1. What, Where, How and Action Steps… XDR-TB
Extensively Drug-Resistant Tuberculosis
What, Where, How
and Action Steps…

2. Confirmed cases to date
Countries with XDR-TB
Confirmed cases to date
Argentina
Armenia
Bangladesh
Brazil
Canada
Chile
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.  WHO All rights reserved
China, Hong Kong SAR
Czech Republic
Ecuador
France
Portugal
Georgia
Republic of Korea
Germany
Russian Federation
Islamic Republic of Iran
Italy
South Africa
Japan
Spain
Latvia
Sweden
Mexico
Thailand
Norway UK
Based on information provided to WHO Stop TB Department March 2007
Peru
USA

3. Emergence of XDR-TB March 2006
XDR = Multidrug-resistant TB (MDR-TB) plus resistance to (i) any fluoroquinolone, and (ii) at least 1 of 3 injectable second-line drugs capreomycin, kanamycin, amikacin (new definition agreed October 2006)
MDR-TB = resistance to at least isoniazid and rifampicin, the two most powerful first-line anti-TB drugs
Of 17,690 isolates from 49 countries during , 20% were MDR-TB and 2% were XDR-TB
XDR-TB found in:
USA: 4% of MDR-TB
Latvia: 19% of MDR-TB
S Korea: 15% of MDR-TB

4. Given the underlying HIV epidemic in Africa,
XDR-TB in Southern Africa
August 2006
Church of Scotland Hospital, Tugela Ferry,
KwaZulu-Natal Province, South Africa
53 of 544 patients defined as XDR-TB cases
52 of the 53 patients died on average within 25 days, including those on antiretroviral therapy
Further investigations being carried out
XDR-TB likely in bordering African countries
Given the underlying HIV epidemic in Africa,
drug-resistant TB could have a major impact on mortality and requires urgent action on care and prevention

5. WHO Stop TB Strategy addresses
drug resistance by strengthening TB control 14

6. The Stop TB Strategy & The Global Plan
However,
Even at maximum DOTS coverage, case detection seems to remain below the 70% target level in most settings (Dye et al 2002)
So we need innovative approaches to case detection.
The DEWG is a mechanism to do whatever it needs to be done
We need to ensure we make good use of it.
The 2nd ad hoc Committee produced some recommendations for action, the DEWG is a tool to facilitate/implement some of them.
The Stop TB Strategy strengthens TB control,
preventing the emergence of drug-resistant TB…
…and underpins the Stop TB Partnership's Global Plan to Stop TB ,
to treat 50 million patients and save 14 million lives

7. WHO Global Task Force on XDR-TB, October 2006
International response
to the XDR-TB emergency
WHO Global Task Force on XDR-TB, October 2006
"Priority for the immediate strengthening of TB control in countries"
Accelerate access to rapid tests for rifampicin resistance
Ensure adherence to WHO drug resistance guidelines, improve programme management, access to MDR-TB drugs under proper conditions including direct observation. Ensure all patients with HIV are adequately treated for TB and started on antiretroviral therapy
Accelerate implementation of infection control measures to reduce transmission especially among those HIV positive
Strengthen laboratory capacity to diagnose, manage and survey drug resistance. Commence rapid survey so that the size of the XDR-TB epidemic can be determined
Initiate information-sharing strategies that promote prevention, treatment and control of XDR-TB

8. to respond to the XDR-TB emergency
Resources needed in 2007
to respond to the XDR-TB emergency
Estimated needs for 14 Southern African Development Community countries from November 2006 to end 2007
US$
Costs in the 14 countries:
$35m: Strengthening XDR-TB response: human resources development, lab strengthening, infection control, surveillance, monitoring and evaluation, community health, cross border collaboration, communication and health education etc.
$40m: Second line anti-TB drugs to 9,000 MDR-TB and XDR-TB patients
$ 5m: Rapid diagnostic tests to 154,000 MDR-TB and XDR-TB suspects
$80 million
Technical assistance costs (coordinated by WHO and provided by WHO and partners):
$9,460,000: Strengthening of general TB and TB/HIV control in countries most affected by XDR-TB by provision of technical assistance by international organizations and human resource development
$ 450,000: Revision of the Global Plan to Stop TB to reflect XDR-TB (not restricted to Africa)
$1,230,000: Support for management of persons suspected of having MDR-TB or XDR-TB
$1,200,000: Laboratory strengthening: development/revision of global and country strategic plans, strengthening of the global Supranational TB Reference Laboratory Network
$ 375,000: Infection control: updating of guidelines, training of consultants
$1,700,000: XDR-TB surveillance: establishment of regional reference laboratories in the African Region, support to countries by the Supranational Reference Laboratory Network, rapid XDR-TB surveys
$ 285,000: Advocacy, communication and social mobilization: communication support, advocacy materials, health education tools etc.
$ 100,000: Planning and resource mobilization support and coordination of partners
$ 200,000: Research and Development Strategy: meeting with TB diagnostics, drugs and vaccine working groups and partners
$15 million
TOTAL
$95 million

9. XDR-TB
The Facts
Drug-resistant TB poses a grave public health threat especially in populations with high HIV rates
XDR-TB occurs as a result of poorly-managed TB control programmes
XDR-TB, if identified early, can be treated and cured in some cases under proper TB control conditions, based on the experiences in a few successful programmes where HIV prevalence was low
Infection control measures must be strengthened everywhere, and especially where HIV prevalence is high, to protect the vulnerable and those at risk of XDR-TB
XDR-TB strains have been found in all regions of the world, although still thought to be uncommon 
XDR-TB underlines the need for investment in the development of new TB diagnostics, treatments and vaccines, since the current tools are outdated and insufficient

10. World Health Organization Leading the fight against TB and XDR-TB
"We will build greater momentum to control malaria, TB and neglected diseases"
Dr Margaret Chan
WHO Director-General Elect Acceptance speech to
the World Health Assembly
"WHO is absolutely committed to supporting country efforts to fight TB in all forms"
Dr Anders Nordström
WHO Acting Director-General Address to the Global Task Force on XDR-TB
"WHO Stop TB, with full resources in place, will ensure the response to the XDR-TB emergency is effective and robust"
Dr Mario Raviglione
WHO Director
Stop TB Department

11. XDR-TB For more information: WHO Stop TB: Stop TB Partnership:
for latest XDR-TB data, country reports, monthly updates, guidelines, FAQs,
Stop TB Partnership:
for information on XDR-TB activities of the Partnership's Working Groups and
its 500 partners