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International respiratory societies to assist in finding the 3 million “missed” TB cases

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A major focus of this World TB Day is the 3 million TB cases that the World Health Organization (WHO) estimates are "missed" each year - that is, cases that go undetected, undiagnosed, and untreated. Clearly, this must change if global TB control is to be achieved. "The Forum of International Respiratory Societies (FIRS) is committed to mobilizing all its members to help reach the 'missing' 3 million tuberculosis cases," said Dr Maria Montes de Oca, chair of FIRS. "FIRS members represent 70,000 health professionals working in almost every country of the world, so the capacity to increase case finding and provide TB care that meets the International Standards of TB Care is there."

World TB Day, which is observed on 24 March each year, is an opportunity to remind governments, politicians, funding agencies, clinicians, public-health personnel, and also the general public about tuberculosis, which is still causing a high burden of disease, death and suffering around the world, both in developing and high-income countries.

World TB Day was launched in 1982 to mark the 100th anniversary of Robert Koch's discovery of the TB bacillus. Countries around the world use marches, street theatre, murals, media workshops, government briefings, and other World TB Day events to educate people about the symptoms of TB; build awareness of the need for resources, including new TB diagnostic tools and drugs; and celebrate the survival of those who have recovered.

In 2012, there were an estimated 8.6 million new cases of tuberculosis and 1.3 million deaths. According to WHO, 95% of TB deaths occur in low- and middle-income countries. About 450 000 people are estimated to have developed multidrug-resistant tuberculosis (MDR-TB). Of these, 3 out of 4 MDR-TB cases remain without a diagnosis and many of those diagnosed are not put on treatment. A lot of progress has been made in the last two decades in TB control, but many challenges remain.

On behalf of all the presidents of FIRS, Dr Montes de Oca summarized the challenges to Citizen News Service (CNS) that need to be tackled in order to find the missing 3 million TB cases:

1. We need to ensure that tuberculosis patients are not stigmatized and that all patients receive high-quality treatment without being discriminated against. Persons who are sick and show symptoms suggesting tuberculosis should not be afraid to get help and treatment.

2. Health systems should be strengthened to offer the best possible diagnostic tools and should be well equipped to provide not only treatment for TB but also to initiate antiretroviral therapy promptly for TB patients living with HIV.

3. Many patients with MDR-TB remain undiagnosed. We need to make sure that diagnostic services for MDR-TB are improved rapidly and that all those diagnosed are put on treatment. This requires well-trained health-care personnel at all levels of the health system.

4. We need to pay particular attention to poor communities and vulnerable groups. These may be mainly people in low- and middle-income countries, but we should not become complacent and forget tuberculosis in high-income countries.

5. FIRS will advocate that governments and funders, such as The Global Fund, continue to support health systems in low- and middle-income countries with enough resources to allow health-care personnel in all parts of their countries to apply sound tuberculosis-control policies using good management practice.

The spread of TB, including multidrug-resistant TB, is facilitated by today's highly mobile populations. TB-control policy has to take into account not only issues of public health, but also of human rights. Reaching out and treating undocumented immigrants with TB will certainly reduce the number of missed cases. Only if these vulnerable populations can be guaranteed  confidentiality, free diagnosis, and treatment, will we be successful in our endeavor to reduce the number of missed cases.

FIRS is an organization composed of the world's leading international respiratory societies working together to improve lung health globally: American Thoracic Society (ATS), American College of Chest Physicians (ACCP), Asociación Latinoamericana De Tórax (ALAT), AsianPacific Society of Respirology (APSR), European Respiratory Society (ERS), International Union Against Tuberculosis and Lung Diseases (The Union) and the Pan African Thoracic Society (PATS). The goal of FIRS is to unify and enhance efforts to improve lung health through the combined work of its more than 70,000 members globally.

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