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COVID-19

Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus.

Most people infected with the virus will experience mild to moderate respiratory illness and recover without requiring special treatment. However, some will become seriously ill and require medical attention. Older people and those with underlying medical conditions like cardiovascular disease, diabetes, chronic respiratory disease, or cancer are more likely to develop serious illness. Anyone can get sick with COVID-19 and become seriously ill or die at any age. 

The best way to prevent and slow down transmission is to be well informed about the disease and how the virus spreads. Protect yourself and others from infection by staying at least 1 metre apart from others, wearing a properly fitted mask, and washing your hands or using an alcohol-based rub frequently. Get vaccinated when it’s your turn and follow local guidance.

The virus can spread from an infected person’s mouth or nose in small liquid particles when they cough, sneeze, speak, sing or breathe. These particles range from larger respiratory droplets to smaller aerosols. It is important to practice respiratory etiquette, for example by coughing into a flexed elbow, and to stay home and self-isolate until you recover if you feel unwell.

Source: WHO

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Poliomyelitis

Polio in Nigeria

  • Nigeria and Africa were officially certified by WHO as free from Wild Polio Virus (WPV) in August 2020, an incredible milestone in global polio eradication campaign;
  • Another type of polio virus called cVDPV (Circulating Vaccine-Derived Polio Virus) is still causing polio outbreaks in Nigeria. Since 2016, there have been 61 confirmed cases of cVDPV. Nigeria’s neighboring countries including Benin, the Republic of the Niger and Cameroon are also experiencing the cVDPV outbreaks;
  • Nigeria’s polio eradication programme has responded to the outbreaks by implementing polio immunisation campaigns and strengthening routine immunisation. Thanks to this, the number of cVDPV2 cases has decreased steadily, from 18 in 2019 to 8 in 2020;
  • Nigeria needs to continue its outbreak and using all available tools to deal with cVDPV outbreak to keep Nigeria free from wild polio virus and other types of polio viruses.

Action in Nigeria

  • With support from the Global Polio Eradication Initiative (GPEI), which includes WHOUNICEFGAVICDC and Rotary, NPHCDA plans to conduct two rounds of house-to-house polio nationwide campaign with an aim of vaccinating at least 95 per cent children aged 0-5 years while observing COVID-19 protocols to ensure vaccinators, health workers and communities adhere to COVID-19 precautions and are protected from COVID-19;
  • With support from partners, the NPHCDA will conduct trainings for vaccinators and other health workers on polio immunization and COVID-19 precautions such as wearing of masks, keeping a safe distance and frequent handwashing with soap and clean water. In addition, personal protective equipment such as masks will be provided to all health workers participating in the polio campaign;
  • To better address ongoing outbreaks of type 2 cVDPV, as recommended by WHO, the government of Nigeria is deploying an additional outbreak response tool, the novel oral polio vaccine (nOPV2), which is clinically proven to reduce the risk of cVDPV and is specifically designed to protect children from the only type of poliovirus that remains in Nigeria.

Polio, cVDPV and nOPV2

  • Polio virus, both WPV and cVDPV, cause lifelong paralysis in children under five years of age;
  • There is no cure for polio, but it can be prevented with two drops of the oral polio vaccine;
  • The best protection against polio is ensuring all children are vaccinated during routine and supplementary immunization campaigns, and maintaining strong disease surveillance;
  • Millions of doses of polio drops have been administered throughout the world and have saved millions of children from paralysis;
  • All vaccines for children are safe even if a child is suffering from fever, cough, or diarrhea. Polio vaccine is also safe for newborns, even if they have been born a few hours before;
  • Polio vaccine has little to no side effects and can be given multiple times to boost immunity against the polio virus;
  • If a population is optimally immunized with polio vaccines, they will be protected from all types of polio including WPV and cVDPV;
  • cVDPV occurs when weakened strain of the poliovirus contained in the oral polio vaccine (OPV) circulates among under-immunized population for a long time;
  • cVDPV outbreaks are stopped using same tactics that enabled progress against WPV polio, ensuring every child is given oral polio vaccine in high-quality immunization campaigns;
  • nOPV2 is an improved oral polio vaccine which based on the current oral polio vaccine, that has been proven effective and safe in eradicating wild polio virus from Nigeria;
  • nOPV2 is a modified version of mOPV2, made available through a WHO Emergency Use Listing recommendation to combat type 2 cVDPV outbreak/s affecting Nigeria;
  • nOPV2 is a safe and effective polio vaccine that has been in development for over 10 years and has been thoroughly tested in adults, children and infants across multiple countries;
  • nOPV2 has been approved by the National Agency for Food and Drugs Administration and Control (NAFDAC) and is recommended by WHO for use in controlling polio outbreaks.

Public and Media Support

  • Share accurate information with the public contained on this page to ensure parents are aware of the risk from polio and seek vaccination for their children;
  • Counter rumors and misinformation whenever identified, without repeating the rumors, through facts and correct information on this page;
  • Report rumors and misinformation to NPHCDA so that it can be immediately responded to and stop spread of harmful behaviors;
  • Refrain from exacerbating or repeating rumors and misinformation which can result in negative attitudes towards health workers and the polio campaign by the community;
  • Maintain ethical reporting standards by protecting identities of persons infected with the disease to prevent stigmatization of patients and their families;
  • Inform your families and communities about protecting all children below five years from contracting polio by getting vaccinated during both rounds of the polio campaign 13- 16 March 2021 and 10-13 April 2021;
  • Inform people to seek medical help if their child or a child in their community is suffering from sudden paralysis of one or multiple limbs;
  • Create awareness on the disease and encourage parents to immunize their children against polio;
  • Distribute accurate information with the public based on this document so that parents in Nigeria are aware of the risk from polio virus;
  • Counsel and encourage parents who refuse the polio vaccine and convince them to vaccinate their children, so that their own child and other children in the community can remain safe;
  • Encourage vaccinators and parents to observe all COVID preventive measures; always wash hands with soap and clean water, wear face masks and continue social distancing;
  • Encourage parents and caregivers to always take their children to the nearest health facility so their children can be vaccinated against all vaccine-preventable diseases;
  • Reach out to NPHCDA for accurate information, clarifications interviews and support for stories.

Key Messages

  • All children in Nigeria aged 0-59 months are at an immediate risk of contracting polio virus;
  • Tests have confirmed that polio virus is already circulating in Monrovia. Polio does not respect borders or boundaries hence every child below five years must be protected from the disease;
  • There is an urgent need to ensure all children aged 0-59 months are protected against polio by giving them two drops of the polio vaccine;
  • Polio is a dangerous disease that has no cure and can only be prevented through multiple doses of polio vaccine;
  • Polio vaccine requires multiple doses to achieve complete immunity and ensure the child’s full protection from polio; multiple doses of the polio vaccine pose no harm to children;
  • The best protection against polio is ensuring all children are vaccinated during routine and supplementary immunization campaigns;
  • NPHCDA is conducting two-rounds of house-to-house national polio immunization campaign from 13-16 March 2021 and 10-13 April 2021 in five states: Zamfara, Niger, Sokoto, Bayelsa and Delta and one LGA in FCT: Gwagwalada.;
  • All children below five years must be vaccinated against polio with two drops of polio vaccine during the two rounds of national house-to-house polio immunization campaigns;
  • The polio vaccine is free, safe and efficacious to protect children in Nigeria from the remaining type of polio;
  • Polio vaccine is given in the mouth of the child and only protects from polio. Children need other vaccines to be protected from other diseases;
  • Polio drops have successfully protected millions of children around the world from polio for decades, and continuous protection is needed;
  • Polio drops have safely eradicated the wild poliovirus in Nigeria and globally, with an exception of Pakistan and Afghanistan only;
  • Polio vaccine is recommended for use in Nigeria by the World Health Organization and NAFDAC because it can provide continuous, urgently needed protection against the remaining type of poliovirus;
  • The polio vaccine to be used is clinically shown to be a safe and efficacious option for vaccination against the remaining type of polio in Nigeria.

POLIO FREQUENTLY ASKED QUESTIONS (FAQ)

  1. What is Polio?

Poliomyelitis (polio) is a highly infectious disease caused by poliovirus, a virus which affects mostly children. It has no cure, causes lifelong paralysis in children, and in some cases, it can cause death. The only way to protect children is to give them two drops of the oral polio vaccine during routine immunization and supplementary polio immunization days.

  1. Africa was declared polio free by the World Health Organization, can you explain why we have an outbreak in the country despite the polio free certification?

There are two forms of polio: the wild polio virus (WPV) and circulating vaccine-derived polio virus(cVDPV). Nigeria and therefore the whole Africa eradicated WPV.  WPV remains only in Afghanistan and Pakistan. Nigeria currently has an active outbreak of cVDPV with presence of the virus confirmed in several states.

cVDPV outbreaks occur when the weakened strain of the polio virus contained in the Oral Polio Vaccine (OPV) circulates in under-immunized communities for a long time. While Nigeria has been declared free from WPV, a lot of children remain at risk of cVDPV due to the low immunization rates in Nigeria.

cVDPV outbreaks are stopped using same tactics that enabled progress against WPV polio, ensuring every child is given oral polio vaccine in high-quality immunization campaigns

  1. Why are we reporting cases of the vaccine-derived polio in Nigeria?

Circulating vaccine-derived polio virus (cVDPV) is spreading due to the low immunization coverage in Nigeria and other countries. The COVID-19 pandemic has worsened the already low coverage in the country as most activities were put on hold.

Many parents and caregivers did not immunize their children for fear of leaving their houses due to COVID-19. Rumors and misconceptions around vaccines, especially COVID-19 vaccines, have created fear in communities, leading parents and caregivers to not seek immunization for their children.

The outbreak is attributed to importation and poor hygiene and sanitation in the country. Nigeria is amongst 24 African countries that have reported cVDPV polio outbreaks from 2020-2021

  1. How is cVDPV polio transmitted?

cVDPV, like wild polio virus, is transmitted through the oral-fecal route. The weakened virus is excreted through feces after a child is vaccinated and can easily spread in places with poor hygiene, sanitation, open defecation and overcrowding. This weakened virus can also be transmitted when water, food or hands become contaminated by stool containing the weakened virus. The weakened virus can offer what is called passive immunity to those who have not received the vaccine. However, if a population is seriously under-immunized and the virus is allowed to spread between people for a long period of time, it can become cVDPV.

  1. Who is at risk of contracting polio?

Due to the low immunization rates in the country, all children aged below five years are at high risk especially unvaccinated children or children with low immunity. The best protection against polio is ensuring all children are vaccinated during routine and supplementary immunization campaigns. If a child is optimally immunized with polio vaccines, he/she will be protected from all types of polio.

  1. Why is it important to immunize children again and again with the polio vaccine?

Oral Polio Vaccine (OPV) requires multiple doses to achieve complete immunity in the child and ensure the child’s full protection from polio. Receiving multiple doses of the polio vaccine poses no harm to your child and is completely safe for children.

  1. Will the NPHCDA use the same vaccine to stop the outbreak?

With recommendation from WHO, the NPHCDA is using type 2 Novel Oral Polio vaccine (nOPV2) to stop the polio outbreak. This vaccine is clinically shown to be safe and more efficacious at reducing the risk of cVDPV.

  1. How do we know the vaccine against polio is safe?

nOPV2 is clinically shown to be safe and efficacious in protecting children from the remaining type of polio in Nigeria – type 2 cVDPV. The vaccine is recommended by the World Health Organization (WHO) and the NAFDAC to address this specific type of outbreak. The vaccines are supplied through UNICEF.

Polio vaccines are safe even if the child is suffering from fever, cough, or diarrhea, and is also safe for newborns as young as a few hours old. Polio vaccines have little to no side effects and can be safely given to children multiple times.  All countries except Pakistan and Afghanistan have used oral polio vaccines to eradicate wild polio virus and to protect millions of children from paralysis.

  1. How does the NPHCDA plan to vaccinate all eligible children in the country?

Through two rounds of house-to-house polio campaigns in March and April 2021 in five states (Bayelsa, Delta, Zamfara, Sokoto and Niger) and one LGA in FCT, NPHCDA is targeting to vaccinate more than 7.2 million children below five years while strictly observing COVID-19 protocols to ensure children, vaccinators, health workers and communities are protected.

  1. How will NPHCDA ensure safety of community, health workers and children from COVID-19 during the house-to-house polio campaign?

All vaccinators and health workers who will be engaged in the polio vaccination campaign will strictly adhere to the COVID-19 protocols by wearing masks, keeping a safe distance while in the communities and frequently cleaning their hands with alcohol-based sanitizer.

NPHCDA also urges the public to adhere to all COVID-19 protective measures and support health workers by presenting all children under the ages of five for vaccination whenever a polio team arrives.

The NPHCDA requests the public to ensure that only parents/caregivers support children to open their mouths for the vaccine to be administered. The vaccinators will not have any physical contact with children. All vaccinators must sanitize or wash their hands with soap and clean water before administering the polio vaccine in each home. Mothers/caregivers should wear a mask or cover their nose and mouth with a cloth while holding child for vaccination.

  1. What impact do COVID-19, rumors, misconceptions and disinformation have on the polio campaigns?

COVID-19 rumors and misconceptions have affected routine immunization services as well as polio campaigns all over the world, including in Nigeria. Dissemination of false information regarding vaccines have led to vaccine hesitancy.

NPHCDA would like to reiterate that the polio vaccine is free, safe and efficacious. Polio vaccines have been used globally to protect millions of children from lifelong paralysis. NPHCDA would also like to urge to the public to desist from spreading false information and encourages health workers, community influencers, the media and health experts to counter rumors by providing accurate information to the public.

13. What is nOPV2 and why is it being used?

nOPV2 is an improved type of polio vaccine that has been in development for over 10 years and has been thoroughly tested in adults, children and infants across multiple countries. It has been declared safe and efficacious by the NPHCDA and is recommended for use by WHO to stop cVDPV2 outbreaks around the world.

meningitis

Meningitis

Meningococcal meningitis is a bacterial form of meningitis, a serious infection of the meninges that affects the brain membrane. It can cause severe brain damage and is fatal in 50% of cases if untreated.

Several different bacteria can cause meningitis. Neisseria meningitidis is the one with the potential to cause large epidemics. There are 12 serogroups of N. meningitidis that have been identified, 6 of which (A, B, C, W, X and Y) can cause epidemics. Geographic distribution and epidemic potential differ according to serogroup.

Transmission

The bacteria are transmitted from person-to-person through droplets of respiratory or throat secretions from carriers. Close and prolonged contact – such as kissing, sneezing or coughing on someone, or living in close quarters (such as a dormitory, sharing eating or drinking utensils) with an infected person (a carrier) – facilitates the spread of the disease. The average incubation period is 4 days, but can range between 2 and 10 days.

Neisseria meningitidis only infects humans; there is no animal reservoir. The bacteria can be carried in the throat and sometimes, for reasons not fully understood, can overwhelm the body’s defenses allowing infection to spread through the bloodstream to the brain. It is believed that 10% to 20% of the population carries Neisseria meningitidis in their throat at any given time. However, the carriage rate may be higher in epidemic situations.

Symptoms

The most common symptoms are a stiff neck, high fever, sensitivity to light, confusion, headaches and vomiting. Even when the disease is diagnosed early and adequate treatment is started, 5% to 10% of patients die, typically within 24 to 48 hours after the onset of symptoms. Bacterial meningitis may result in brain damage, hearing loss or a learning disability in 10% to 20% of survivors. A less common but even more severe (often fatal) form of meningococcal disease is meningococcal septicaemia, which is characterized by a haemorrhagic rash and rapid circulatory collapse.

Diagnosis

Initial diagnosis of meningococcal meningitis can be made by clinical examination followed by a lumbar puncture showing a purulent spinal fluid. The bacteria can sometimes be seen in microscopic examinations of the spinal fluid. The diagnosis is supported or confirmed by growing the bacteria from specimens of spinal fluid or blood, by agglutination tests or by polymerase chain reaction (PCR). The identification of the serogroups and susceptibility testing to antibiotics are important to define control measures.

Treatment

Meningococcal disease is potentially fatal and should always be viewed as a medical emergency. Admission to a hospital or health centre is necessary, although isolation of the patient is not necessary. Appropriate antibiotic treatment must be started as soon as possible, ideally after the lumbar puncture has been carried out if such a puncture can be performed immediately. If treatment is started prior to the lumbar puncture it may be difficult to grow the bacteria from the spinal fluid and confirm the diagnosis.

A range of antibiotics can treat the infection, including penicillin, ampicillin, chloramphenicol and ceftriaxone. Under epidemic conditions in Africa in areas with limited health infrastructure and resources, ceftriaxone is the drug of choice.

Prevention

There are 3 types of vaccines available.

  • Polysaccharide vaccines have been available to prevent the disease for over 30 years. Meningococcal polysaccharide vaccines are available in either bivalent (groups A and C), trivalent (groups A, C and W), or tetravalent (groups A, C, Y and W) forms to control the disease.
  • For group B, polysaccharide vaccines cannot be developed, due to antigenic mimicry with polysaccharide in human neurologic tissues. The first vaccine against NmB, made from a combination of 4 protein components, was released in 2014.
  • Since 1999, meningococcal conjugate vaccines against group C have been available and widely used. Tetravalent A, C, Y and W conjugate vaccines have been licensed since 2005 for use in children and adults in Canada, the United States of America, and Europe.

The extended meningitis belt of sub-Saharan Africa, stretching from Senegal in the west to Ethiopia in the east (26 countries), has the highest rates of the disease. The 26 countries include: Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Côte d’Ivoire, Democratic Republic of Congo, Eritrea, Ethiopia, The Gambia, Ghana, Guinea, Guinea Bissau, Kenya, Mali, Mauritania, Niger, Nigeria, Rwanda, Senegal, South Sudan, Sudan, Tanzania, Togo and Uganda. The risk of meningococcal meningitis epidemics differs within and among these 26 countries.

In December 2010, a new meningococcal A conjugate vaccine was introduced nationwide in Burkina Faso, and in selected regions of Mali and Niger (the remaining regions were covered in 2011), targeting persons 1 to 29 years of age. As of June 2015, 220 million persons have been vaccinated with this vaccine in 16 countries (Benin, Burkina Faso, Cameroon, Chad, Côte d’Ivoire, Ethiopia, The Gambia, Ghana, Guinea, Mali, Mauritania, Niger, Nigeria, Senegal, Sudan, and Togo).

The MenA conjugate vaccine has several advantages over existing polysaccharide vaccines:

  • it induces a higher and more sustainable immune response against group A meningococcus;
  • it reduces the carriage of the bacteria in the throat and thus its transmission;
  • it is expected to confer long-term protection not only for those who receive the vaccine, but on family members and others who would otherwise have been exposed to meningitis;
  • it is available at a lower price than other meningococcal vaccines (around 0.50 USD per dose, other meningococcal vaccine prices range from 2.50 USD to 117.00 USD per dose); and
  • it is expected to be particularly effective in protecting children under two years of age, who do not respond to conventional polysaccharide vaccines.

In addition, its thermostability allows for a use under Controlled Temperature Chain (CTC) conditions. More than 2 million persons in 4 countries have been vaccinated without ice use at the vaccination site.

It is planned that all 26 African countries considered at risk for meningitis epidemics and targeted by this vaccine introduction programme will have introduced this vaccine by 2016. High coverage of the target age group of 1–29 years is expected to eliminate meningococcal A epidemics from this region of Africa.

Outbreak trends

Meningococcal meningitis occurs in small clusters throughout the world with seasonal variation and accounts for a variable proportion of epidemic bacterial meningitis.

The largest burden of meningococcal disease occurs in an area of sub-Saharan Africa known as the meningitis belt, which stretches from Senegal in the west to Ethiopia in the east. During the dry season between December to June, dust winds, cold nights and upper respiratory tract infections combine to damage the nasopharyngeal mucosa, increasing the risk of meningococcal disease. At the same time, transmission of N. meningitidis may be facilitated by overcrowded housing and by large population displacements at the regional level due to pilgrimages and traditional markets. This combination of factors explains the large epidemics which occur during the dry season in the meningitis belt.

Following the successful roll-out of the MenA conjugate vaccine, epidemics due to N. meningitidis serogroup A are disappearing, but other meningococcal serogroups such as NmW, NmX and NmC still cause epidemics albeit at a lower frequency and smaller size.

Source : WHO
Photo Credit: SundiataPost

tubercolosis

Tuberculosis

Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis is curable and preventable.

TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.

About one-third of the world’s population has latent TB, which means people have been infected by TB bacteria but are not (yet) ill with the disease and cannot transmit the disease.

People infected with TB bacteria have a 10% lifetime risk of falling ill with TB. However, persons with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a much higher risk of falling ill.

When a person develops active TB disease, the symptoms (such as cough, fever, night sweats, or weight loss) may be mild for many months. This can lead to delays in seeking care, and results in transmission of the bacteria to others. People with active TB can infect 10–15 other people through close contact over the course of a year. Without proper treatment, 45% of HIV-negative people with TB on average and nearly all HIV-positive people with TB will die.

Who is most at risk?

Tuberculosis mostly affects adults in their most productive years. However, all age groups are at risk. Over 95% of cases and deaths are in developing countries.

People who are infected with HIV are 20 to 30 times more likely to develop active TB (see TB and HIV section below). The risk of active TB is also greater in persons suffering from other conditions that impair the immune system.

One million children (0–14 years of age) fell ill with TB, and 170 000 children (excluding children with HIV) died from the disease in 2015.

Tobacco use greatly increases the risk of TB disease and death. More than 20% of TB cases worldwide are attributable to smoking.

Global impact of TB

TB occurs in every part of the world. In 2015, the largest number of new TB cases occurred in Asia, with 61% of new cases, followed by Africa, with 26% of new cases.

In 2015, 87% of new TB cases occurred in the 30 high TB burden countries. Six countries accounted for 60% of the new TB cases: India, Indonesia, China, Nigeria, Pakistan, and South Africa. Global progress depends on advances in TB prevention and care in these countries.

Symptoms and diagnosis

Common symptoms of active lung TB are cough with sputum and blood at times, chest pains, weakness, weight loss, fever and night sweats. Many countries still rely on a long-used method called sputum smear microscopy to diagnose TB. Trained laboratory technicians look at sputum samples under a microscope to see if TB bacteria are present. Microscopy detects only half the number of TB cases and cannot detect drug-resistance.

The use of the rapid test Xpert MTB/RIF® has expanded substantially since 2010, when WHO first recommended its use. The test simultaneously detects TB and resistance to rifampicin, the most important TB medicine. Diagnosis can be made within 2 hours and the test is now recommended by WHO as the initial diagnostic test in all persons with signs and symptoms of TB. More than 100 countries are already using the test and 6.2 million cartridges were procured globally in 2015.

Diagnosing multi-drug resistant and extensively drug-resistant TB (see Multidrug-resistant TB section below) as well as HIV-associated TB can be complex and expensive. In 2016, 4 new diagnostic tests were recommended by WHO – a rapid molecular test to detect TB at peripheral health centres where Xpert MTB/RIF cannot be used, and 3 tests to detect resistance to first- and second-line TB medicines.

Tuberculosis is particularly difficult to diagnose in children and as yet only the Xpert MTB/RIF assay is generally available to assist with the diagnosis of paediatric TB.

Treatment

TB is a treatable and curable disease. Active, drug-susceptible TB disease is treated with a standard 6 month course of 4 antimicrobial drugs that are provided with information, supervision and support to the patient by a health worker or trained volunteer. Without such support, treatment adherence can be difficult and the disease can spread. The vast majority of TB cases can be cured when medicines are provided and taken properly.

Between 2000 and 2015, an estimated 49 million lives were saved through TB diagnosis and treatment.

TB and HIV

At least one-third of people living with HIV worldwide in 2015 were infected with TB bacteria. People living with HIV are 20 to 30 times more likely to develop active TB disease than people without HIV.

HIV and TB form a lethal combination, each speeding the other’s progress. In 2015 about 0.4 million people died of HIV-associated TB. About 35% of deaths among HIV-positive people were due to TB in 2015. In 2015 there were an estimated 1.2 million new cases of TB amongst people who were HIV-positive, 71% of whom were living in Africa.

WHO recommends a 12-component approach of collaborative TB-HIV activities, including actions for prevention and treatment of infection and disease, to reduce deaths.

Multidrug-resistant TB

Anti-TB medicines have been used for decades and strains that are resistant to 1 or more of the medicines have been documented in every country surveyed. Drug resistance emerges when anti-TB medicines are used inappropriately, through incorrect prescription by health care providers, poor quality drugs, and patients stopping treatment prematurely.

Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not respond to isoniazid and rifampicin, the 2 most powerful, first-line anti-TB drugs. MDR-TB is treatable and curable by using second-line drugs. However, second-line treatment options are limited and require extensive chemotherapy (up to 2 years of treatment) with medicines that are expensive and toxic.

In some cases, more severe drug resistance can develop. Extensively drug-resistant TB (XDR-TB) is a more serious form of MDR-TB caused by bacteria that do not respond to the most effective second-line anti-TB drugs, often leaving patients without any further treatment options.

About 480 000 people worldwide developed MDR-TB in 2015. In addition, around 100 000 people developed resistance to rifampicin (the most effective first-line medicine) and needed MDR-TB treatment. The MDR-TB burden largely falls on 3 countries – China, India, and the Russian Federation – which together account for nearly half of the global cases. About 9.5% of MDR-TB cases had XDR-TB in 2015.

Worldwide, only 52% of MDR-TB patients and 28% of XDR-TB are currently successfully treated. In 2016, WHO approved the use of a short, standardised regimen for MDR-TB patients who do not have strains that are resistant to second-line TB medicines. This regimen takes 9–12 months and is much less expensive than the conventional treatment for MDR-TB, which can take up to 2 years. Patients with XDR-TB or resistance to second-line anti-TB drugs cannot use this regimen, however, and need to be put on longer MDR-TB regimens to which 1 of the new drugs (bedquiline and delamanid) may be added.

WHO also approved in 2016 a rapid diagnostic test to quickly identify these patients. More than 20 countries in Africa and Asia have started using shorter MDR-TB regimens. By the end of 2015, 70 countries had introduced bedaquiline and 39 countries had introduced delamanid, in an effort to improve the effectiveness of MDR-TB treatment regimens.

Source: WHO
Photo Credit: Nigeria Health Watch