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1 1 (December 27, 2018)

handle is hein.crs/govyxa0001 and id is 1 raw text is: ~ Infrn iii th s' %aiv dat sir.14 Updated December 27, 2018 Global Trends: Tuberculosis Tuberculosis (TB) remains a major, and evolving, health challenge in many parts of the world and a priority for the U.S. Congress and international community. The U.S. government is one of the largest donors to global TB control efforts. The 116th Congress may consider future funding needs for TB control, particularly for vaccine research and disease surveillance and detection through strengthening health care infrastructure. Tuberculosis Transmission and Prevalence. Infectious diseases cause over 25% of deaths globally, and TB is the leading cause of death from a single infectious agent. TB is spread through the air, such as when a person inhales germs from an infected person's cough or sneeze. An estimated 23% of the global population is infected with TB bacteria, and about 10% of individuals infected with the TB bacteria will develop active TB. Latent TB becomes active and transmittable when a person's immune system is suppressed, for example due to pregnancy, chemotherapy, or HIV/AIDS. The latter represents a serious public health concern, as people with HIV are 20 to 30 times more likely to develop active TB than those without HIV. TB is considered a disease of poverty, and the global disease burden is uneven. India, China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh, and South Africa account for two-thirds of TB cases worldwide (see Figure 1). In countries without comprehensive health care infrastructure, TB control is especially difficult. The WHO estimates that 3.6 million TB cases are undetected annually, primarily because of inadequate monitoring and surveillance capacity. Figure I. Burden of New TB Cases in 2017, by WHO Region Africa Americas E. Mediterranean Europe South-East Asia Western Pacific Source: CRS graphic created using WHO data, 2018. Diagnosis and Treatment. TB is generally diagnosed using rapid molecular tests, sputum smear microscopy, and culture-based methods. Many countries rely on the second to diagnose TB, because it is the cheapest method. However, that method detects only half of all TB cases and cannot detect Rifampicin Resistant-TB (known as RR-TB which is resistance to the first line TB drug Rifampicin), or Multi Drug Resistant (MDR)-TB. Drug-susceptible TB is treated by a six-month course of four antimicrobial drugs. The majority of cases are curable when medicines are available and patients adhere to treatment. On average, 85% of drug-susceptible TB cases were cured in 2017. If patients do not complete the treatment regiment, they can develop MDR-TB-when TB does not respond to at least two anti-TB drugs. MDR-TB is a top concern of many global health experts because MDR- TB carriers can transmit resistant forms of TB to others. Of those who contracted MDR-TB in 2017, 55% survived. Figure 2. Global TB Mortality Rate, 2000-2016 TB mortality (HIV-negative) 30 a 1; 20- a 10- 0 - 2000 2008 2016 Source: WHO Global TB Report, 2017. Global Developments The international community has made significant strides in curbing TB deaths worldwide (see Figure 2); however, the disease continues to spread, mostly unabated. The international community has adopted several multiyear plans to combat TB. In 2018, reflecting a deepening global commitment to TB eradication, the WHO, the Stop TB Partnership, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) launched a joint initiative to scale up access to TB prevention and care. The End TB Strategy focuses on 30 high-burden countries to diagnose, treat and report an additional 40 million people with TB. The aim is a 95% reduction in TB deaths by 2035 and a 90% reduction in the TB incidence rate compared with 2015 levels. The strategy calls for bringing together https://crsreportstcongress~go

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