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¹û¶³Ö±²¥ÊÓƵ – TB resurges as leading cause of infectious disease deaths

LSHTM expert explains why identifying and treating asymptomatic TB cases may be key to minimising spread
“We need new ways to go after TB. Rather than wait for people to get very ill and infect others, we need to find TB early to prevent transmission and protect people from long-term lung damage." Rein Houben, Professor of TB Epidemiology, LSHTM

The highest number of tuberculosis (TB) cases since global monitoring began were recorded in 2023, according to a published by the World Health Organization (WHO).

TB is an infectious disease caused by bacteria. It mostly affects the lungs and is spread through the air through coughing, sneezing and saliva. The infection is preventable and usually curable with antibiotics. If treated, most patients will survive.

Despite this, a total of 1.25 million people died from TB in 2023, including 161 000 people with HIV. The WHO report estimates that TB has likely returned to being the world’s leading cause of death from a single infectious agent, following three years in which it was replaced by COVID-19.

Rein Houben, Professor of TB Epidemiology at the London School of Hygiene & Tropical Medicine (LSHTM), is leading on work which looks to understand how important asymptomatic TB is in onwards transmission. The work of his team, alongside global collaborators, feeds into WHO’s activities in TB care and monitoring around the world.

Professor Houben said: “Tuberculosis has been and remains an enormous problem, and this WHO announcement brings attention to just how big a challenge we face, and the opportunities we need to take.

“There are two clear messages here. More people than ever got diagnosed and treated for TB, which is good. But this is matched by more people getting TB, which is a major problem.

“Every year an estimated 10 million families have to deal with TB, with all the costs and consequences it brings. Unless we do something different, another 10 million will have to deal with TB again next year.

“The challenge we have is that even with treating eight million people we are still not seeing a drop in cases. One reason may be the continued effect of disrupted care during COVID-19. However, the biggest reason is that our current approaches to tackling TB are failing to stop transmission.

“Current TB policies are passive and wait for people to fall unwell with symptoms that drive them to seek healthcare. But we now understand that half or more of infectious TB is likely asymptomatic, and we have shown that even if our current policies work perfectly, most transmission is missed.

“We need new ways to go after TB. Rather than wait for people to get very ill and infect others, we need to find TB early to prevent transmission and protect people from long-term lung damage. The other priority is an effective vaccine, but that is at least several years away and we should not wait to take action.

“With this report, we need to make sure that research and conversations around TB remain a priority everywhere, so we support TB patients, their families and those on the frontline pushing back against this disease.â€

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