Tuberculosis is the world’s deadliest infectious disease, killing 1.7 million people each year. There has been little progress lowering the rate of new cases of the disease — and in some countries, it may be increasing. In an editorial, infectious disease expert Barry Bloom of Harvard T.H. Chan School of Public Health outlines the health system failures behind the global TB epidemic, and argues that systems’ ability to diagnose and treat TB must be strengthened to control the disease.

The editorial was published in the Jan. 18, 2018 issue of the New England Journal of Medicine.

Current TB control strategies largely depend on patients with symptoms seeking treatment, but this can miss a third of cases, writes Bloom, Joan L. and Julius H. Jacobson Research Professor of Public Health. There is no inexpensive diagnostic test for TB, increasing the chance in low-income countries that cases will be missed. Although an effective treatment regime exists for patients with drug-sensitive TB, it requires multiple drugs given for six to nine months, which can be a significant burden. According to Bloom, only 45 percent of patients with any form of tuberculosis complete treatment by one year.

In an accompanying paper, researchers found that by studying household contacts of TB patients in Vietnam, they were better able to detect early and asymptomatic cases.

Bloom writes in his editorial that this is an important new finding. “At a time when support for biomedical research and foreign aid is threatened, better tools, including active case finding in high-burden countries, are critically needed to improve control of the largest cause of death from an infectious disease and to improve the lives of millions of people.”

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