Drug-resistant tuberculosis: worldwide trends, problems specific to Eastern Europe and other hotspots, and the threat to developing countries

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Abstract
Although it had been appreciated that high levels of antituberculous drug resistance existed in some regions of the world, the full extent of the problem was not known. A combined initiative by the World Health Organization and the International Union Against Tuberculosis and Lung Disease was launched in 1994 to address this. A second report was issued in March 2000, in which surveillance of drug resistance had been extended to 72 countries and regions. A number of drug resistant “hotspots,” where there are high levels of combined multidrug-resistant tuberculosis (> 3% prevalence), have been identified. Particular areas of concern are countries of the former Soviet Union, India, and China, because these countries have the highest burden of multidrug-resistant tuberculosis. For the first time, information on trends in global drug resistance is available.