The Tuberculosis Threat

Many countries are ill-equipped to combat the spread of drug-resistant tuberculosis, already in 104 countries and the world's leading infectious cause of death among adults, a new study says.

It will take $1 billion to fight its growth, according to the Harvard Medical School study sponsored by philanthropist George Soros.

Russian prisons are among the epicenters of the hard-to-treat and potentially fatal disease. About 100,000 inmates have active TB and about 40 percent have drug-resistant TB, prison chief Gen. Vladimir Yalinin said at a Thursday news conference.

About 30,000 people with active cases are released from prison there each year, and 400 prison workers have developed TB, Yalinin said.

"These epidemics are only briefly local," said Dr. Paul Farmer, a professor of social medicine at Harvard and author of the report. "They will not remain within prisons, they will not remain within national borders."

TB is the leading infectious cause of death among adults worldwide, killing up to 2 million people each year. Eight million are infected annually by the airborne disease, which can spread through contact as casual as sitting on the same airplane with someone who is infected.

The study says a TB strategy successfully implemented in New York City in the mid-1990s deploying health workers to watch patients take each and every dose is the only way to cure the disease and stop the proliferation of drug-resistant strains.

While the approach required less than a year of treatment for each case, new strains of multi-drug-resistant TB may require up to two years of complex treatment, costing anywhere from several hundred dollars to several thousand per patient.

Many countries lack the funding, personnel and public health infrastructure for such an intensive method of treatment.

The report identified TB hot spots countries where at least 5 percent of all TB cases are drug-resistant. The highest percentage of drug-resistant TB cases were found in Latvia, at 22 percent.

Behind Latvia was the Delhi state in India, Estonia, the Henan province of China, the Dominican Republic, Argentina, the Ivanovo region of Russia and the Ivory Coast.

The report also suggests that physicians in many countries are improperly prescribing TB drugs, contributing to the problem.