WHAT'S NEW IN TUBERCULOSIS
Monday, 26 April 2010
Saturday, 24 April 2010
The facility has not become self-sustaining during its five years of operation, according to Joseph Hornett, senior vice president, treasurer and chief operating officer of the Purdue Research Foundation, which owns and manages the research park.
The Chao Center is a pharmaceutical manufacturing facility that produces and distributes legacy and small-volume drugs.
The facility will continue manufacturing and distributing the multidrug-resistant tuberculosis drug Seromycin and other life-saving legacy drugs until new manufacturers are found.
Globally, more than four million people are currently receiving treatment, with support of PEPFAR, the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNITAID, national governments, and other donors. But there are at least six million people who need treatment now, who are still unable to get it.
Instead of scaling up, now the Obama Administration is saying enough is enough. It is telling the health providers that it funds that they can only put new people on AIDS treatment if some of the people they are already treating die.
The Boston Globe article quotes Eric Goosby, the U.S. Global AIDS Coordinator, as saying “People are struggling to find resources to honor the commitments we have made… We’re not at a cap point yet. If it gets worse, we’ll have another discussion.”
To detect diseases such as pandemic flu, tuberculosis and measles, federal regulations require airlines to notify health officials of passenger illnesses involving diarrhea or fever plus rash, swollen glands or jaundice. The International Civil Aviation Organization, a United Nations agency, also includes persistent vomiting or coughing in its guidelines.
Concerns about fliers spreading dangerous diseases have been fueled by the 2003 SARS outbreak, high-profile tuberculosis patients and the H1N1 flu pandemic.
Data on outbreaks and infection rates are spotty and kept secret under the guise of patient confidentiality. Jurisdictional squabbles between the federal and provincial governments stymie treatment and prevention programs on reserves. A nearly 20-year-old national plan to combat the disease is only slowly being reviewed. There are no national standards on monitoring and controlling TB and it's tricky to do simple things like fly in a mobile X-ray unit to help confirm a diagnosis in a remote community.
Kimberley Barker, a doctor and adviser to the Assembly of First Nations, said Ottawa has so little control over its regional operations that there's little accountability on TB spending.
That bleak assessment follows a Winnipeg Free Press investigation that found some Manitoba communities have recorded some of the highest TB rates in the world since the 1970s.
Places like Lac Brochet have recorded 636 cases per 100,000 people, a fact Chief Joseph Dantouze reminded the Commons health committee of Tuesday.Read more: http://www.montrealgazette.com/health/Inaction+infighting+have+stalled+effort+reserves+Health+officials/2934665/story.html#ixzz0m3qaZOnS
The Hillsborough County Health Department tested 23 people Tuesday at the school, district spokeswoman Linda Cobbe said.
"Nobody had any symptoms," she said, but they may have had prolonged contact with others who tested positive.
Tuesday, 20 April 2010
The smear will become Postive when one has bacilli more than 5,000 – 10, 000 / 1 ml of sputum. Multiple smear examinations, at least three morning specimens are advised and appropriate collection of specimens will increase yield to > 43 %. If efforts were taken in educating patients for 1- 2 minutes in methods to collect the sputum, will yield higher results. Sputum induction procedures are helpful. Today’s emphasis to identify AFB, in smears is more demanding with associated HIV/AIDS, as few bacilli are excreted. Concentration of specimens and digestion of thick and mucous associate specimens with Sodium hypochlorite, Sodium hydroxide, N-acetyl –cystine – Sodium hydroxide will increase rate of detection to > 18 % in sensitivity and incremental yield of 9 %( positve after treatment with above chemicals – positives with direct Ziehl Nelson’s straining ) Sodium hypochlorite is beneficial in HIV positive patients as it is Mycobactericidal and also kills human Immunodeficiency virus, but not suitable for culturing specimens.
Need for Florescent Microscopy
The developing world should explore the Fluorescence microscopy, which will improve the sensitivity of Microscopy in patient who excrete few bacilli as in association HIV infection, The role of Ziehl Neelsen’s method of staining and conventional Microcopy is losing the sensitivity with ever increasing work load, technicians opting to see few fields, monotonous nature of work, the lack of accountability, and inter Institutional quality control protocols. Many systematic reviews indicated use of Florescent Microscopy will increase 10% higher sensitivity and 9 % in incremental yield when compared with Z.N method of staining. About 15 times as many fields of view can be scanned by Fluorescent Microscopy as by conventional Microscopy in the same period. The developing countries face crunch to buy Fluorescent microscopes and to maintain the regular availability of florescent dyes. It is utmost important to develop centralized and dedicated centers for Microscopy to have control on peripheral laboratories. Negative smears by conventional Microscopy needs further attention with optimal microscopy, concentration methods to detect AFB to reduce early mortality among the infected and to contain the spread in society.
Culturing for Mycobacterial Isolation
Sputum culturing remains a gold standard for diagnosing Mycobacterial infections. A Postive grwoth can be demonstrated with few bacilli to as low as 10 – 100 of viable bacilli per I ml of sputum. Cultures show growth of AFB even when patients where on treatment and negative by smear examination. A simple measure with decontamination of specimens and inoculation of at least 150 – 200 µl of concentrate on culture medium will increase the success in culturing. In spite of best decontamination procedures, 1 – 4 % of the isolates are false Postive. The greatest limitation of culturing on Lowenstein – Jensen medium and other equivalent medium is long periods (2 – 12 weeks) for isolation of bacteria.
Advances in Diagnostic Methodologies.
1. Mycobacterial growth in Incubator tube MGIT (Mycobacterium Growth Indicator Tube) is one new culturing method, costlier to install and automated system. Economic limitations and timely availability of reagents (closed system committed to the manufactures.) continue to hamper the growth of technolology in developing world
2.. Recent success with MODS ( the Microscopic Observation of drug susceptibility Assay ) developed in Peru gained the success as affordable, and primary drug resistance can be performed with simple efforts, But inverted microscope is essential to read the results at frequent intervals. Contamination or hazard to technical personnel is minimal. Even the district laboratories can report resistance to Isoniazid and Rifampicin In spite of several controlled studies on MODS assay is poor to discriminate between, M.tuberculosis from Non Tuberculosis Mycobacterium. The success of MODS is a great breakthrough in detection of MDR strains provided the prevalence of NTM prevalence is low MODS assay can identify patients with TB in approximately on third of time required for culturing on L J medium.
Emerging and Rapid Diagnostic methods.-
1 Fast plaque with phage amplification technology, tested in areas with high rates of HIV infection, had contradicting results, needs more understanding.
2. Quanti – Feron TB test – Done on Blood specimens, based on the principle of ELISA and enzyme linked immunospot. With higher production of Interferon γ (Inf-γ) by cells in response to Mycobacterium tuberculosis, than to the other environmental Mycobacterium in particular to Mycobacterium avium complex. The testing results correlated with Tuberculin skin test reactivity, but still hampered in BCG vaccinated.
3 Elispot – Tested by Elisa methodology detects Interferon γ produced by T lymphocytes in response to latent Tuberculosis
Infection. Elispot gained more clinical acceptability and advantageous, being negative in majority of BCG vaccinated individuals
Both the above testing methods were limited to high end laboratories and cost of testing remained the major limitation in many developing countries. More helpful to diagnose the latent Tuberculosis Infections.
The fast gains of Polymerase technologies by amplification of DNA (PCR) are limited to controlled studies interpreted in relation to clinical context and performance of the laboratory .Rapidly changing molecular technologies, out dating earlier hardware, other equipment and patented primers, added to limitations in the Developing world. Mainly used as restricted research tool, and unaffordable to the needy poor.
Many extra pulmonary tuberculosis cases were benefited with Molecular technology.
Future Goals in Control of Tuberculosis ;
Stop TB partnership, Global Plan for 2006 to 2015 call for strengthening of network to facilitate detect all TB cases including smear negative tuberculosis. The Emphasis should focus on Sputum concentration methods, promoting the use of Fluorescent Microscopy. Helping the smaller laboratories to initiate culturing, and antibiotic sensitivity testing. The present affordable option may remain with utilizing the methodology of MODS .The Developing world wishes to utilize this upcoming technology for practical, and simple way to detect the MDR tuberculosis even at district Laboratories
. Yet there is no fool proof, sensitive and specific test, which is inexpensive and rapid method for Diagnosing the Tuberculosis.
Great challenges include detection and controlling of MDR TB. Strengthening the Smear Microscopy, and more aggressive provisions for enforcing the Fluorescent microscopy, may reduce the incidence of spread of tuberculosis. We have to watch the Impact of X-MDR in the Indian continent. The undergraduate and postgraduate Medical students should be taught with more emphasis on control of drug resistant tuberculosis The best options with implementation of International standards for tuberculosis care with initiation of Major global health participation may bring hope to reduce the incidence of Tuberculosis by 2015.
Farmabrasilis welcomes contact with other individuals and organizations interested in the further development of the proposed approach.
Tests carried out by Tuberculosis Antimicrobial Acquisition and Coordinating Facility (TAACF) under contract signed by Farmabrasilis and US NIAID has shown that P-MAPA is active against M. tuberculosis in vivo
At the time Kathleen weighed 97 pounds and had just undergone a pulmonary lobectomy, which in her case meant the right lower lobe of her lung was removed. She had had TB for six months before she was taken to Cook County.
Kathleen wasn’t the first in her family to reside at the sanitarium. In all, at least ten members of her family suffered from TB. From the 1940s to the 1960s six were admitted: her father, who died of TB at the sanitarium in March 1957; her grandfather; her uncle’s wife; two of her uncle’s siblings; and her uncle’s niece, who died as an infant from TB.
“This has been seen very well in Sweden. Tuberculosis among the population has become increasingly rare, even though the country has taken in immigrants for decades. It should also be noted that young children with tuberculosis do not infect others,” Kilpi explains.
Finland stopped routinely vaccinating children against tuberculosis in 2006 because it was found to cause more harm than good, with bone infections as a possible side effect
The report identified several concrete steps that could be taken by the government, business and the philanthropic sector to reduce the incidence of TB in the San Diego-Tijuana border region by investing in laboratory diagnostics, prevention, infection control, expanded surveillance and expanded cooperation of area employers in TB health education, diagnosis and treatment. In the case of laboratory diagnostics no such services currently exist in Baja California yet could be provided for less than $213,000 a year permitting the state to accurately identify, detect and diagnose tuberculosis cases using cultures and drug susceptibility testing.
Additional key findings:
Over 600 cases of pulmonary TB were confirmed and reported annually in Tijuana in 2006 and 2007 with an overall rate of 46 per 100,000 inhabitants, which is substantially higher than rates in neighboring Mexican states.
Since 2000 there has been an average of over 300 new TB cases per year in San Diego County, of which nearly 40 percent were born in Mexico according to the San Diego County Health & Human Services Agency.
The estimated cost of TB in San Diego is a minimum of $21.3 million annually for an average of 300 cases. This includes approximately $12.7 million in lost earnings for patients due to their disease.
Monday, 19 April 2010
Sunday, 18 April 2010
Saturday, 17 April 2010
To find out the efficacy of community-based case finding, we did a community randomized trial and cost-effectiveness analysis in south Ethiopia. The trial Ethiopia aimed to evaluate if community health workers could improved smear-positive case detection and treatment success rates (Datiko and Lindtjørn, 2009 and Datiko and Lindtjørn, 2010).
The study showed that involving of health extension workers (HEWs) in sputum collection and treatment improved smear-positive case detection and treatment success rate, possibly because of an improved service access. This finding has policy implications and could be applied in settings with low health service coverage and a shortage of health workers.
Recently, National TB Control Programme in Ethiopia started to decentralize case finding and treatment to local communities (in Ethiopia called kebeles) using community based-treatment by health extension workers.
Tests will now be carried out on those inmates and staff who were in close contact with the unnamed man, who died on April 2.
The Western Mail understands the man was in his 30s and was an illegal immigrant from Cameroon.
The TB Diagnostics Project is being led by the Bay Area TB Consortium, which Perry directs, and the Nuclear Threat Initiative, a Washington nonprofit group working to strengthen global security. The program came about after a team of North Korean health officials visited California and met with Stanford and Bay Area tuberculosis experts in 2008.
It’s unusual for any outsiders to visit North Korea, but extremely rare for Americans. Safe to say that it's an unprecedented partnership between U.S. researchers and health officials in North Korea. So far, Perry has ventured there three times and is soon to return for a fourth visit.
Epidemic rates of HIV/TB coinfection as well as emerging multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB strains are contributing to increased TB-associated deaths worldwide. PA-284, a compound capable of being formulated into a dry powder, has not only shown promising activity against MDR and XDR but has also proven safe and effective in patients coinfected with HIV and TB. Previous studies showed that PA-284 was well-tolerated in tablet form, however, side effects such as headache and stomach discomfort were reported. Aerosol delivery of PA-284 directly to the primary site of infection would limit systemic exposure and ultimately eliminate potentially bothersome side effects.
In the study guinea pigs were used to evaluate the effects of PA-284 aerosols on TB infection. One month following infection with TB some guinea pigs received high daily aerosol treatments while others received low daily treatments for 4 weeks. Lung and spleen analysis of guinea pigs receiving the high dose of aerosol PA-284 showed less inflammation, bacterial burden and tissue damage.
"The present studies indicate the potential use of PA-824 dry powder aerosols in the treatment of TB," say the researchers.
The man, referred to in court documents as TC, has been subjected to a public health order that he be detained ''subject to such security as may be considered necessary in hospital''.
Most patients with tuberculosis are hospitalised when infectious and then closely monitored during treatment while they live within the community.
The NSW Health Department applied to the Administrative Decisions Tribunal to extend a previous public health order made in January to detain the man at Royal Prince Alfred Hospital for treatment after the ''very difficult and unco-operative patient'' had resisted numerous treatment attempts.
The Chief Health Officer of NSW, Dr Kerry Chant, certified that the man's behaviour, while suffering from the disease, was a danger to public health.
There are about 1000 new cases of tuberculosis in Australia each year.
The news is positive for beef cattle producers in Minnesota especially, which has been under split-state status since Oct. 10, 2008. Minnesota had been a TB-free state up until 2005, when tuberculosis was discovered in a beef cattle herd in northwest Minnesota. Since then, 12 herds in Beltrami and Roseau counties have had confirmed cases of the disease.
“The important part is that we haven’t found an infected herd for over a year now,” said Bill Hartmann, executive director of Minnesota’s Board of Animal Health (BAH) and state veterinarian. “We continue to test 300 herds every year in that modified accredited area of the state, and we haven’t found any infection in over a year.”
The number of TB cases in the county fell below 200 for the first time last year. It is so serious that the medication is hand-delivered wherever an infected person can be found, even if it's in a cardboard box under a downtown bridge.
"We can meet them at a McDonald's or a 7-Eleven or a gas station," said Tesfa Kidane of Dallas County Health and Human Services.
He oversees the 10 outreach workers who religiously keep track of and treat Dallas County's nearly 200 tuberculosis patients – an approach so successful that TB cases dropped 11 percent in 2009 from the previous year.
Why such a hard-nosed approach for a disease that has nearly been stamped out in the U.S. and is highly treatable?
"This disease, if left untreated and unchecked, could decimate a community," said Dr. Garry Woo, medical director of tuberculosis control for Dallas County.
And if patients refuse to take their meds or miss too many of these rendezvous, county health officials will have them quarantined.
"Treatment is held under control for released prisoners with drug-resistant form of tuberculosis to be fully treated. We want to expand the scope of activities in this regard, " the department head said.
Mehdiyev said that the activity to continue treatment after release of prisoners with a resistant form of tuberculosis is based on the agreement reached by the Chief Medical Office, Institute for Lung Diseases and the International Committee of the Red Cross (ICRC).
"The prisoners is a special category of people with mentality, requiring an individual approach. In some cases, detainees released under various pretexts, begin to shy away from treatment. It was agreed to achieve full recovery of these individuals to avoid such facts. Therefore, the corresponding work is being held", the department head said.
The 3 1/2 year old doe was located in the southeastern corner of the county.
The Michigan Department of Natural Resources and Environment will test at least 300 deer within a 10 mile radius by the end of the year.
This "circle" testing will be in effect for at least 5 years after the last TB positive deer is found on surveillance.
Last month a cattle herd tested positive for tuberculosis in Emmet County. As a result, all cattle herds within a ten mile radius has to be tested in the next six months.
The Open Source Drug Discovery (OSDD) program, a CSIR-led Team India consortium is leading the way in bringing open source collaboration techniques to drug research and health care. Their mission is to hasten the development of drugs and treatments for tropical diseases which have not gotten adequate attention from the "closed door" pharmaceutical industry.
In 2008, there were 408 TB cases reported in Denpasar. That number rose to 418 by the end of 2009.
The increase, according to Made Wirajaya, an official from the Indonesia Tuberculosis Eradication Association (PPTI), was probably caused by the high mobility of the city's residents as well as the low public awareness of the highly contagious but curable disease.
This is the first time that a complete mapping of the Mtb genome has been accumulated, confirmed and made available publicly. C2D's results might include significant information to release previously unnoticed aspects of tuberculosis (TB); consequential in development opportunities for immediately required new TB drugs in India and other developing nations.
The World Health Organization (WHO) states that every year, 1.7 million people die from TB and that in some parts of the globe, one in four people with TB has a form of the disease, which can no longer be cured with ordinary drugs procedures. In spite of this public health emergency, TB research endowment, principally for new drugs, remains alarmingly insufficient.
Dr. Samir K. Brahmachari, Scientist and Director-General of the Council of Scientific and Industrial Research (CSIR), said, "We need to have a balanced view between health as a right and health as a business. It is because there has been imbalance in this view that diseases like TB, with high mortality but low profitability, are neglected by the current system of pharmaceutical research".
Loon Gangte of the Delhi Network of Positive People, a support group for people living with HIV/AIDS, said that the irony is that with the accessibility of medications for HIV and principally of safe and reasonable Indian standards, people are living with HIV but dying of TB.
The company’s software algorithms can spot distinctive shapes, colors and densities that untrained eyes may miss. In a recent test in South Africa, which has some of the highest TB rates in the world, the technology was 93 percent accurate in detecting the bacillus on microscope slides and had a false positive rate of less than 2 percent, the company said.
The original Guardian system fit a digital camera to a standard microscope. Now, it is making an automated version that can hold 50 slides and work all night while no one is in the lab.
Adult patients who had been diagnosed with smear-positive PTB at a primary care clinic or at the referral hospital and who were being treated at any of the three clinics were interviewed. Associations between having taken the test as the main outcome and explanatory variables were assessed by multivariate logistic regression.
Between April and October 2007, 112 adults were included in the study. An HIV test had been offered to 74 (66%). Of the 112 patients, 61 (82%) had accepted the test; 45 (74%) had eventually been tested; and 32 (29%) had received their test results. Patients who were <25 yeas old, female or unemployed, or had reported no previous HIV testing, were more likely to have been tested. The strongest predictor of having been tested was if patients had been diagnosed at the referral hospital compared to the city clinic (adjusted OR 24.2; 95% CI 6.7-87.7; p<0.001). This primarily reflected an "opt-out" (uptake 94%) versus an "opt-in" (uptake 53%) testing policy.
The overall HIV test uptake was surprisingly low at 40%. The HIV test uptake was significantly higher among TB patients who were identified at hospital, among females and in the unemployed.
Agbana also revealed that the country ranks fourth on the prevalence rate, with a 536 persons infected among 100,000.
Agbana, who works at the University of Ilorin Teaching Hospital, made these revelations at the World TB day 2010, organised by the Excellence Foundation International in Ilorin.
He noted that increase in the growth rate of the disease rose from 2.2 percent in the early 90s to over 19.1 percent currently
This is the first time that a comprehensive mapping of the Mtb genome has been compiled, verified and made publicly available. C2D's findings may contain critical data to unlock previously undiscovered details of tuberculosis (TB); resulting in development opportunities for urgently needed new TB drugs in India and other developing countries.
The World Health Organization (WHO) reports that 1.7 million people die annually from TB and that in some parts of the world, one in four people with TB has a form of the disease that can no longer be treated with standard drugs regimens. Despite this public health emergency, TB research funding, particularly for new drugs, remains alarmingly inadequate.
Wednesday, 14 April 2010
But the hospital was on the verge of evolving into something new.
Change is a constant at Freeport, from its beginning as a sanatorium for tuberculosis patients in the early 1900s to its current incarnation as a complex continuing care and rehabilitation centre.
Longtime TB control director Dr. Earl Hershfield will appear alongside other TB experts and First Nations representatives at a health committee hearing in Ottawa on April 20. Recommendations stemming from the testimony will be debated in Parliament, raising hopes the Harper government will address the poverty, poor housing and lack of access to medical care that help TB spread.
Hershfield spent 37 years at the helm of Manitoba's TB control program and recently blasted provincial health officials for losing track of sick TB patients, saying the system is "falling apart."
Hershfield said he will likely raise his concerns about gaps in tracking and treating TB patients at the upcoming hearing and offer his opinion on what could be done to improve it.
"That's not the way to run tuberculosis control," Hershfield said. "You need a director to make the policy and people to carry it out in the field."
Manitoba recently recorded the highest TB rates of any province, making it a national hot spot of an infectious disease that experts say is a by-product of overcrowded homes, malnutrition and poor overall health. The airborne disease is rampant in many northern Manitoba communities where cramped living quarters help it spread.
Winnipeg MP and NDP health critic Judy Wasylycia-Leis brought TB to the federal health committee's attention after a Free Press series revealed some Manitoba communities recorded some of the highest TB rates in the world.
Some northern First Nations communities have recorded more than 600 cases of TB per 100,000 people. By comparison, Canada's national rate is five cases per 100,000 and the rate in Bangladesh is slightly below 400 cases per 100,000.
Wasylycia-Leis said she's hopeful the federal government will be forced to act on the recommendations from the hearings.
She said eliminating TB should be a priority, and that Canada needs a better national strategy to eradicate it.
Referring to a long-term study undertaken by a small non-governmental organisation, Jan Swarth Sahyog, which functions from the Ganiyari village in Chhattisgarh's Bilaspur district, he said the people in the region suffer from chronic malnutrition and malnutrition-related diseases like malaria and pulmonary tuberculosis during the period of August to November each year.
“There is no Maoist in this area. So the government argument that Maoist violence is responsible for the terrible level of under-development, poverty and inequity does not hold here…if body mass index is monitored on a monthly basis, there is a dip of BMI when rice harvest from the previous year runs out…The starvation leads to low immunity of the body and so malaria sets in. Also 95 per cent of the pulmonary tuberculosis cases have been found with BMI less than 18.5,” Dr. Sen said.
Saturday, 10 April 2010
The costs of tuberculosis diagnosis incurred by patients and escorts represent a significant portion of their monthly income. The costs arising from time lost in seeking care comprised a major portion of the total cost of diagnosis, and may worsen the economic position of patients and their families. Getting treatment from alternative sources and low index of suspicion public health providers were key problems contributing to increased cost of tuberculosis diagnosis. Thus, the institution of effective systems of referral, ensuring screening of suspects across the district public health system and the involvement of alternative care providers in district tuberculosis control can reduce delays and the financial burden to patients and escorts. open source database, has given us permission to reproduce articles, of particulat interest is the BMC International Journal of Human Rights
J Leukoc Biol. 2010 Apr 6;
Authors: Vesosky B, Rottinghaus EK, Stromberg P, Turner J, Beamer G
Control of M.tb, the causative agent of TB, requires immune cell recruitment to form lung granulomas. The chemokines and chemokine receptors that promote cell migration for granuloma formation, however, are not defined completely. As immunity to M.tb manifests slowly in the lungs, a better understanding of specific roles for chemokines, in particular those that promote M.tb-protective TH1 responses, may identify targets that could accelerate granuloma formation. The chemokine CCL5 has been detected in patients with TB and implicated in control of M.tb infection. To define a role for CCL5 in vivo during M.tb infection, CCL5 KO mice were infected with a low dose of aerosolized M.tb. During early M.tb infection, CCL5 KO mice localized fewer APCs and chemokine receptor-positive T cells to the lungs and had microscopic evidence of altered cell trafficking to M.tb granulomas. Early acquired immunity and granuloma function were transiently impaired when CCL5 was absent, evident by delayed IFN-gamma responses and poor control of M.tb growth. Lung cells from M.tb-infected CCL5 KO mice eventually reached or exceeded the levels of WT mice, likely as a result of partial compensation by the CCL5-related ligand, CCL4, and not because of CCL3. Finally, our results suggest that most T cells use CCR5 but not CCR1 to interact with these ligands. Overall, these results contribute to a model of M.tb granuloma formation dependent on temporal regulation of chemokines rather than on redundant or promiscuous interactions.
Tuberculosis (TB) is considered a serious public health challenge and last year some 629 persons joined the local treatment programme. The incidence rate is currently 83 per 100,000 and statistics show that about 60 persons died each year from TB, but many were also HIV positive.
Ramsammy, in a message to mark World TB Day on Sunday, underscored the challenges of co-infection in the health sector saying they are working to lower the rate of TB patients living with HIV to around 12 percent because as of 2009, some 23 percent of TB patients were listed as HIV positive. “Because these two diseases combined to be a serious killer, we need to ensure we protect persons living with HIV from TB and also protect persons infected with TB from HIV”, Ramsammy said.
Donors covered 43 percent of health care expenses in Ethiopia in 2006, up four times from 2002. Over the same period donor backing for health care in Benin dropped 10 percent to 13.4 percent
Donors spent $43.74 per person in development assistance to health (DAH) in Namibia in 2007 versus 65 US cents in Mauritius
DAH increased the most in East Africa from 2002 to 2006 (19.6 to 28.4 percent), versus 22 percent in West and Central Africa, 20.3 percent in Southern Africa and 11.5 percent in North Africa
In 2007 half of African countries set aside at least 5 percent of their national income for health care
In 2007 seven African countries spent less than 5 percent of total budgets on health care, compared to eight in 2001
Patients in Africa’s lowest income countries paid out-of-pocket for more than half their health care, with governments pitching in 46 percent
By 2007 four countries had met or all but met the Abuja Declaration goal of spending 15 percent of annual budgets on health: Burkina Faso (14.8 percent), Botswana (17.3 percent), Djibouti (15.1 percent) and Rwanda (18.8 percent). Liberia and Malawi had exceeded the target in 2006 at 16.4 and 18 percent, respectively, but then dropped to 6.4 and 12.1 percent in 2007
Botswana and Rwanda had the biggest jumps in health care spending as a percentage of overall expenses from 1999 to 2007 – 8.9 and 9.7 percent, respectively, while Ghana and Benin had the largest drops – 6.1 and 3.6 percent
Nigeria spent 3.5 percent of its 2007 budget on health care, a nearly 2-percent drop since 1999. The oil sector has accounted for more than 80 percent of government revenue, according to Extractive Industries Transparency Initiative
According to the World Health Organization, about one person dies of TB every 17 seconds, causing nearly 2 million deaths annually. The disease continues to be a contagious scourge in developing countries, and with the world shrinking rapidly due to global migration, it is a major public health threat in developed nations as well, including the United States. Each infected person represents a potential yet preventable future outbreak, WHO says. Testing for TB infection is necessary in order to quickly identify the appropriate persons for treatment and thereby prevent its spread.
New data from a meta-analysis of existing literature published this week in CHEST, the official journal of the American College of Chest Physicians, provide evidence supporting a new, scientifically-proven standard for detecting TB infection. The study demonstrates that Interferon Gamma Release Assays (IGRAs) are superior to the previous standard in diagnostics, the 100+-year-old tuberculin skin test (TST), for detecting confirmed active TB disease. This was especially true when the IGRAs -- both QuantiFERON®-TB Gold (QFT) and T-SPOT®-TB (T-Spot) -- were administered in developed countries.
College spokeswoman Catherine Bergerson said the school is working with the health department to notify all 46 people believed to have come in close contact with the student at Edison’s Lee County campus: four faculty members and 42 students. All 46 people have been asked to take a tuberculosis test, which will be administered by health department officials at Edison early next week.
Lee County Health Department spokeswoman Jennifer James-Mesloh said her office does not have any information on where the student picked up the illness, but said it is usually shared by people who come in close contact. No other details on the student, including her condition, were available Thursday.
"The people that are going to be tested are going to be classmates of the student," she said. "The whole entire Edison campus doesn't need to think they need to be tested. It doesn't mean if you pass someone in the hallway you're going to get it."
The most recent statistics for tuberculosis in Lee County are from 2008, when 32 people had confirmed cases of tuberculosis. That is consistent with the rest of the state, James-Mesloh said.
SM TBDx's 92.86% accuracy in positive cases and 3.75% false positive field of views, in the November 2009 clinical trials, far exceeded the NHLS program objectives of 80% accuracy and no more than 20% false positives, as well as industry norms of less than 70% accuracy.
Thursday, 8 April 2010
While modern medicine has rendered this highly contagious, and life-threatening disease curable, and treatable, the disease continues to challenge the medical community even to the present day. As the bacterium causing TB continues to evolve, mutate, and develop resistance against modern drugs, there exists an urgent and dire need to develop newer next generation drugs to fight the disease. The growing prevalence of XDR (extensively drug resistant) TB and MDR (multi-drug resistant) TB strains has created the need for newer diagnostics tools, and drugs to manage and control tuberculosis. R&D in this area confronts its toughest challenge ever, with global investments, and R& D funding on total TB research still continuing to fall short of requirements. The uncertainties over the level of the US government's contribution towards the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) has also taken its toll on research funding, leading to funding deficits. This shortfall in funds has knifed the availability of finances in high-burden regions, such as the Sub-Saharan region.
"Despite seeing the lowest number of new tuberculosis cases in Illinois during 2009, we've already experienced a tuberculosis outbreak in the state this year," State Public Health Director Dr. Damon T. Arnold said in a press release announcing World TB Day. "Although most of us don't think about tuberculosis much anymore thanks to the advances in medicine, this outbreak reminds us that TB is still circulating in Illinois. I urge all citizens to increase their awareness of tuberculosis and to join the global effort to stop the spread of this disease."
U.S. Strategy Expands Tuberculosis Treatment, Control
Goals include faster TB detection, more HIV tests, stronger health systems
By Cheryl PellerinScience Writer
Washington ― On World Tuberculosis Day, March 24, the United States released a five-year strategy for dealing with the ancient and relentless contagious lung disease that sickens 9 million people a year and kills nearly 5,000 every day in some of the world’s poorest nations.
The strategy, called for by the 2008 Lantos-Hyde Leadership Act Against AIDS, TB and Malaria, details the government’s plans from 2009 to 2014 to address the global public health threat of TB, including multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), forms of the disease that threaten to undermine recent progress in controlling TB.
“As part of the President’s Global Health Initiative we are accelerating our programs to control TB,” Dr. Rajiv Shah, administrator of the U.S. Agency for International Development (USAID), said in a video March 24 as he released the strategy.
“Working with our many partners,” he said, “we believe it will be possible to halve the number of TB cases and deaths by 2015. In doing so, 14 million lives could be saved.” The plan lays the groundwork for detecting and treating TB in 2.6 million people and 57,200 MDR patients.
“This is our blueprint for expanded treatment and control over the next five years,” Shah said. “We will work in close partnerships with host nations to implement this strategy.”
One-third of the planet’s population is infected with TB, which can be deadly if it becomes active in the body and is left untreated. The immune system can keep TB bacteria under control after a person becomes infected, but bacteria can become active when something — a medical condition such as HIV, for example — reduces a person’s immunity.
People in almost every country are infected with TB, but 22 countries account for 80 percent of the TB cases. The countries, in order, are India, China, Indonesia, Nigeria, South Africa, Bangladesh, Ethiopia, Pakistan, Philippines, Democratic Republic of Congo, Russia, Vietnam, Kenya, Brazil, Tanzania, Uganda, Zimbabwe, Thailand, Mozambique, Burma, Cambodia and Afghanistan.
TB is treated with a six- to nine-month course of “first-line” (most effective) drugs that cost less than $20. If patients do not complete the drug course or are treated improperly, they can develop MDR-TB. These patients must be treated with more expensive, less effective second-line drugs for 18 to 24 months.
If patients do not complete this course or are treated with the wrong drugs, they can develop XDR-TB, whose bacteria strains are resistant to all TB drugs. Fewer than 30 percent of XDR-TB patients who are otherwise healthy and whose immune systems are not compromised can be cured. More than half of those with XDR-TB die within five years of diagnosis.
We performed a systematic search (to December 2008) to identify trials describing outcomes of patients treated for MDRTB. We pooled appropriate data to estimate WHO-defined outcomes at the end of treatment and follow-up. Where appropriate, pooled covariates were analyzed to identify factors associated with worse outcomes. Among articles identified, 36 met our inclusion criteria, representing 31 treatment programmes from 21 countries. In a pooled analysis, 62% [95% CI 57–67] of patients had successful outcomes, while 13% – defaulted, 11% – died, and 2% – were transferred out. Factors associated with worse outcome included male gender 0.61 (OR for successful outcome) [0.46–0.82], alcohol abuse 0.49 [0.39–0.63], low BMI 0.41[0.23–0.72], smear positivity at diagnosis 0.53 [0.31–0.91], fluoroquinolone resistance 0.45 [0.22–0.91] and the presence of an XDR resistance pattern 0.57 [0.41–0.80]. Factors associated with successful outcome were surgical intervention 1.91 [1.44–2.53], no previous treatment 1.42 [1.05–1.94], and fluoroquinolone use 2.20 [1.19–4.09].
We have identified several factors associated with poor outcomes where interventions may be targeted. In addition, we have identified high rates of default, which likely contributes to the development and spread of MDRTB.
A transthoracic infection involving a low dose of Mycobacterium tuberculosis has been used to establish a new model of infection in minipigs. The 20-week monitoring period showed a marked Th1 response and poor humoral response for the whole infection. A detailed histopathological analysis was performed after slicing the formalin-fixed whole lungs of each animal. All lesions were recorded and classified according to their microscopic aspect, their relationship with the intralobular connective network and their degree of maturity in order to obtain a dissemination ratio (DR) between recent and old lesions. CFU counts and evolution of the DR with time showed that the proposed model correlated with a contained infection, decreasing from week 9 onwards. These findings suggest that the infection induces an initial Th1 response, which is followed by local fibrosis and encapsulation of the granulomas, thereby decreasing the onset of new lesions. Two therapeutic strategies were applied in order to understand how they could influence the model. Thus, chemotherapy with isoniazid alone helped to decrease the total number of lesions, despite the increase in DR after week 9, with similar kinetics to those of the control group, whereas addition of a therapeutic M. tuberculosis fragment-based vaccine after chemotherapy increased the Th1 and humoral responses, as well as the number of lesions, but decreased the DR. By providing a local pulmonary structure similar to that in humans, the mini-pig model highlights new aspects that could be key to a better understanding tuberculosis infection control in humans.
Its forerunner was established in 1902, mainly to provide free treatment for tuberculosis-stricken Jewish workers from the sweatshops of New York and other East Coast cities.
Out of the 32 separate indicators, the borough was considered worse than the London average in 15 of them.
Worst areas included drug misuse, new cases in Tuberculosis, diabetes and male life expectancy which sits at 76.
But 35 in every 1000 residents are claiming incapacity benefit because of mental illness, according to the Department of Health report. That equals 1 in 29.
India has one of the most severe burdens of tuberculosis in the world, accounting for one-fifth of the global incidence. TB is India's leading cause of adult illness and death from a communicable disease. Most of those infected are 15- to 59-year-old adults, the most economically productive segment of society.
In 1993, the Indian Government began to treat tuberculosis patients with the World Health Organization-recommended Directly Observed Treatment Short-course (DOTS). Left on their own, many TB patients fail to take the entire regimen of medication, contributing to the spread of drug-resistant TB for which treatment is long, difficult and expensive. Under DOTS, healthcare workers observe patients as they take their medicine.
More than one billion people covered by DOTS Strategy
In 1997 the Government formally launched the DOTS strategy nationwide. The first World Bank credit (1997- 2005) allowed rapid expansion of the DOTS strategy throughout the country. By providing free diagnostic and treatment services through public or non-public institutions, the project ensured the availability of TB diagnosis and treatment to all citizens regardless of their economic status. Full nationwide coverage of the DOTS strategy was achieved in March 2006, covering over one billion people.
"In the earlier TB control program, patients were good with collecting medicines, but we could not ensure that they took them. Now these medicines are administered at the clinic and its several satellite centers, thus ensuring that patients actually do take their medicines," said Dr. Ravinder Verma, Medical Officer In-charge, at a government Chest Clinic and HIV Center in New Delhi.
Detection and cure rates increased dramatically
The results have been dramatic. Diagnosis is far more accurate. While x-rays were used to detect the disease earlier, the sputum analysis test has increased detection levels from 30% to 70% at the national level, achieving global targets. Between 1997 and 2008, more than 9.5 million people suffering from TB were diagnosed and placed on treatment, thus saving more than 1.7 million additional lives.
Cure rates for those placed on treatment have also increased dramatically - tripling from 25% in 1997 to 86% in 2009, exceeding the global target. As a result, deaths from the disease were cut sevenfold - from 29% in 1997 to 4% in 2008.
Another key reason for the success is that the entire DOTS program is decentralized. Diagnosis done in the villages rather than in district hospitals. Quality-assured diagnostic facilities are available through more than 12,000 microscopy centers.
Moreover, more than 300,000 local health workers or trained community volunteers ensure that patients adhere to their drug regimen. Associations of medical professionals are promoting international standards for TB care. Also participating are over 250 medical colleges and some 2,500 NGOs.
WASHINGTON, April 7 /PRNewswire-USNewswire/ -- This year the focus of World Health Day is on the world's growing urban population. The theme, "1000 cities, 1000 lives" provides an opportunity to highlight the work that is being done to improve health in urban settings. The unprecedented rate of urban growth has far outstripped the ability of these cities to provide infrastructure for new residents. This lack of infrastructure will lead to an estimated 2 billion people living in slums over the next 20 years.
The growth of slums, which results from poorly managed urban growth, can give rise to the spread of both chronic and infectious diseases. Poor air quality, lack of access to potable water, limited sanitation, and poverty can lead to higher rates of infant and child mortality, higher rates of infectious diseases such as tuberculosis, and poor nutrition.
The U.S. Agency for International Development (USAID) is working to meet the challenges of urbanization and health through our "Making Cities Work" strategy. This strategy targets the needs of the urban poor and other vulnerable people by driving economic growth and improving access to health care and quality education. The United States has also made a bold commitment to invest in healthy and productive lives as part of President Obama's Global Health Initiative. Finally, USAID's Urban Programs Team engages local governments, citizens, non-governmental organizations and the private sector to develop sustainable solutions to urban challenges.
USAID is committed to working with our partners to promote health, development and a better quality of life for people in cities around the world.