Make TB a Disease of the Past

Christine F Sizemore PhD, Richard E Hafner MD, and Anthony S Fauci MD, National Institute of Allergy and Infectious Diseases, National Institutes of Health in Native Health. Discussion »

BETHESDA, MARYLAND – Today is World TB Day. This year's theme, Eliminate TB in My Lifetime, boldly challenges us to improve and expand tuberculosis (TB) control and related research efforts that recently have led to slowly declining rates of illness and death from this ancient disease.

Eliminate TB

American Indians and Alaska Natives rate of tuberculosis infection is still about six times higher than whites. Minority groups tend to have more tuberculosis risk factors than whites. Tuberculosis risk factors include lower economic status and HIV infection.

Even with the technological advances available in the early part of the 21st century, the elimination of tuberculosis will be an enormous task. Tuberculosis claimed 1.45 million lives worldwide in 2010, according to the World Health Organization. An estimated one third of the world's population is latently infected with the bacterium that causes tuberculosis, meaning they experience no symptoms but are at risk for developing active disease.

Among people with HIV/AIDS, tuberculosis is a major co-infection and the leading cause of death, responsible for killing approximately 350,000 HIV infected individuals in 2010. The interface of the tuberculosis and HIV epidemics and the continuing emergence of drug resistant tuberculosis are serious threats to achieving TB control worldwide. Although recent progress against the disease is heartening, the control and eventual elimination of tuberculosis will require a long term, multifaceted commitment from the global health and research communities.

Tuberculosis control and the care of TB infected people are being improved by making existing tuberculosis interventions more accessible and affordable, as well as simpler to administer. Comprehensive tuberculosis control can be markedly enhanced, however, with better medical tools.

To transform the field, we must address long standing challenges in tuberculosis research, such as identifying the factors involved in the immune control of latent tuberculosis infection that allow 90 percent of otherwise healthy TB infected individuals to never develop active disease.

We need to use novel scientific tools and apply modern approaches to answer this and other fundamental questions. High throughput sequencing, for example, can efficiently analyze the genomes of drug sensitive and drug resistant tuberculosis strains and help us to identify genetic markers useful for developing tests to quickly detect resistance to anti-TB drugs.

A systems biology approach helps us make sense of the complex networks of biological responses in the tuberculosis bacterium on the part of the human host so we can better understand the disease and give direction to vaccine and drug discovery projects. In this regard, a renewed focus on fundamental tuberculosis research will enable us to refine our strategies for developing and applying innovative interventions against tuberculosis.To this end, the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health leads the US government's biomedical research effort in TB and supports scientists worldwide engaged in these efforts.

An important milestone in modernizing tuberculosis control was the WHO Global Tuberculosis Control Report 2011, which for the first time included biomedical research as a critical component of the global fight against tuberculosis. Integrating biomedical research into the framework of global tuberculosis control is an essential component of the WHO report as well as other recent strategic documents developed by the TB research community, including An International Roadmap for Tuberculosis Research and the updated Strategic Blueprint for TB vaccines. These collaborative efforts to identify gaps and opportunities in biomedical research are critical for developing new interventions and control strategies.

Eliminating tuberculosis in a generation, while an ambitious goal, can become a reality through the continued commitment and collaboration of the key stakeholders in biomedical research and global health. To date, these efforts have provided the knowledge and novel methodologies to develop a robust pipeline of new tuberculosis countermeasures. Fostering even closer integration of biomedical research with the tuberculosis control community will help assure that new medical tools are applied in the most effective manner to make tuberculosis a disease of the past.

For more information about tuberculosis, visit NIAID's Tuberculosis Web portal and the HHS Healthfinder link on Tuberculosis.

Anthony S Fauci MD, is director of National Institute of Allergy and Infectious Diseases. Richard E Hafner MD, is acting chief of the TB Clinical Research Branch in the National Institute of Allergy and Infectious Diseases Division of AIDS; Christine F Sizemore PhD, is chief of the Tuberculosis and Other Mycobacterial Diseases Section in the National Institute of Allergy and Infectious Diseases Division of Microbiology and Infectious Diseases. All are part of the National Institutes of Health.

posted March 23, 2012 6:00 am edt