University of Milan, Italy
Stop TB Department, World Health Organization, Switzerland
Tuberculosis has been a disease of human beings for some ten thousand years, and even affected our Neanderthal cousins. It emerged as a major epidemic disease particularly in North West Europe during the 17th century, accounting for the deaths of perhaps one per cent of the population annually in the... read moreworst affected areas. From there it has colonised almost all populations and now nearly nine million people develop tuberculosis each year, with one and half million deaths. Over the last thirty years tuberculosis has developed a cruel synergy with the human immunodeficiency virus, leading to a fourfold rise in tuberculosis in sub-Saharan Africa. It is a disease of poverty, but even barristers can catch it.
Tuberculosis, together with AIDS and malaria, is seen as one of the three infectious plagues of the developing world, and a low-cost approach to controlling it has been developed based on public health principles and structures. Partly as a result, numbers of cases and deaths are now falling in most parts of the world, although rising wealth, nutrition and better living conditions also play a part. In the industrialised countries, as tuberculosis cases fell in the 1950s and 60s, responsibility for control of the disease was integrated into the general systems of provision of medical care. Now rates of tuberculosis remain low but they have stagnated thus raising the question as to whether elimination will be possible.
One of the earliest vaccines was developed against tuberculosis, the BacilleCalmette-Guérin or BCG, although it is far from being completely effective. Efforts to find treatments against tuberculosis resulted in the first controlled clinical trial in 1948. The development of drug resistance then led to the introduction of multi drug regimens, but now we are faced with cases, especially in Eastern Europe, which are resistant to almost all drugs.
Research was revitalised into tuberculosis around the turn of the millennium and is focused on the development of new tools. Although cell-mediated immunity has been known for decades to be the main defence against the Mycobacterium that causes tuberculosis, the development of new vaccines has proven to be very hard, although some are now reaching clinical trials. New drugs are more promising and the diagnosis of tuberculosis has been revolutionized by DNA-based technologies that are now being introduced all over the world.