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Australia’s critical role in TB control

Tuberculosis (TB) is one of the world’s great killers, and it is time for Australia to step up and play a role in assisting developing countries in our region, according to the authors of an editorial published today in the Medical Journal of Australia.

Dr James Trauer from Monash University and Professor Allen Cheng from Alfred Health in Melbourne wrote that TB, particularly drug-resistant TB, is not a problem that is about to go away.

“Many countries are now reporting significant rates of drug-resistant tuberculosis, with at least 480 000 cases worldwide now attributable to multidrug-resistant TB (MDR-TB; defined as resistance to the two most effective first-line agents, isoniazid and rifampicin),” they wrote.

Australia has been relatively protected thanks to a strong public health system, with 90% of the 1300 cases reported each year occurring in people born overseas.

Most cases occur in large immigrant communities from India, Vietnam, the Philippines, China and Nepal, and usually occur in permanent residents and students rather than refugees or those on humanitarian visas.

Globally, MDR-TB made up approximately 3.3% of new and 20% of retreatment cases in 2014. However, countries with the highest rates of drug resistance often have the poorest quality data, generally due to a lack of testing. For example, although numbers in one of our neighbours, Papua New Guinea, are estimated to be similar to the global percentages, “a nationwide drug-resistance survey has not been undertaken and other data sources suggest that the rates could be underestimates” the authors wrote.

The US National Action Plan for Combating MDR-TB provides a vision for expanded international response and includes coordinated responses from global partners, governments, multinational organisations, affected individuals and communities, Trauer and Cheng wrote.

“Given that 57% of MDR-TB cases occur in the Asia””Pacific region, a similar response to improve clinical diagnostics and management in our region would help keep MDR-TB from our shores,” they wrote.

The authors say ambitious post-2015 targets for TB control provide an opportunity for Australian leadership. “Australia has a critical role to play in supporting developing countries of our region to improve TB control programs and their health systems generally.”