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Tuberculose : forte baisse des infections mais pas assez vite dans les populations pauvres (OMS)

Dimanche 20 Octobre 2019

L'année dernière, 1,5 million de personnes sont décédées des suites de la tuberculose, a indiqué l'Organisation mondiale de la Santé (OMS), qui réclame un financement et un soutien politique plus importants pour éradiquer cette maladie curable et évitable.


PNUD Tuvalu/Aurélia Rusek Une patiente âgée de 25 ans atteinte de tuberculose est traitée chez elle à Funafuti, l'île principale de Tuvalu, dans le Pacifique.
PNUD Tuvalu/Aurélia Rusek Une patiente âgée de 25 ans atteinte de tuberculose est traitée chez elle à Funafuti, l'île principale de Tuvalu, dans le Pacifique.
Causée par la bactérie Mycobacterium tuberculosis, la tuberculose provoque généralement une toux persistante, de la fatigue et une perte de poids.

Dans un nouveau rapport publié jeudi, l’OMS  indique qu’environ 10 millions de personnes ont contracté la tuberculose en 2018 et trois millions de personnes « ne reçoivent pas les soins dont elles ont besoin ». Les pays les plus touchés sont la Chine, l’Inde, l’Indonésie, le Nigéria, le Pakistan, les Philippines et l’Afrique du Sud.

Mettant en exergue quelques bonnes nouvelles, l’OMS a souligné que le Brésil, la Chine, la Russie et le Zimbabwe - qui sont lourdement touchés par la tuberculose - ont atteint des niveaux de couverture de traitement supérieurs à 80% en 2018.

Néanmoins, même si le nombre de cas de tuberculose en 2018 était légèrement meilleur que celui de 2017, cette maladie reste élevée chez les populations pauvres et marginalisées, en particulier les personnes vivant avec le VIH.

Cela s'explique notamment par le coût des soins antituberculeux, des données montrant que près de quatre patients sur cinq dans des pays dits « à forte charge » dépensent plus de 20% du revenu de leur ménage pour le traitement.

La pharmaco-résistance constitue un autre obstacle, avec en 2018, une estimation d’un demi-million de nouveaux cas de tuberculose pharmaco-résistante. Un tiers seulement de ces personnes ont reçu un traitement. L’OMS recommande de traiter désormais la tuberculose multirésistante avec des schémas thérapeutiques entièrement oraux, qui « plus sûrs et plus efficaces ».

Des systèmes de santé plus solides sont nécessaires

Insistant sur le fait que le monde doit accélérer les progrès pour atteindre l'objectif de développement durable visant à mettre fin à la tuberculose d'ici 2030, le Directeur général de l'OMS, Tedros Adhanom Ghebreyesus, a déclaré qu'en pratique, cela nécessitait « des systèmes de santé solides et un meilleur accès aux services ». « Cela signifie un investissement renouvelé dans les soins de santé primaires et un engagement en faveur de la couverture maladie universelle », a-t-il ajouté.

A la suite de l'engagement pris le mois dernier par des chefs d'État et de gouvernement à New York de mettre les soins de santé à la portée de tous et de lutter contre les maladies transmissibles telles que la tuberculose, le VIH et le paludisme, l'OMS a souligné l'utilité de campagnes nationales permettant de diagnostiquer et de traiter plusieurs maladies en même temps.

L'agence onusienne a cité des programmes de lutte contre le VIH et la tuberculose, qui ont permis aux deux tiers des personnes diagnostiquées atteintes de tuberculose de connaître leur statut VIH, pour lequel elles sont actuellement traitées.

L'OMS a également salué le fait que 7 millions de personnes ont été diagnostiquées et traitées pour la tuberculose l'année dernière, contre 6,4 millions en 2017.

C'est « la preuve que nous pouvons atteindre les objectifs mondiaux si nous unissons nos forces, comme nous l'avons fait par le biais de l'initiative conjointe ‘Find.Treat.All.EndTB’ de l'OMS, du partenariat Halte à la tuberculose et du Fonds mondial de lutte contre le sida, la tuberculose et le paludisme », a déclaré le chef de l'OMS.

Faisant écho à ce message, Dre Tereza Kasaeva, Directrice du programme mondial de lutte contre la tuberculose de l’OMS, a confirmé que l’agence onusienne travaillait en étroite collaboration avec les pays, les partenaires et la société civile sur des innovations visant à « briser la trajectoire de l’épidémie de tuberculose ».

Selon l'OMS, il existe un sous-financement massif et chronique pour la recherche sur la tuberculose, estimé à 1,2 milliard de dollars par an. De plus, le déficit en matière de prévention et de prise en charge de la tuberculose est estimé à 3,3 milliards de dollars en 2019. Ceci en dépit du fait qu'environ un quart de la population mondiale est atteinte de tuberculose latente, ce qui signifie que les personnes ont été infectées par la bactérie mais ne sont pas encore malades et ne peuvent donc pas la transmettre.

Les besoins prioritaires incluent un nouveau vaccin ou un traitement médicamenteux préventif efficace, des tests de diagnostic rapides et des schémas thérapeutiques plus sûrs, plus simples et plus courts.
La stratégie mondiale de lutte contre la tuberculose approuvée par l'Assemblée mondiale de la santé vise une réduction de 90% du nombre de décès dus à la tuberculose et de 80% du taux d'incidence de la tuberculose d'ici 2030 par rapport aux niveaux de 2015.
Un.org


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