Messages for National Action Plan to Combat MDR TB – 12.14.15
The White House National Action Plan to Combat Multidrug-Resistant Tuberculosis charts the best course of
action to ensure the U.S. does its part to prevent, treat, and control the spread of MDR TB
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The goals of the National Action Plan are to strengthen domestic capacity to combat MDR TB, improve
international capacity and collaboration to combat MDR TB, and accelerate basic and applied research
and development to combat MDR TB
The domestic portion of the plan addresses recommendations from state and local health departments
about ways to improve their capacity to address drug-resistant TB.
Eliminating the threat of drug-resistant TB ultimately will require an urgent and coordinated global
response.
CDC will lead many of the proposed initiatives to achieve the goals proposed in the National Action Plan.
CDC will utilize new and existing partnerships, validated tools, and evidence-based strategies to move us
closer to eliminating MDR TB in the United States and around the world.
CDC is committed to accelerating progress towards a TB-free world.
The National Action Plan aims to reduce the number of newly diagnosed multidrug-resistant tuberculosis
cases in the United States by 15% by 2020 (if funding becomes available). To achieve this goal, CDC and our
partners will:
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Upgrade TB surveillance, nationwide, to ensure complete and accurate detection of drug-resistant TB
o CDC and partners will lay the groundwork for an updated TB surveillance system.
o CDC and partners will update electronic surveillance systems for collecting, analyzing, and
storing national and state-level TB clinical data.
Strengthen state and local capacity to prevent transmission of drug-resistant TB
o CDC will work with the National TB Controllers’ Association to develop a plan to create surge
capacity for drug-resistant TB contact investigations.
o CDC along with state and local health departments will strengthen partnerships with clinicians,
institutions, and community leaders to ensure rapid detection and complete treatment of drugresistant TB among vulnerable populations and medically underserved groups.
o CDC and partners will develop new tools to facilitate contact investigations.
Ensure that patients with drug-resistant TB receive treatment until cured
o CDC will explore the development of a National TB Stockpile to store and rotate TB treatment
and diagnostic supplies that can be ordered by state and local TB programs.
o CDC will work with public and private sector partners to maintain a supply of TB drugs.
o CDC and state and local TB programs will work together on plans for completion of therapy once
MDR TB or XDR TB patients are released from the hospital.
o CDC will explore ways to strengthen medical management of transnational cases of TB disease.
The National Action Plan outlines efforts to increase capacity and improve international collaboration among
CDC and our partners to improve global TB control.
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CDC will work to accelerate global efforts to prevent, find, and cure TB by:
o Strengthening and revamping surveillance systems to identify and track emerging patterns of TB
drug resistance;
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Supporting cutting-edge research to find better TB diagnostic approaches and shorter, less toxic
MDR TB treatment regimens;
o Designing and implementing comprehensive plans to strengthen the capacity of laboratories to
diagnose MDR TB;
o Establishing best practices to end MDR TB transmission in health facilities;
o Intensifying collaboration with developers to expedite the discovery of an effective vaccine; and
o Continuing to accelerate efforts to prevent MDR TB among one of the most vulnerable
populations—those co-infected with both TB and HIV—through PEPFAR.
To win the fight against this disease, we will need greater and more focused global action from partners
and policymakers:
o Enhanced engagement and collaboration between governments, multilateral agencies, and
other international partners;
o Increased attention from policymakers to the human and economic toll that poorly managed TB
and MDR TB will take on health systems and national budgets without intensified action; and
o Continued and strengthened communication and education efforts to help expand access to
quality screening, treatment, and care to prevent the development and spread of drug-resistant
TB.
CDC and our partners will expand international capacity and collaboration to combat MDR TB through
investments in innovative health technologies and greater access to prevention and care.
The National Action Plan proposes interventions to accelerate research and development efforts that will lead
to better diagnostics, effective vaccines, innovative prevention approaches, and new treatment options. CDC
will work with our partners at the National Institutes of Health (NIH) and USAID to support clinical and
biomedical research initiatives to:
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Increase options for preventing TB disease, latent TB infection, and TB transmission
o CDC and NIH will advance research and development of new vaccines.
o CDC and USAID will support the development of new TB treatment regimens to prevent
transmission and/or development of TB and MDR TB.
Improve the diagnosis of latent TB infection and the diagnosis of drug-susceptible and drug-resistant TB
disease
o NIH, CDC, and USAID will support the development of new tools and approaches for detection of
drug-resistant TB to help ensure patients receive timely and effective treatment.
o NIH, CDC, and USAID will support research to identify biological markers to help detect latent TB
infection and progression to TB disease in children and adults.
Improve treatment options for drug-susceptible and drug-resistant TB
o NIH, CDC, and USAID will improve the use of existing TB drugs for treatment of drug-susceptible
and drug-resistant TB.
o NIH, CDC, and USAID will work to increase knowledge to enable optimal and safe use of newly
registered TB drugs.
o NIH, CDC, and USAID will support the development of novel drugs and shorter regimens to treat
drug-resistant TB and improve the selection of drug candidates for clinical trials.
Background on Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis
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Tuberculosis (TB) is a disease caused by bacteria that are spread from person to person through the air.
In most cases, TB is treatable and curable.
TB bacteria may become resistant to the drugs used to treat TB, which means these can no longer kill
the bacteria. This is called drug-resistant TB.
o MDR TB is caused by organisms that are resistant to at least two of the best anti-TB drugs,
isoniazid and rifampin. These drugs are recommended for treatment of all people with drugsusceptible TB disease.
Extensively drug-resistant TB (XDR TB) is a rare type of multidrug-resistant TB.
o XDR TB is resistant two of the best anti-TB drugs, isoniazid and rifampin and also resistant to
fluoroquinolones and at least one of three injectable drugs (i.e., amikacin, kanamycin, or
capreomycin).
People with MDR TB must be treated with special medicines. These medicines are not as effective as the
usual medicines used to treat drug-susceptible TB, and they may cause side effects that are difficult to
tolerate.
Health care providers can help prevent MDR TB by quickly diagnosing people with TB disease, following
recommended treatment guidelines, monitoring patients’ response to treatment, and making sure
therapy is completed.
Cases of TB disease have declined annually over the past twenty years in the United States. However,
this progress could easily be eroded or reversed by the further development and spread of MDR TB.
o In 2014, the U.S. reported 91 cases of MDR TB and 2 cases of XDR TB.
o On average, it costs about $482,000 to treat a single patient with XDR TB and $150,000 to treat
a single patient with MDR TB, compared to $17,000 to treat a patient with drug-susceptible TB.
It is critical that we work quickly to halt the spread of drug-resistant TB
o To effectively and fully address MDR TB in the U.S., we must also address MDR TB around the
globe in the places hardest hit. TB anywhere is TB everywhere – it spreads from person to
person and moves with people across borders.
o If we don’t act now, the problem will get worse. Recent models show that unless we scale up
efforts to address this growing threat, the number of people dying from drug-resistant TB will
nearly double every 5 years.
o We must find better ways to diagnose and treat MDR TB, and also use every tool at our disposal
to find, cure, and prevent TB before it develops resistance. Only then will we truly eliminate the
threat of drug-resistant TB.