My eyes were opened to the threat posed by multi-drug resistant tuberculosis (MDR-TB) when I read about Dr. Paul Farmer’s evangelical efforts to raise the world’s consciousness in Tracy Kidder’s book Mountains Beyond Mountains.  Years later I’ve learned the threat continues to grow. The World Health Organization works very closely with Farmer’s Partners In Health organization to monitor and combat MDR-TB around the world.  The WHO’s 2010 report is cause for alarm but also offers some seeds of hope.

First some worldwide statistics from the report:

• In 2008, there were estimated 440,000 MDR-TB cases and 150,000 deaths
• Only 7% of all MDR-TB patients were diagnosed and notified
• 60% of those enrolled in treatment programs were cured
• In 2010, only 22% of the $1.3 billion needed to fund MDR-TB control is available
• In 2015, funding required to control MDR-TB will be nearly $4.5 billion

How did we arrive at this dangerous place?

Tuberculosis thrives in the poorest neighborhoods and in prisons and hospitals that house the poor.  Treatment with antibiotics is effective, but the course of treatment is long, and the side effects can be serious.  Therefore, it is not unusual for patients to abandon their antibiotics too early, giving rise to the MDR strain.  Today the prevalence of MDR-TB is growing, and so is the risk of encountering it on your travels, especially if you are visiting any of the 27 countries with a high burden of TB.

See the chart below for the prevalence of MDR-TB in these countries and the number of cases annually.  Travelers should also note that MDR-TB has a significant foothold in Jordan and Peru.  Further, only 22 of 46 African countries provide data to the WHO.

On the hopeful side, treatment efforts seem to have turned the tide in Estonia, Latvia, Hong Kong, the U.S. and certain parts of Russia. Twenty of the 27 high burden countries are strengthening their efforts by scaling up access to diagnostic tests.  As is so often true, sustained progress depends on increasing resources, expertise and coordination around the globe.  The price tag to control MDR-TB is relatively affordable when compared to global expenditures to combat HIV and H1N1, but until the problem reaches crisis proportions, adequate funding may not materialize.

And don’t bet against the microbes.  They have continued to evolve to elude even more forms of antibiotics.  The Extensively Drug-Resistant (XDR-TB) strain has now appeared in 58 countries, and the WHO estimates there are 25,000 cases annually.