Many countries are ill-equipped to combat the spread of drug-resistant tuberculosis, already in 104 countries and the world's leading infectious cause of death among adults, a new study says. It will take $1 billion to fight its growth, according to the Harvard Medical School study sponsored by philanthropist George Soros.

Russian prisons are among the epicenters of the hard-to-treat and potentially fatal disease. About 100,000 inmates have active TB and about 40 percent have drug-resistant TB, prison chief Gen. Vladimir Yalinin said at a Thursday news conference. About 30,000 people with active cases are released from prison there each year, and 400 prison workers have developed TB, Yalinin said. These epidemics are only briefly local," said Dr. Paul Farmer, a professor of social medicine at Harvard and author of the report. ‘They will not remain within prisons; they will not remain within national borders.’

TB is the leading infectious cause of death among adults worldwide, killing up to 2 million people each year. Eight million are infected annually by the airborne disease, which can spread through contact as casual as sitting on the same airplane with someone who is infected.

Six years after health officials declared tuberculosis a global crisis, deadly strains that are resistant to various drugs are spreading faster than anticipated, Harvard Medical School researchers said on Thursday. In a report released in New York entitled, "The Global Impact of Drug Resistant Tuberculosis," doctors said the phenomenon was a "man-made problem" unknown five decades ago. They said "multidrug-resistant tuberculosis" has been reported in 104 countries -- mostly in the developing world but threatening to spread to Western Europe and North America.

"There is debate about quantifying infectiousness but there are a number of experiences now from airplanes so that someone with active pulmonary tuberculosis on an airplane can readily infect other passengers," the report's primary author, Dr Paul Farmer, said at a news conference. "As some of my colleagues have noted, upgrading yourself to first class will not necessarily protect you."

In 1993, the World Health Organization (WHO) warned the world that the airborne bacteria that can afflict almost any tissue in the body but especially the lungs, was a global emergency. The disease infects about eight million people worldwide a year and kills up to two million.

Researchers said that without at least $1 billion in new funding for tuberculosis treatment, strains of the bacteria resistant to drugs "will spread to all corners of the earth." The development of new drugs was also needed, they said.

A DANGEROUS new strain of flu that could trigger a worldwide epidemic has broken out in Hong Kong, scientists warn today.

Like the 1918 Spanish flu pandemic which killed around 20 million people worldwide, the Hong Kong strain is believed to have jumped from pigs to humans. Health officials were alerted after a 10-month-old girl was admitted to hospital last month. Two years ago, a strain of flu from chickens struck 18 people in Hong Kong, killing six.

Although health officials are anxious not to cause panic, they are warning that killer strains usually come from pigs or poultry. According to New Scientist, the girl was successfully treated, but her virus bears all the molecular hallmarks of a strain from pigs.

Most new flu strains are variants of existing viruses, but every few decades a radically different virus comes along, triggering a pandemic that can kill millions. The last two were in 1957 and 1968. To trigger a pandemic, viruses must be extremely infectious and be transmitted rapidly. Swine-type viruses crossed to humans in 1977 and 1986 but were not passed on fast enough to create a crisis.

The new influenza drug Relenza, which dramatically cuts symptoms of the illness, has now been shown to prevent flu as well. An unpublished trial of 340 families has demonstrated that the chance of a flu patient infecting other members of their family dropped by 80 per cent if the whole family took Relenza.

Glaxo Wellcome, which manufactures the drug, confirmed that it is to apply for a licence for Relenza to be given preventatively. The Government recently advised GPs not to prescribe Relenza for relieving flu symptoms. The cost of the drug to the NHS was estimated at between £15 million and £100 million in an epidemic year.

About 1 million people in the Western Pacific are now infected with HIV and the rate of infection is rising rapidly in many countries in the region, the World Health Organization said today. Last year, WHO officials estimated there were about 700,000 HIV infections in the region and 40,000 actual cases of AIDS. If left unchecked, they said, the number of HIV infections in the region will exceed 1.5 million in 2000.

For over five decades, the world has conquered infectious diseases like meningitis with a vast array of wonder drugs. Faith in the power of antibiotics to cure everything from pneumonia to postnasal drip has resulted in their becoming one of the most commonly prescribed categories of drugs in the United States. More than 133 million courses of antibiotics are prescribed by doctors each year to nonhospitalized patients. Fully 190 million doses a day are administered in hospitals.

But our wonder weapons are becoming less potent: The bugs have discovered newer, more efficient ways to elude destruction. Bacteria also have more avenues of attack: Day-care facilities have thrown youngsters together as never before; hospitalized patients are sicker and more susceptible to infections; modern agriculture, which relies on antibiotics to boost growth and limit disease among cattle, chickens, and other animals, has led to the spread of more dangerous microbes.

But the main demon driving the rise of antibiotic-resistant pathogens is us. "People don't see a downside to antibiotic use," says Lee Harrison, an epidemiologist at the University of Pittsburgh and Johns Hopkins University. "But there's a major downside: Antibiotic resistance is becoming a public-health nightmare." A new report by the General Accounting Office indicates that antibiotic resistance is increasing worldwide--more kinds of bacteria are becoming resistant and they are resistant to multiple drugs.

The latest turn in the battle of the bugs is no surprise. Scientists have known since the dawn of the antibiotic age in the 1940s that the more an antibiotic is used, the quicker it becomes useless. That's because, while most bacteria exposed to the drug are killed, the fittest survive and pass survival traits to their offspring. With continued use of the antibiotic, the resistant bugs proliferate.

Bugs that have become resistant to one antibiotic also seem to find it easier to build resistance to others. As a result, says James Hughes, director of the National Center for Infectious Diseases at the federal Centers for Disease Control and Prevention, "We're facing a serious global problem with antimicrobial resistance now. It affects virtually all of the pathogens we previously considered easily treatable."

Pneumococci are the deadliest bacteria in the United States, killing 40,000 yearly. The bug also causes an estimated 7 to 10 million middle-ear infections in children a year, 500,000 cases of pneumonia, and thousands of cases of meningitis and bloodstream infections. "This is a bug that all clinicians encounter every day in their practice," says Scott Dowell, a medical epidemiologist in the CDC's Respiratory Diseases Branch. At one time, it was easy and cheap to treat with penicillin. But overuse of penicillin, its synthetic cousins, and other antibiotics over the years has made pneumococci multidrug resistant. An average of 25 percent of cases are resistant; in some areas the rate tops 40 percent.

Using antibiotics kills off many of the bacteria that normally inhabit the human body and allows resistant ones to take over.

It may be that higher socioeconomic levels and greater access to health care are a mixed blessing in dealing with the microbial world. "Patients who have been exposed to antibiotics for whatever reason are more likely in one to three months to acquire a resistant pneumococcal infection," explains the CDC's Dowell.

Tuberculosis (TB) is man's oldest infectious killer, and it remains such a serious health threat that the World Health Organization (WHO) compares it to a time bomb. "We are in a race against time," warns a WHO report on TB. If man fails to defuse this bomb, he may one day face a drug-resistant disease that "spreads through the air, yet is virtually as incurable as AIDS." The time has come, urges WHO, to wake up to TB's devastating potential. "Everyone who breathes air, from Wall Street to the Great Wall … needs to worry about this risk."

An overstatement? Hardly. Just imagine how wide-awake the world would be if a disease threatened to rage out of control and erase the entire population of, say, Canada in ten years! Though this sounds like fiction, the threat is real. Worldwide, TB kills more people than AIDS, malaria, and tropical diseases combined: 8,000 persons each day. Some 20 million people now suffer from active TB, and some 30 million could die from it in the next ten years--a number larger than the population of Canada.

The cure for TB was discovered more than four decades ago. Since then, over 120 million people have died of TB, and nearly 3 million more people will die this year. Why are so many people still dying from TB when there is a cure? For three main reasons: neglect, HIV/AIDS, and multidrug-resistant TB.

Neglect. The eyes of the world are focused on such infectious diseases as AIDS and Ebola. In 1995, however, for every person who died of Ebola, 12,000 died of TB. In fact, TB is so common in developing countries that people there have come to view the disease as a fact of life. Meanwhile, in the richer countries, TB has been allowed to spread even while effective medicines to cure it sit on the shelves. This global neglect has proved to be a fatal mistake. While the world's concern about TB was weakening, the TB bacilli were growing stronger. Today they attack more people in more countries than ever before in human history.

HIV/AIDS. TB is a traveling companion of HIV and AIDS. When people become infected with HIV--which lowers their immunity--they are 30 times more likely to develop TB. No wonder the current worldwide HIV epidemic has caused an increase in the number of TB patients as well! It is estimated that 266,000 HIV-positive people died from TB in 1997.

Multidrug-Resistant TB. "Superbugs," immune to man's antibiotic arsenal, are the stuff of science fiction, but in the case of TB, they are rapidly becoming a fact. More than 50 million people may already be infected with multidrug-resistant (MDR) TB. Patients who stop taking their medicines after a few weeks because they feel better, because the drug supplies run out, or because the disease carries a social stigma do not kill all the TB bacilli in their body. In one Asian country, for instance, 2 out of every 3 TB patients drop out of treatment early. When they become sick again, the disease may be harder to treat because the surviving bacteria fight back and triumph over every available anti-TB medicine. As a result, the patients end up with a type of TB which is incurable--for them and for whomever they may infect. And once this deadly MDR genie is out of the bottle, we are left with the grim question: Will man be able to put it back?