Multidrug-resistant

tuberculosis (MDR-TB)
October 2013 Update
WHO October 2013 (GTB number C7) For more information: www.who.int/tb/challenges/mdr
Detection of MDR-TB cases (red line) and additional rifampicin-resistant TB (RR-TB)
cases (blue) compared with TB cases enrolled on MDR-TB treatment (green), trends
between 2009 and 2012 in the 27 high MDR-TB burden countries and globally
Key findings:
Drug-resistance among TB cases:
about 3.6% of new tuberculosis (TB)
patients in the world have multidrug-
resistant strains (MDR-TB). Levels are
much higher about 20% - in those
previously treated for TB. The frequency
of MDR-TB varies substantially between
countries. About 10% of MDR-TB cases
are also resistant to the two most
important second-line drug classes, or
extensively drug-resistant TB (XDR-TB).
By September 2013, 92 countries had
reported at least one XDR-TB case.
MDR-TB case-load and deaths: WHO
estimates that there were about 450,000
new (incident) MDR-TB cases in the
world in 2012. More than one half of
these cases occurred in China, India, and
the Russian Federation. About 170,000
MDR-TB deaths are estimated to have
occurred in 2012.
Detection of MDR-TB patients: is
increasing. Almost 84,000 patients with
MDR-TB were notified to WHO globally
in 2012, up from 62,000 in 2011. The
biggest increases were in India, South
Africa and Ukraine. Only about 9% of
retreatment TB cases had DST results
reported although the proportion was
much higher in certain high burden
countries.
Enrolments on MDR-TB treatment in
2012: were equivalent to one in four of
the MDR-TB cases estimated to occur
among pulmonary TB patients notified in
the world. The ratio of enrolments to
MDR-TB cases detected was about 92%
but varied widely by country (upper
graphic).
Treatment success: 48% of patients
with MDR-TB enrolled on treatment in
2010 were reported to have been
successfully treated (lower graphic).
More patients have been monitored for
outcomes over time but the proportion
without outcome data remains high.
Treatment outcomes for MDR-TB patients started on treatment globally, 2007-2010.
The number of MDR-TB cases monitored shown beside each bar.
www.who.int/tb/
FUNDING FOR MDR-TB
In 2009, the World Health Assembly urged WHO Member States
"to achieve universal access to diagnosis and treatment of MDR-TB and XDR-TB by 2015
WHAT ARE MDR-TB, XDR-TB AND RR-TB ?
TB organisms resistant to the antibiotics used in its treatment are widespread and occur in all countries surveyed. Drug resistance
emerges as a result of inadequate treatment and once TB organisms acquire resistance they can spread from person to person in
the same way as drug-sensitive TB.
Multidrug-resistant TB (MDR-TB) is caused by organisms that are resistant to at least the two most effective anti-TB drugs,
isoniazid and rifampicin.
Extensively drug-resistant TB (XDR-TB) is a form of TB caused by organisms that are resistant to isoniazid and rifampicin (i.e.
MDR-TB) as well as any fluoroquinolone and any of the secondline anti-TB injectable drugs (amikacin, kanamycin or capreomycin).
Rifampicin-resistant TB (RR-TB) is caused by organisms that are resistant to rifampicin, with or without resistance to other drugs.
Both MDR-TB and XDR-TB are forms of RR-TB.
These forms of TB do not respond to the standard six month treatment with first-line anti-TB drugs and can take two years or
more to treat with drugs that are less effective, more toxic and more expensive.
In 2015, it is estimated that about 20% of the
USD 8 billion that low- and middle-income
countries require for TB care and control will
be needed for the treatment of MDR-TB. In
2013, funding available for MDR-TB is
expected to reach USD 1 billion in countries
reporting data. Costs for second-line drugs
alone amount to USD 0.4 billion in 2013. The
countries with the greatest amount of
funding available for MDR-TB in 2013 were
India, Kazakhstan, the Russian Federation,
South Africa, and Ukraine.
THE GLOBAL RESPONSE TO MDR-TB AND XDR-TB
Enrolment on MDR-TB treatment (blue squares, 2009
2012), compared with the targets in the Global Plan to
Stop TB, 20112015 (green line) and projections
provided by countries (green circles)
The Global Plan to Stop TB, 2011-2015
envisages that in order to progress towards
universal access, about one million MDR-TB
patients need to be placed on treatment
between 2011 and 2015. The Plan also aims
to have at least 75% of MDR-TB patients
completing their treatment successfully by
2015. In 2012, about 45% of cases targeted
to be placed on treatment globally that year
were reported to have been enrolled.
Among MDR cases starting treatment in
2010, the 75% treatment success threshold
was achieved by 34 of the 107 countries
reporting outcomes.
WHO October 2013 (GTB number C7) For more information: www.who.int/tb/challenges/mdr