Transcript of WHO podcast - 27 February 2008

Highest rates of multidrug-resistant TB recorded; yellow fever vaccines on their way to Paraguay.

Veronica Riemer: You're listening to the WHO podcast. My name is Veronica Riemer. This is episode 28.

In this episode: Multidrug-resistant tuberculosis has been recorded at the highest rate ever, and WHO and partners ship vaccines to Paraguay in response to outbreak of yellow fever.

Story 1

Multidrug-resistant tuberculosis (MDR-TB) has hit the highest rates ever with nearly half a million new cases every year. A World Health Report published this week analysed information collected from over 90 000 TB patients in 81 countries worldwide. Forty-five of those countries also reported the incidence of extensively drug-resistant tuberculosis, a virtually untreatable form of the respiratory disease.

Dr Mario Raviglione, Director of the Stop TB Department, explains the problem.

Dr Mario Raviglione: Drug-resistant tuberculosis is a form of tuberculosis that does not respond to the normal drugs that we use against it. My concern is when we have multi-drug-resistant tuberculosis, which is a form of TB that doesn't respond to most of the drugs that we have against it, that means that we have to use much more toxic drugs, much more expensive [drugs] and for a much longer period of time. This report shows the highest levels reported ever in this world of multidrug-resistant TB. If we don't act now, we are going to lose the battle against tuberculosis this time.

Veronica Riemer: However, the true scale of the problem remains unknown in some pockets of the world. Many countries lack the equipment and trained personnel needed to identify drug-resistant TB, which makes it difficult to estimate the true burden and trends of the disease. Outbreaks of drug resistance frequently go unnoticed and undetected, which means that patients remain untreated.

Although the report highlights the extent of drug resistance, it also points to some successes. Thirteen years ago, Estonia and Latvia were singled out by WHO as drug-resistant TB "hotspots". Today, following a substantial investment, rates in these two Baltic countries are stabilizing.

Story 2

Veronica Riemer: In response to an outbreak of yellow fever in South America, WHO and its partners have shipped vaccines to Paraguay. Yellow fever is a viral disease spread by mosquitoes and is responsible for approximately 30 000 deaths per year.

While there is no treatment for the illness beyond supportive care, the vaccine is highly efficient. A recent outbreak of the disease in South America has put a strain on the global supply and introduced new concerns among the population.

Vaccine production and distribution is coordinated through the WHO International Coordinating Group. This was recently put to the test when Paraguay requested two million emergency doses.

The story underlined the importance and potential of a globally coordinated approach to such challenges. Dr. William Perea, who leads Epidemic Readiness and Interventions at the WHO, came into the studio to tell us more.

Dr. William Perea: We managed to respond to an emergency request from Paraguay for two million doses. This was only several weeks after we responded to a similar request from Brazil asking for four million doses to help them to control the outbreaks of yellow fever that are going on in those two countries.

We are very happy, because we succeeded to send to send these six million doses and contribute to stopping the spread of the disease. All this, thanks to the emergency stockpile that we maintain at the global level.

Yellow fever vaccine is not an easy vaccine to produce. It has to be forecasted several months, if not years, in advance in order to appropriately cover the needs. So these outbreaks in South America hadn't been foreseen. Now, the use of the vaccine in those places is obviously depleting our global supply. So we need to start working right away on increasing the global supply, to be able to first, continue the routine programmes in Africa and to maintain the preventive campaigns we have planned for this year. And this can only be done if we have an appropriate supply, so we are working hard with our manufacturers to get them increasing the production.

Veronica Riemer: Yellow fever is frequently fatal for those who have not been vaccinated. The vaccine is safe and highly effective. Immunity occurs within one week in 95% of people vaccinated. A single dose of vaccine provides protection for 10 years and probably for life.

Veronica Riemer: That's all for this WHO podcast. Thanks for listening. You can read more about these stories, and get more public health information at www.who.int