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War on TB must not let up

War on TB must not let up


Tomorrow is World Tuberculosis Day, and Cambodia is enjoying significant success in the fight against TB.


A national survey last year by the National Centre for Tuberculosis and Leprosy Control, with technical assistance from the World Health Organisation and the Japan International Cooperation Agency, revealed that since 2002, tuberculosis prevalence had declined from 269 to 170 infectious cases per 100,000 people, a drop of almost 40 per cent.

Based on these results, the WHO estimates Cambodia is one of the few countries that has already achieved the UN Millennium Development Goal targets for reducing TB prevalence and mortality rates by 2015.

If not treated, tuberculosis – caused by a highly contagious bacteria called Mycobacterium tuberculosis (MTB) – is lethal, especially in developing countries.

But if detected early and treated with high-quality drugs, it’s entirely curable.

TB usually attacks the lungs, but can affect other parts of the body.

It spreads through the air when people who have an active MTB infection cough or sneeze.

Most infections in humans result in an asymptomatic, latent infection that doesn’t result in active disease.

But one in 10 latent infections eventually progresses to an active disease.

If left untreated, the active disease kills more than 50 per cent of those infected.

Living with TB patients who are not on treatment, smoking, being a diabetic, being elderly, having poor nutrition and HIV co-infection are risk factors for developing active tuberculosis.

Overcrowding and poor living conditions contribute to the spread of the disease.

Tuberculosis is a serious public health challenge for Cambodia, which has the second-highest prevalence rate among the 22-high-TB-burden countries.

But by training community health workers, delivering home treatment, enlisting patient supporters and providing food, free medicines and economic opportunities, thousands of Cambodians with TB have been successfully treated.

A keystone in Cambodia’s success in fighting TB is the strong commitment of the government in ensuring that free-of-charge tuberculosis services are available at all government health facilities.

Over the past decade, Cambodia has reported treatment success rates of well over 90 per cent every year.

Such success has been possible only because of the DOTS strategy, which remains at the heart of the national TB program.

It involves using microscopy to diagnose patients and treating them with a course of anti-TB drugs.

A trained health worker or a community DOT watcher directly observes every dose the patient takes.

We can also attribute the treatment success rates to the uninterrupted supply of high-quality anti-TB drugs that are provided free of cost to patients, with the support of partners including JICA, the Global Fund for HIV/AIDS, TB and Malaria and the Global Drug Facility.

In developing countries, young children have high TB rates.

Children often acquire the disease from infected adults in their own family or their neighbourhood.

Cambodia’s national TB program uses globally recommended guidelines to diagnose and treat the disease in children.

Children also benefit from high quality, child-friendly drugs that are available free of cost at all public health facilities.

The Bacille-Calmette-Guérin (BCG) vaccine to prevent TB is almost 100 years old.

There is widespread documented evidence that it provides protection against severe forms of TB in children, but its efficacy in preventing pulmonary TB in adults is limited.

It is these limitations that drive the search for a better, fully protective vaccine.

Efforts to develop new vaccines for the prevention of TB have intensified.

There are candidates in Phase I or Phase II trials, and it’s expected that one or two of the candidates in a Phase II trial will enter a Phase III trial in the next two to three years, with the possibility of licensing at least one by 2020.

The extraordinary progress made by Cambodia in the fight against TB has been remarkable. 

We must ensure these gains are not reversed.

Last November, the Global Fund for HIV/AIDS, TB and Malaria announced it would not announce new grants for the scaling-up of TB treatment until at least 2014.

This will seriously affect Cambodia, as continuous financial support from development partners is critical to sustain effective TB control.

Technologies such as LED fluorescence microscopy and GeneXpert are being rolled out, and new approaches such as active case-finding among high-risk groups are being designed.

Without a new commitment of funds, the national TB program will be unable to expand these technologies and approaches.

The National TB program has made commendable progress, but only long-term commitment from the government and development partners will ensure TB can be eliminated in this country.

Pulling the rug from under Cambodia at this moment, when the country is marching with pride and confidence in its battle against TB, will surely be a recipe for a public-health disaster.

Dr Mao Tan Eang is director of the National Centre for Tuberculosis and Leprosy Control.
Dr Pieter JM Van Maaren is the World Health Organization’s representative in Cambodia.


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