World Tuberculosis Day

A clearer picture ofdrug resistant TB
ABOUT TB

#2

Tuberculosis (TB) is the second leading
infectious killer after COVID-19, yet it isa preventable, treatable and curable
disease.1

In 20211(cases: millions)1

Undernourishment

10.6M

2.2

HIV Infection

0.86

Alcohol use disorders

0.74

Smoking

0.69

Diabetes

Incidence

1.6M

Mortality

0.37

DRUG-RESISTANT TB (DR-TB)
Anti-TB drugs
Rifampicin

Isoniazid

Fluoroquinolones

Group A drugs

RR-TB(Rifampicin-resistant)3

Hr-TB(Isoniazid-resistant)3,4MDR-TB(Multidrug-resistant)3

pre-XDR-TB(Pre-extensively drug-resistant)3

XDR-TB(Extensively drug-resistant)3

2.4 million

TB and DR-TB can have significant individual
and household financial impact, resulting in lost
income and catastrophic costs (costs that accountfor more than 20% of household income).1,2

tested for
Rifampicin
resistance% of TB cases that experiencecatastrophic costs:1

25,038All people with TB

141,953

pre-XDR/XDR-TB cases

48%
47%

MDR/RR-TBcases
Drug-susceptible TB

COVID-19-related disruptions to essential TB
services contributed to a rise in TB incidence
rates and drug-resistant TB burden in 2021,
reversing decades of declines1.

82%

Drug-resistant TB

161,746 patients started treatment for MDR/RR-TB in 2021

1

Cost of TB
TB

MDR-TB

XDR-TB$ 67,000$ 420,000$ 801,000

6-9

20-26

32

60%

60%

2019

20199

Average cost
per case5.*

including direct treatment
costs and productivity losses(2020; USD)

Length oftreatment5(months)

Treatment
success rate(Global average)

86%

new, 20206

74%

relapsed, 202078*The dollar amount cited in this document is from the CDC's 'The Costly Burden of TB' fact sheet, and represents costs specific to the United States.

DRUG RESISTANCE SURVEILLANCE AND
DRUG SUSCEPTIBILITY TESTING (DST)
Routine TB drug resistance surveillance and drug-susceptibility testing (DST) are critical tocombat the global TB epidemic and informs TB treatment guidelines.1,15

Targetednext-generation
sequencing (tNGS)

Whole Genome Sequencing (WGS)
1-2 days from positive culture10,11

CCGATAGATCGAACTA

Provide complete genome of M.
tuberculosis (MTB), comprehensive
detection of known genes anddiscovery of novel genes associatedwith anti-TB drug resistance, and reportgenetic relatedness between isolates toprovide insights for tuberculosis control
measures.10<48 hours10

Culture-free method that provides
a broad resistance profile of first-line
drugs (FLD) and second-line drugs(SLD) through deep sequencingof DR-TB gene targets.10

Phenotypic – culture-based

4-13 days from positive culture.12

Nucleic acidamplification tests

Approximately 2 hours.13
Targeted method to detectresistance to some FLD
and some SLD.13

SIMPLEFAST

ACCURATE

1Collect Sputum Sample

2DNA Extraction

3
Prepare Library

4Sequence

5Analyze Data

6
Report Results<48 HOURS

Total Turnaround Time

Accurate characterisation of
nucleotide-level genetic
polymorphisms.10

Detection of mixed infection
and heteroresistance down to
3% subpopulations(inaccessible by other rapid
molecular tests).14

Detailed sequence information
for multiple gene regions orwhole genomes.10

Genotyping and spoligotyping of
Mycobacterium tuberculosis
complex (MTBC) strains.14

Detect resistance to a widerange of first and second-line
antituberculosis drugs.10,14

Differential detection of
mycobacterial species withclinical relevance.14,15

Revolutionize universal
access to rapid, accurate
and comprehensive detectionof known anti-TB drug resistance.10

CCGATAGATCGA
ACTA

Routine TB drug
resistance surveillance
to detect path of transmission
and monitor novel
resistance mechanism.15

OUTLOOK

Globally, of the estimated 10.6 million people who fell illwith TB, only 6.4 million were diagnosed and reported.
That is a gap of 4.2 million people.1 Improved drug
resistance-detection and surveillance is possible throughnext-generation sequencing to help address this gap
and can bring us closer to the Sustainable Development
Goal (SDG) of ending TB by 2030.10,15
References:1.
World Health Organization. (2022). Global Tuberculosis Report 2022. Retrieved March 9, 2023, fromhttps://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022
2.
Tanimura T, Jaramillo E, Weil D, Raviglione M, Lönnroth K. Financial burden for tuberculosis patients in low- and middle-income countries: a systematicreview. Eur Respir J. 2014 Jun;43(6):1763-75. doi: 10.1183/09031936.00193413.
3.
Meeting report of the WHO expert consultation on the definition of extensively drug-resistant tuberculosis, 27-29 October 2020. Geneva: World HealthOrganization; 2021. CC BY-NC-SA 3.0 IGO.
4.
Sulis G, Pai M (2020) Isoniazid-resistant tuberculosis: A problem we can no longer ignore. PLoS Med 17(1): e1003023. https://doi.org/10.1371/journal.pmed.1003023
5.
https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/costly-burden-dr-tb-508.pdf
6.
World Health Organization. (2022, October 11). Treatment success rate of new tuberculosis cases. Retrieved March 9, 2023, fromhttps://www.who.int/data/gho/data/indicators/indicator-details/GHO/treatment-success-rate-new-tb-cases
7.
World Health Organization. (2022, October 11). Treatment success rate of previously treated tuberculosis cases. Retrieved March 9, 2023, fromhttps://www.who.int/data/gho/data/indicators/indicator-details/GHO/treatment-success-rate-previously-treated-tb-cases
8.
World Health Organization. (2022, October 11). Treatment success rate for patients treated for multidrug-resistant tuberculosis (MDR-TB). Retrieved
March 9, 2023, from https://www.who.int/data/gho/data/indicators/indicator-details/GHO/treatment-success-rate-for-patients-treated-for-mdr-tb-(-)
9.
World Health Organization. (2022, October 11). Treatment success rate of extensively drug-resistant tuberculosis (XDR-TB) cases. Retrieved March 9,2023, from https://www.who.int/data/gho/data/indicators/indicator-details/GHO/treatment-success-rate-xdr-tb-cases10. The use of next-generation sequencing technologies for the detection of mutations associated with drug resistance in Mycobacterium tuberculosis
complex: technical guide. Geneva: World Health Organization; 2018 (WHO/CDS/TB/2018.19). Licence: CC BY-NCSA 3.0 IGO.
11. Walker TM, Cruz ALG, Peto TE, Smith EG, Esmail H, Crook DW. Tuberculosis is changing. Lancet Infect Dis. 2017 Apr;17(4):359-361. doi:
10.1016/S1473-3099(17)30123-8.
12. BACTECTM MGITTM 960 SIRE Kits. Accessed March 10, 2023, fromhttps://www.bd.com/resource.aspx?IDX=18269#:~:text=The%20BD%20BACTEC%E2%84%A2%20MGIT
13. WHO consolidated guidelines on tuberculosis. Module 3: diagnosis - rapid diagnostics for tuberculosis detection, 2021 update. Geneva: World HealthOrganization; 2021. Licence: CC BY-NC-SA 3.0 IGO.
14. Jouet A, Gaudin C, Badalato N, Allix-Béguec C, Duthoy S, Ferré A, Diels M, Laurent Y, Contreras S, Feuerriegel S, Niemann S, André E, Kaswa MK,Tagliani E, Cabibbe A, Mathys V, Cirillo D, de Jong BC, Rigouts L, Supply P. Deep amplicon sequencing for culture-free prediction of susceptibility orresistance to 13 anti-tuberculous drugs. Eur Respir J. 2021 Mar 18;57(3):2002338. doi: 10.1183/13993003.02338-2020.
15. Guidance for the surveillance of drug resistance in tuberculosis, sixth edition. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.

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