The United States last year recorded its lowest number of cases of tuberculosis, and many other countries also reported a decrease in cases of the deadly infectious disease.

For 2018, the U.S. reported 9,025 cases of tuberculosis (TB) and its lowest incidence rate of 2.8 cases per 100,000 persons on record, according to the Centers for Disease Control and Prevention.

The highest number of cases the CDC has on record for the U.S. dates back to 1953, when 84,304 cases or 52.6 cases per 100,000 people were reported.

Globally, there were an estimated 10 million new tuberculosis cases last year, according the World Health Organization, which shared its tuberculosis report Thursday at the National Press Club. Of those, about 1.5 million individuals died from the disease, including 251,000 people with HIV.

WHO notes while millions are still impacted by tuberculosis, the mortality rate dropped by 42% globally between 2000 and 2018.

“Although we have achieved much in this fight to end TB, we can and must do better,” said Tereza Kasaeva, director of the WHO’s Global TB Programme, at Thursday’s panel event. “No one with TB should miss out on the care they need.”

The United Nations set a goal last September to reduce the number of tuberculosis deaths by 90% and the number of cases by 80% by 2030, compared to 2015 levels. For 2020, the U.N. is aiming for a 35% decrease in deaths and a 20% drop in the incidence.

But many countries and regions are not currently on track to reach the 2020 goals. Globally, the drop in the incidence rate from 2015 to 2018 was only 6.3%, about 14% short. There was an 11% drop in deaths between 2015 and 2018, 24% below next year’s goal.

However, the WHO European Region is on track to meet the 2020 goals.

Most of the tuberculosis cases last year came from the WHO regions of South-East Asia (44%), Africa (24%), and the Western Pacific (18%). Both the Americas and Europe each had about 3% of the cases.

According to WHO’s report, eight countries made up two-thirds of the cases worldwide: India (27%), China (9%), Indonesia (8%), the Philippines (6%), Pakistan (6%), Nigeria (4%), Bangladesh (4%) and South Africa (3%).

While 7 million people were diagnosed and treated for TB last year, there is still an estimated 3 million who did not receive the care they needed, according to WHO’s report.

“An unacceptably large gap remains between the number of reported cases and the estimated 10 million new cases each year,” said Irene Koek, acting assistant administrator for global health for the U.S. Agency for International Development. “Unless we are able to detect individuals with TB, start appropriate treatment quickly, support adherence until treatment is completed successfully, we will not be able to defeat this disease.”

Funding for tuberculosis research and development has increased and peaked in 2017 with $772 million from the U.S. But this is only 39% of the estimated $2 billion needed from the U.S. each year, the global health agency says.

To defeat the infectious disease, WHO says technological breakthroughs such as a vaccine to lower the risk of infection, rapid diagnostics for use at time of care and easier, shorter drug regimens for treating tuberculosis need to be prioritized.

No new technological advancements have emerged so far this year.

As of August, there were 23 drugs for tuberculosis, various combination regimens and 14 vaccine candidates in clinical trials. A vaccine candidate has proven effective in protecting against tuberculosis in a phase two clinical trial among individuals with a latent disease infection.

Tuberculosis is a bacterial disease that mainly affects the lungs and spreads through coughing and sneezing. Signs and symptoms could include coughing that lasts for weeks, coughing up blood, weight loss, chest pain, fever, fatigue and night sweats.

Many strains of the infectious disease are resistant to the drugs most commonly used for treatment. Those with active tuberculosis have to take several medications for months to prevent antibiotic resistance and to treat the infection.

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