Despite Progress, TB Remains a Serious Health Concern in Ontario

World TB Day – March 24, 2013

March 21, 2013

Toronto, ON – As health organizations worldwide prepare to commemorate World Tuberculosis Day on Sunday (March 24), the Ontario Lung Association warns that the province’s battle against this infectious lung disease is far from over.

While the total number of tuberculosis (TB) cases reported each year is slowly declining, experts are concerned that the appearance of new drug-resistant TB strains could reverse this trajectory. Several countries have reported TB cases with resistance to virtually all drugs available to treat the disease.

The most recent figures from the Public Health Agency of Canada show that 1,577 new cases of TB were reported nationwide in 2010, with higher incidence rates among Aboriginal communities and people arriving from countries where the disease is endemic. Ontario had the most TB cases of any province (633) and about a third of all people with TB in Canada live in the Greater Toronto Area (GTA).

Over the past decade, one in every six TB patients in the GTA has a strain of the disease that is resistant to at least one first-line drug, reflecting global patterns of TB. Cases of MDR-TB (multi-drug resistant) and even – very rarely – XDR-TB (extensively drug-resistant) have also been documented.

“There is a popular misconception that TB is a disease of the past here,” said Dr. Elizabeth Rea, Associate Medical Officer of Health at Toronto Public Health and a member of the Ontario Lung Association TB Committee. “This is not true. TB continues to be a public health concern in Ontario and we must remain vigilant to maintain and continue our success in the fight against this disease.

“And TB anywhere is TB everywhere,” Dr. Rea said. “Drug-resistant strains of TB elsewhere in the world will inevitably find their way to Ontario. This means we have a vested interest in supporting good TB diagnosis and treatment throughout the world, not just here at home.”

As well as posing a serious threat to public health, cases of drug-resistant TB are complex and costly to treat. It is estimated that a single case of MDR-TB – a strain that does not respond to at least two of the standard drug treatments – could cost the health system about $500,000. For a case of XDR-TB – a strain resistant to virtually all known drug treatments – the cost of health care could hit $1 million, higher than the annual TB control program budget in several provinces and territories.

The World Health Organization (WHO) Stop TB strategy calls upon all countries and partner organizations to enable and promote research to stimulate production and dissemination of knowledge for TB prevention and control. The Stop TB Partnership’s theme for World TB Day 2013 is Stop TB in My Lifetime.

George Habib, president and CEO of the Ontario Lung Association, says that research is critical to the success of the worldwide campaign to prevent and treat TB and other chronic lung diseases. “We know from the TB conferences organized every two years by the Ontario Lung Association that Canada has a wealth of globally recognized TB expertise,” said Habib. “But they need more support from funding agencies to maintain Canadian engagement in the global TB research effort. With a stronger focus on research, we could witness the end of TB in our lifetime.”

The WHO has identified a number of research priorities, including production of a safe and effective vaccine, new treatments for different types of drug-resistant TB and development of a simple diagnostic test that can be used in a basic health-care setting by someone with little technical knowledge.

What is TB?

TB is an infectious disease caused by bacteria that spread through the air. About one-third of the world’s population has latent TB, which means they are infected but are not ill and cannot transmit the disease. People with latent TB have a lifetime 10 per cent risk of getting active TB. People who smoke or who have compromised immune systems caused by HIV, malnutrition or diabetes have a much higher risk of becoming ill. Most TB cases are treatable and curable with a standard six- to 12-month supervised treatment course. Drug-resistant TB has emerged in recent years because of the inappropriate or incorrect use of anti-TB drugs, and use of poor quality medicines.

Global Status

Although the global TB death rate dropped 41 per cent between 1990 and 2011, 8.7 million people became ill and 1.4 million died from TB in 2011, making it the second biggest infectious killer of adults worldwide. More than 95 per cent of TB deaths occur in low- and middle-income countries where it is among the top three killers of women aged 15 to 44.

World TB Day

World TB Day falls on March 24 each year, commemorating the day in 1882 when the German scientist Dr. Robert Koch announced that he had discovered the cause of TB, the TB bacillus. At the time, TB was raging through Europe and the Americas, killing one out of every seven people. The discovery of TB bacteria led to the development of treatments for the disease.

The Lung Association and TB

The Lung Association was founded in 1900 to fight TB. Its original name was The Canadian Association for the Prevention of Consumption and other Forms of Tuberculosis. Today, the Canadian Lung Association acts as the secretariat for Stop TB Canada, part of a global partnership dedicated to stopping the spread of TB around the world.

The Ontario Lung Association publishes TB resources for health professionals including TB: Information for Health Care Providers and Assessment and Treatment of Latent Tuberculosis Infection (LTBI): Quick Reference. The seventh edition of Canadian Tuberculosis Standards will be published this year by the Canadian Thoracic Society and the Public Health Agency of Canada. Additional TB resources for health professionals and the public can be found on the websites of the Canadian Lung Association (www.lung.ca) and Ontario Lung Association (www.on.lung.ca).

Efforts to prevent and control TB overlap with other Lung Association initiatives such as its long-standing smoking prevention and cessation program. More than 20 per cent of TB cases worldwide are linked to smoking. PHAC says that a smoker with latent TB has two to three times the risk of developing active TB as a non-smoker. Smoking also increases the risk of death among TB patients by up to six times.

About the Ontario Lung Association

The Lung Association is a registered charity that provides information, education and funding for research to improve lung health. The organization focuses on the prevention and control of asthma, chronic lung disease, tobacco control as well as healthy air and the effects of pollution on lung health. For information on lung health, call our certified respiratory educators at 1‐888‐344‐LUNG (5864) or visitwww.on.lung.ca. You can also follow us on Twitter @OntarioLung and Facebook.

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For more information:
John Chenery
Ontario Lung Association
416-864-9911 ext. 292 | Cell: 647-293-9911
[email protected]

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