nearly two years down to just nine months, and it greatly reduces the more risky and difficult side effects involved.
The latest data reported to WHO shows a treatment success rate of only 54% for patients starting treatment in 2014. In 8% of patients the treatment failed, 16% died, 15% were lost to follow-up and 7% had no outcome information. This data is obtained by countries having groups of people (known as cohorts) who started treatment at a particular time and who are then followed for a number of years.
A total of 129,689 patients were enrolled on treatment in 2016 (up from 125,629 cases in 2015). However, this represents only about 22% of the estimated total number of cases (600,000) in 2016. Ten countries accounted for about 75% of the gap between enrollment in treatment and the estimated number of cases. China and India accounted for about 39% of the total gap.
In addition this total of 129,689 patients starting treatment was not even the total number of patients notified (153,119) in 2016. The numbers notified exceeded 90% in 14 high MDR TB burden countries and the WHO European Region and the Region of the Americas. However it was much lower in the WHO African and Western Pacific Regions. Enrollments represented less than 60% of the number of notified cases in two high burden countries in 2016, China (50%) and South Africa (59%). These low percentages show that:
progress in detection is outstripping the capacity to provide treatment. In these settings the risk of transmission of drug resistant TB is very high.
Once patients have been diagnosed with drug resistant TB it really is essential that they are provided with treatment. This is not only for their sake, and it may indeed save their lives. It is also because once people are taking treatment they stop being infectious, and can no longer spread drug resistant TB to other people.
Using bedaquiline & delamanid
By June 2017 89 countries were known to have imported or started using bedaquiline and 54 countries had used delamanid. Most of the patients treated with bedaquiline were reported by the Russian Federation and South Africa.
Cost of treatment for MDR TB
For MDR TB the median cost per patient treated was US$9,529 in 2016. New shortened regimens of 9-12 months cost about US$1,000 per person.
MDR TB high burden countries
There are 30 high burden countries for MDR TB. The list of high burden countries was revised in 2016.
The tables below show the estimated number of cases for each “high burden” country. But these are only the estimates for the number of cases of MDR TB among those cases of pulmonary TB notified to WHO. There will in addition have been many cases of MDR TB among those cases of TB which were either not detected and/or not notified.
|Country||Estimated % of new cases with MDR TB or RR TB||Estimated % of previously treated cases with MDR TB or RR TB||Incidence of MDR TB or RR TB||% of MDR among MDR TB or RR TB cases|
|Papua New Guinea||3.4||26||1,900||78|
|Republic of Moldova||26||56||2,300||97|
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