The Tuberculosis Front

This has been a good decade in the fight against tuberculosis, but not nearly good enough. While new drugs, vaccines, and diagnostic methods are urgently needed, the emergence of highly drug-resistant strains also calls for entirely new approaches to combating the disease.

BERLIN – This has been a good decade in the fight against tuberculosis. We are likely to achieve the United Nations Millennium Development Goal of cutting TB prevalence and mortality in half by 2015, from 1990 levels. At least a dozen new vaccines and drug candidates are in clinical trials, and the World Health Organization has endorsed a new diagnostic test called the GeneXpert.

This progress is all the more important given the complacency that led to a complete standstill in research and development for new TB interventions toward the end of the twentieth century. The TB drugs currently in use were developed between 1950 and 1970. Indeed, the Bacille Calmette–Guérin (BCG) vaccine is almost 100 years old, while the most widely used diagnostic test, microscopic detection of bacilli in sputum, was developed 130 years ago.

No wonder that the efficacy of these tools has weakened. The current vaccine prevents severe TB in infants, but not the most prevalent pulmonary TB in all age groups. The microscopic test gives false results in nearly half of all cases.

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