Statement of Christine F. Sizemore,
Ph.D., Barbara E. Laughon, Ph.D., and Anthony S. Fauci, M.D.,
National Institute of Allergy and Infectious Diseases, National
Institutes of Health on World TB Day March 24, 2009
This year, as we commemorate World TB Day, we renew our resolve
to stop tuberculosis. Although mindful of the substantial challenges
that confront us in the ultimate goal of eliminating tuberculosis,
we are encouraged by recent progress in fighting this lethal infection.
The theme of this year’s World TB Day, "I Am Stopping TB," is
enthusiastically embraced by the National Institute of Allergy
and Infectious Diseases (NIAID), part of the National Institutes
of Health, as we continue working side by side with our international
partners, other government agencies, communities and individuals
affected by TB to stop this deadly disease.
TB is an ancient disease; however, it remains one of the major
causes of disability and death throughout the world. Today, one-third
of the world’s population is thought to be infected with Mycobacterium
tuberculosis (Mtb), the microbe that causes TB. An estimated 13.7
million people have the active form of the disease. In 2007, approximately
9.27 million people developed TB, of whom 1.37 million were HIV
positive, and 1.75 million died, including 456,000 individuals
co-infected with HIV.
With Mtb infection among people with HIV/AIDS rapidly on the rise,
the two largest infectious disease pandemics of modern times are
heading for a perilous collision. This threat is heightened by
the rapid rise and spread of multidrug-resistant (MDR) TB, which
is unresponsive to the first-line drugs isoniazid and rifampin,
and extensively drug-resistant (XDR) TB, which resists most existing
TB antibiotics. Although the true extent of drug resistance is
unknown, estimates from the World Health Organization (WHO) suggest
that an average of approximately 5 percent of all TB cases are
MDR. Currently, the prevalence of XDR TB can only be inferred,
because relatively few countries are able to test for XDR TB. While
drug-sensitive TB comprises the largest burden of the disease globally,
the continued emergence of drug-resistant Mtb strains raises serious
concerns that gains in TB control may be rapidly reversed and treatment
options reduced to what was available in the pre-antibiotic era.
TB is a serious public health issue throughout the world, particularly
among populations in resource-poor nations. However, because no
nation is immune from the effects of TB, stopping it requires a
global commitment. In addition to our collaborations with other
NIH Institutes and Centers, NIAID works with the U.S. Centers for
Disease Control and Prevention, the U.S. Agency for International
Development, and other federal agencies as part of the Federal
TB Task Force and the NIAID-CDC Joint U.S. Partnership Implementing
TB Elimination Research. NIAID leverages resources through international
government and non-governmental agencies, industry and public-private
partnerships. Through the WHO/Stop TB Partnership, NIAID coordinates
research efforts with organizations that monitor disease and drug-resistance
surveillance, treat TB patients — including those also infected
with HIV — and support research training and TB control programs
throughout the world.
As we enhance and strengthen our global partnerships to stop TB,
we must also approach the science of TB with a global perspective.
While TB by itself is a disease of immense public health consequence,
we cannot forget that it occurs amid other public health challenges,
particularly in resource-limited regions. Only through better understanding
the impact of comorbidities, or co-infections such as HIV, on disease
progression, pathology and immune responses, will scientists be
able to assess fundamental research needs, identify strategies
for product development and conduct realistic clinical evaluation
of new tools and approaches. Data from clinical studies will inform
researchers whether new drugs, vaccines and diagnostics are broadly
applicable or whether TB control will require a more targeted,
setting-specific approach. As we develop new tools and evaluate
the usefulness of evolving strategies and treatments, we must be
keenly aware of the impact of overall patient health and comorbidities.
During the past year, we have seen advances in many aspects of
TB research, from the laboratory bench to treating patients in
endemic settings. For example, NIAID-supported studies have revealed
new information on mechanisms of action of anti-TB compounds that
may facilitate the development of improved therapies. Genomic and
field-based studies have provided insight into how drug-resistant
TB develops. Clinical trials have shown that mortality among TB
patients co-infected with HIV is drastically reduced when antiretroviral
therapy is provided at the same time as TB therapy. Additional
studies are under way to determine optimal strategies for the prevention,
treatment and diagnosis of TB in the setting of HIV infection.
The development and implementation of rapid and sensitive diagnostics
and tools to appropriately treat and monitor how individuals with
TB respond to therapy are urgently needed if we are to control
the spread of the disease and the emergence of drug resistance.
Several NIAID-supported academic institutions, public-private partnerships
and commercial entities are developing rapid tests for early detection
of MDR and XDR TB. To aid the transition of diagnostic platforms
to field use and advanced development, NIAID recently issued a
request for proposals to develop a TB Clinical Diagnostics Research
Consortium for assessing the performance of novel, early-stage
TB diagnostics.
As we move forward to apply new fundamental knowledge to modernize
health care interventions, we will continue to work with our global
partners to integrate scientific disciplines and technologies and
to study TB in the broadest possible context of other relevant
and co-emergent diseases and morbidities. It is important that
we balance basic research with product development, to ensure a
steady pipeline of new diagnostics, drugs and preventive and treatment
strategies.
NIAID commemorates this World TB Day with a reaffirmed commitment
to stop TB by enhancing cooperation with our global partners and
fostering collaboration among basic, applied and clinical researchers
across multiple disciplines. It is only through such coordinated
global efforts that progress can be made in stopping TB in its
tracks.
For more information about TB, visit NIAID’s Tuberculosis Web
portal (http://www3.niaid.nih.gov/topics/tuberculosis/default.htm)
and the HHS TB Web site (http://www.hhs.gov/tb/).
Anthony S. Fauci, M.D., is director of the National Institute
of Allergy and Infectious Diseases (NIAID) at the National Institutes
of Health. Christine F. Sizemore, Ph.D., is chief of the Tuberculosis
and other Mycobacterial Diseases Section in the NIAID Division
of Microbiology and Infectious Diseases. Barbara E. Laughon,
Ph.D. is Senior Scientist for TB Drug Development Partnerships
in the NIAID Division of Microbiology and Infectious Diseases.
Media inquiries can be directed to the NIAID Office of Communications
at 301-402-1663, niaidnews@niaid.nih.gov.
NIAID conducts and supports research — at NIH, throughout
the United States, and worldwide—to study the causes of infectious
and immune-mediated diseases, and to develop better means of preventing,
diagnosing and treating these illnesses. News releases, fact sheets
and other NIAID-related materials are available on the NIAID Web
site at http://www.niaid.nih.gov.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov. |