Multi-drug-resistant tuberculosis epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

Epidemiology and Demographics

A 1997 survey of 35 countries found rates above 2% in about a third of the countries surveyed. The highest rates were in the former USSR, the Baltic states, Argentina, India and China, and was associated with poor or failing national Tuberculosis Control programmes. Likewise, the appearance of high rates of MDR-TB in New York city in the early 1990s was associated with the dismantling of public health programmes by the Reagan administration.

MDR-TB can develop in the course of the treatment of fully sensitive TB and this is always the result of patients missing doses or failing to complete a course of treatment.

Thankfully, MDR-TB strains appear to be less fit and less transmissible. It has been known for many years that INH-resistant TB is less virulent in guinea pigs, and the epidemiological evidence is that MDR strains of TB do not dominate naturally. A study in Los Angeles found that only 6% of cases of MDR-TB were clustered. This should not be a cause for complacency: it must be remembered that MDR-TB has a mortality rate comparable to lung cancer. It must also be remembered that people who have weakened immune systems (because of diseases such as HIV or because of drugs) are more susceptible to catching TB.

Incidence

• 3.6 % of the new tubercular cases have multi drug resistant strains.
• About 20% of the previously treated strains have drug resistance.
• The frequency of MDR TB varies substancially among countries.
• 10 % of MDR- TB cases are also resistant to two second line drug classes or XDR (Extensively drug resistant TB)
• 92 countries have reported atleast oe XDR case by september 2013.
• About 450 000 people developed MDR-TB in the world in 2012. More than half of these cases were in India, China and the Russian Federation.
• It is estimated that about 9.6% of MDR-TB cases had XDR-TB.

Image 1-Notified MDR-TB cases (absolute numbers), 2012.png[1]

Image 1 -Primary MDR TB, United States, 1993–2013 [http://www.cdc.gov/tb/statistics/surv/surv2013/slides/surv22.htm

Image 2 Primary Anti-TB Drug Resistance - Center for Disease Control and Prevention(CDC)

Primary MDR TB in U.S.-born vs. Foreign-born Persons, United StatesAdapted from Centers for Disease Control and Prevention.

Race

The highest amount of MDR-TB and resistance in United States is found in foreign born population esspecially from Soviet Union with 8.5 % and 33.5% of any resistance of TB in 2000.

Tuberculosis in prison

A rise in multi drug resistant strains of tuberculosis infection is found in prisons of developing countries as well as spanish prison and outbreaks in some prisons in New york city.