Arch Intern Med. 2007;167(22):2443-2452.
Trends in Tuberculosis/Human Immunodeficiency Virus Comorbidity, United States, 1993-2004
Rachel Albalak, PhD; Richard J. O’Brien, MD; et al.
Background To our knowledge, this is the first assessment of trends in tuberculosis (TB)/human immunodeficiency virus (HIV) comorbidity in the United States based on national TB surveillance data.
Methods We analyzed all incident TB cases reported to the Centers for Disease Control and Prevention national TB surveillance system from all 50 states and the District of Columbia from 1993 through 2004. Trends in TB/HIV cases were examined according to selected demographic and clinical characteristics.
Results Cases of TB/HIV decreased from 3681 (15% of 25 108 TB cases) in 1993 to 1187 (8% of 14 515 TB cases) in 2004, accounting for 23% of the overall decrease in TB cases during this period. The TB/HIV case rate decreased from 1.4/100 000 in 1993 to 0.4/100 000 in 2004. The highest TB/HIV comorbidity rates persisted in persons aged 25 to 44 years (13.8%), males (9.7%), US-born persons (10.7%), non-Hispanic blacks (17.8%), and persons from the Northeast (11.0%) and the South (10.1%). Propensity stratification, used to account for the unequal probability of patients with TB being tested for HIV during the study period, did not show important differences in TB/HIV comorbidity trends.
Conclusions Comorbidity due to TB/HIV decreased substantially between 1993 and 2004, primarily in US-born persons in states that experienced a TB resurgence between 1985 and 1992. These decreases coincide with improvements in TB control and advances in HIV treatment and diagnosis. The overall decreases obscure the wide variation in comorbidity that exists among some demographic groups and the recent slowing in the decline over the past 3 years.
Tuesday, 11 December 2007
Sunday, 9 December 2007
More recent history -- Christmas seals
This year the American Lung Association is celebrating 100 years of Christmas Seals® by launching a new Christmas Seals(R) website, http://www.christmasseals.org. "Most Americans alive today have no vivid memories of how widespread deadly tuberculosis was before the 1950s, but it claimed entire families in this country, struck down people from all walks of life, often in their prime."
Jacob Riis, a journalist best known as the author of How the Other Half Lives, pleaded in a newspaper article for someone in America to develop a stamp or seal like the ones he saw being sold in Denmark as a method of raising funds to provide treatment to those without means. Emily Bissell, an American Red Cross volunteer from a prominent Delaware family, took up Riis' challenge. She designed the first Christmas Seal using the American Red Cross proprietary cross and sold them in her local post office. While not a substitute for official U.S. postage, she encouraged people to buy and affix these seals to holiday packages to demonstrate commitment to helping treat tuberculosis. Sales, however, were slow. Leigh Mitchell Hodges, a columnist for the Philadelphia Inquirer, came to the rescue, convincing his editor to run a picture of the seal every day leading up to Christmas and to publish stories about tuberculosis. Buoyed by this publicity, Ms. Bissell succeeded beyond her wildest dreams, and the American Lung Association, then known as the National Tuberculosis Society, gained a means of raising funds.
Jacob Riis, a journalist best known as the author of How the Other Half Lives, pleaded in a newspaper article for someone in America to develop a stamp or seal like the ones he saw being sold in Denmark as a method of raising funds to provide treatment to those without means. Emily Bissell, an American Red Cross volunteer from a prominent Delaware family, took up Riis' challenge. She designed the first Christmas Seal using the American Red Cross proprietary cross and sold them in her local post office. While not a substitute for official U.S. postage, she encouraged people to buy and affix these seals to holiday packages to demonstrate commitment to helping treat tuberculosis. Sales, however, were slow. Leigh Mitchell Hodges, a columnist for the Philadelphia Inquirer, came to the rescue, convincing his editor to run a picture of the seal every day leading up to Christmas and to publish stories about tuberculosis. Buoyed by this publicity, Ms. Bissell succeeded beyond her wildest dreams, and the American Lung Association, then known as the National Tuberculosis Society, gained a means of raising funds.
Saturday, 8 December 2007
BCG Disease
A vaccine meant to protect against tuberculosis is jeopardising the lives of HIV-infected infants, warn experts in a major new report. They call for improvements to vaccination programmes to avoid increasing the health risks for children whose immune systems are weakened by HIV.
The report focuses on how the “global epidemics of HIV and tuberculosis has exploded to create a deadly co-epidemic”, that is rapidly spreading in sub-Saharan Africa. It warns that about a third of the world’s 40 million people with HIV/AIDS are co-infected with TB, and that the mortality rate these people is five times higher than that for tuberculosis alone.
It also notes that the use of the Bacille Calmette-Guérin (BCG) vaccine against TB in babies with HIV may actually be making the situation worse.
Veronica Miller, a co-author of the report and director of the Washington, DC-based Forum for Collaborative HIV Research, said that there is an "urgent" need for changes to vaccination programmes in sub-Saharan Africa, including improved testing to know whether infants have HIV before vaccinating them against TB.
Live strain
The growing threat of TB and the drug-resistant forms of this bacterial infection that commonly attacks the lungs has increased the need for widespread vaccination, experts say.
Unfortunately, there is a lack of new vaccines against TB, which kills nearly 2 million people each year. For this reason, doctors must rely on the BCG vaccine, developed almost a century ago from a usually non-pathogenic, live strain of Mycobacterium bovis – the cow form of the bacterium that causes TB.
Physicians routinely administer this vaccine to newborns in regions where TB has re-emerged as a threat. This means that millions of infants in developing nations in Africa and Asia receive the vaccine in their first few hours of life.
Unfortunately, though, many of these infants are born with HIV, and subsequently have a weakened immune system. This weakened condition makes them vulnerable to “BCG disease”, a serious illness caused by the M. bovis of the BCG vaccine, which would otherwise not pose a threat.
BCG disease
One recent study conducted in South Africa and published in the journal Clinical Infectious Diseases found that six out of the eight children that became severely ill from the BCG vaccine ultimately died from the M. bovis infection (vol 15, p 559-61). The majority of these children were found to have had HIV.
Miller says that an estimated 600,000 children are born with HIV each year and hundreds are at risk of dying as a consequence of BCG vaccination.
The World Health Organization (WHO) had previously recommended that the BCG vaccine be given to all healthy infants as soon as possible after birth. However, the WHO revised its position and stated in a May 2007 report that "recent evidence shows that children who were HIV-infected when vaccinated with BCG at birth, and who later developed AIDS, were at increased risk of developing BCG disease."
The report adds that, "among these children, the benefits of potentially preventing severe TB are outweighed by the risks associated with the use of BCG vaccine."
Sophisticated tests
The challenge is to develop more sophisticated HIV tests for newborns, says Miller, who also conducts research at George Washington University in Washington, DC, US. But this will take a bigger financial commitment from governments and aid organisations, she adds.
She explains that the types of HIV tests commonly used in the developing world cannot distinguish the HIV status of infants until they reach about six months of age.
The search for more effective tuberculosis vaccines could produce novel options that avoid the problem of BCG-related illness, says Lewellys Barker at the Aeras Global TB Vaccine Foundation in Rockville, Maryland, US.
He notes that scientists are designing TB vaccines that involve the injection of proteins, as opposed to live bacteria, which would not pose as great a threat to children with HIV.
Journal reference: HIV-TB Co-Infection: Meeting the Challenge (pdf)
The report focuses on how the “global epidemics of HIV and tuberculosis has exploded to create a deadly co-epidemic”, that is rapidly spreading in sub-Saharan Africa. It warns that about a third of the world’s 40 million people with HIV/AIDS are co-infected with TB, and that the mortality rate these people is five times higher than that for tuberculosis alone.
It also notes that the use of the Bacille Calmette-Guérin (BCG) vaccine against TB in babies with HIV may actually be making the situation worse.
Veronica Miller, a co-author of the report and director of the Washington, DC-based Forum for Collaborative HIV Research, said that there is an "urgent" need for changes to vaccination programmes in sub-Saharan Africa, including improved testing to know whether infants have HIV before vaccinating them against TB.
Live strain
The growing threat of TB and the drug-resistant forms of this bacterial infection that commonly attacks the lungs has increased the need for widespread vaccination, experts say.
Unfortunately, there is a lack of new vaccines against TB, which kills nearly 2 million people each year. For this reason, doctors must rely on the BCG vaccine, developed almost a century ago from a usually non-pathogenic, live strain of Mycobacterium bovis – the cow form of the bacterium that causes TB.
Physicians routinely administer this vaccine to newborns in regions where TB has re-emerged as a threat. This means that millions of infants in developing nations in Africa and Asia receive the vaccine in their first few hours of life.
Unfortunately, though, many of these infants are born with HIV, and subsequently have a weakened immune system. This weakened condition makes them vulnerable to “BCG disease”, a serious illness caused by the M. bovis of the BCG vaccine, which would otherwise not pose a threat.
BCG disease
One recent study conducted in South Africa and published in the journal Clinical Infectious Diseases found that six out of the eight children that became severely ill from the BCG vaccine ultimately died from the M. bovis infection (vol 15, p 559-61). The majority of these children were found to have had HIV.
Miller says that an estimated 600,000 children are born with HIV each year and hundreds are at risk of dying as a consequence of BCG vaccination.
The World Health Organization (WHO) had previously recommended that the BCG vaccine be given to all healthy infants as soon as possible after birth. However, the WHO revised its position and stated in a May 2007 report that "recent evidence shows that children who were HIV-infected when vaccinated with BCG at birth, and who later developed AIDS, were at increased risk of developing BCG disease."
The report adds that, "among these children, the benefits of potentially preventing severe TB are outweighed by the risks associated with the use of BCG vaccine."
Sophisticated tests
The challenge is to develop more sophisticated HIV tests for newborns, says Miller, who also conducts research at George Washington University in Washington, DC, US. But this will take a bigger financial commitment from governments and aid organisations, she adds.
She explains that the types of HIV tests commonly used in the developing world cannot distinguish the HIV status of infants until they reach about six months of age.
The search for more effective tuberculosis vaccines could produce novel options that avoid the problem of BCG-related illness, says Lewellys Barker at the Aeras Global TB Vaccine Foundation in Rockville, Maryland, US.
He notes that scientists are designing TB vaccines that involve the injection of proteins, as opposed to live bacteria, which would not pose as great a threat to children with HIV.
Journal reference: HIV-TB Co-Infection: Meeting the Challenge (pdf)
Half a million years
ScienceDaily (Dec. 8, 2007) — Although most scientists believe tuberculosis emerged only several thousand years ago, new research from The University of Texas at Austin reveals the most ancient evidence of the disease has been found in a 500,000-year-old human fossil from Turkey.
The discovery of the new specimen of the human species, Homo erectus, suggests support for the theory that dark-skinned people who migrate northward from low, tropical latitudes produce less vitamin D, which can adversely affect the immune system as well as the skeleton.
Prior to this discovery in western Turkey, which helps scientists fill a temporal and geographical gap in human evolution, the oldest evidence of tuberculosis in humans was found in mummies from Egypt and Peru that date to several thousand years ago.
Paleontologists spent decades prospecting in Turkey for remains of Homo erectus, widely believed to be the first human species to migrate out of Africa. After moving north, the species had to adapt to increasingly seasonal climates.
The researchers identified this specimen of Homo erectus as a young male based on aspects of the cranial suture closure, sinus formation and the size of the ridges of the brow. They also found a series of small lesions etched into the bone of the cranium whose shape and location are characteristic of the Leptomeningitis tuberculosa, a form of tuberculosis that attacks the meninges of the brain.
After reviewing the medical literature on the disease that has reemerged as a global killer, the researchers found that some groups of people demonstrate a higher than average rate of infection, including Gujarati Indians who live in London, and Senegalese conscripts who served with the French army during World War I.
The research team identified two shared characteristics in the communities: a path of migration from low, tropical latitudes to northern temperate regions and darker skin color.
People with dark skin produce less vitamin D because the skin pigment melanin blocks ultraviolet light. And, when they live in areas with lower ultraviolet radiation such as Europe, their immune systems can be compromised.
John Kappelman, professor of anthropology at The University of Texas at Austin, is part of an international team of researchers from the United States, Turkey and Germany who have published their findings in the Dec. 7 issue of the American Journal of Physical Anthropology.
It is likely that Homo erectus had dark skin because it evolved in the tropics, Kappelman explained. After the species moved north, it had to adapt to more seasonal climates. The researchers hypothesize the young male's body produced less vitamin D and this deficiency weakened his immune system, opening the door to tuberculosis.
"Skin color represents one of biology's most elegant adaptations," Kappelman said. "The production of vitamin D in the skin serves as one of the body's first lines of defenses against a whole host of infections and diseases. Vitamin D deficiencies are implicated in hypertension, multiple sclerosis, cardiovascular disease and cancer."
Before antibiotics were invented, doctors typically treated tuberculosis by sending patients to sanatoria where they were prescribed plenty of sunshine and fresh air.
"No one knew why sunshine was integral to the treatment, but it worked," Kappelman said. "Recent research suggests the flush of ultraviolet radiation jump-started the patients' immune systems by increasing the production of vitamin D, which helped to cure the disease."
The Leakey Foundation and the Scientific and Technical Research Council of Turkey funded the research.
Adapted from materials provided by University of Texas at Austin.
The discovery of the new specimen of the human species, Homo erectus, suggests support for the theory that dark-skinned people who migrate northward from low, tropical latitudes produce less vitamin D, which can adversely affect the immune system as well as the skeleton.
Prior to this discovery in western Turkey, which helps scientists fill a temporal and geographical gap in human evolution, the oldest evidence of tuberculosis in humans was found in mummies from Egypt and Peru that date to several thousand years ago.
Paleontologists spent decades prospecting in Turkey for remains of Homo erectus, widely believed to be the first human species to migrate out of Africa. After moving north, the species had to adapt to increasingly seasonal climates.
The researchers identified this specimen of Homo erectus as a young male based on aspects of the cranial suture closure, sinus formation and the size of the ridges of the brow. They also found a series of small lesions etched into the bone of the cranium whose shape and location are characteristic of the Leptomeningitis tuberculosa, a form of tuberculosis that attacks the meninges of the brain.
After reviewing the medical literature on the disease that has reemerged as a global killer, the researchers found that some groups of people demonstrate a higher than average rate of infection, including Gujarati Indians who live in London, and Senegalese conscripts who served with the French army during World War I.
The research team identified two shared characteristics in the communities: a path of migration from low, tropical latitudes to northern temperate regions and darker skin color.
People with dark skin produce less vitamin D because the skin pigment melanin blocks ultraviolet light. And, when they live in areas with lower ultraviolet radiation such as Europe, their immune systems can be compromised.
John Kappelman, professor of anthropology at The University of Texas at Austin, is part of an international team of researchers from the United States, Turkey and Germany who have published their findings in the Dec. 7 issue of the American Journal of Physical Anthropology.
It is likely that Homo erectus had dark skin because it evolved in the tropics, Kappelman explained. After the species moved north, it had to adapt to more seasonal climates. The researchers hypothesize the young male's body produced less vitamin D and this deficiency weakened his immune system, opening the door to tuberculosis.
"Skin color represents one of biology's most elegant adaptations," Kappelman said. "The production of vitamin D in the skin serves as one of the body's first lines of defenses against a whole host of infections and diseases. Vitamin D deficiencies are implicated in hypertension, multiple sclerosis, cardiovascular disease and cancer."
Before antibiotics were invented, doctors typically treated tuberculosis by sending patients to sanatoria where they were prescribed plenty of sunshine and fresh air.
"No one knew why sunshine was integral to the treatment, but it worked," Kappelman said. "Recent research suggests the flush of ultraviolet radiation jump-started the patients' immune systems by increasing the production of vitamin D, which helped to cure the disease."
The Leakey Foundation and the Scientific and Technical Research Council of Turkey funded the research.
Adapted from materials provided by University of Texas at Austin.
Wednesday, 21 November 2007
Infliximab
Brief Communication: Characteristics of Spontaneous Cases of Tuberculosis Associated with Infliximab Angela Raval, PharmD; Gita Akhavan-Toyserkani, PharmD, MBA; Allen Brinker, MD, MS; and Mark Avigan, MD, CM
20 November 2007 Volume 147 Issue 10 Pages 699-702
Background: A warning for tuberculosis was added to the approved labeling for infliximab in October 2001.
Objective: To describe adverse event reports of tuberculosis during infliximab therapy after labeling changes.
Design: Case series.
Setting: Spontaneous adverse event reports maintained in the Adverse Event Reporting System database in the United States.
Patients: 130 patients with infliximab-associated tuberculosis.
Measurements: Clinical and laboratory data.
Results: The U.S. Food and Drug Administration received 130 domestic, spontaneous reports of tuberculosis in patients treated with infliximab between 1 November 2001 and 30 May 2006, including 59 (45%) with extrapulmonary disease. The most commonly reported risk factors included concomitant immunosuppressant use (n = 89), history of latent or active tuberculosis (n = 33), and being born into or having spent extensive time in an area where tuberculosis is endemic (n = 25). In the subset of 67 cases with documented initiation of infliximab therapy after the drug labeling change, 34 patients with a negative tuberculin skin test result before initiation of infliximab therapy developed tuberculosis after receiving infliximab.
Limitation: Conclusions from spontaneous case reports may not be generalizable to the entire infliximab-receiving population.
Conclusion: Clinicians should be vigilant in screening and monitoring for tuberculosis in patients receiving infliximab
20 November 2007 Volume 147 Issue 10 Pages 699-702
Background: A warning for tuberculosis was added to the approved labeling for infliximab in October 2001.
Objective: To describe adverse event reports of tuberculosis during infliximab therapy after labeling changes.
Design: Case series.
Setting: Spontaneous adverse event reports maintained in the Adverse Event Reporting System database in the United States.
Patients: 130 patients with infliximab-associated tuberculosis.
Measurements: Clinical and laboratory data.
Results: The U.S. Food and Drug Administration received 130 domestic, spontaneous reports of tuberculosis in patients treated with infliximab between 1 November 2001 and 30 May 2006, including 59 (45%) with extrapulmonary disease. The most commonly reported risk factors included concomitant immunosuppressant use (n = 89), history of latent or active tuberculosis (n = 33), and being born into or having spent extensive time in an area where tuberculosis is endemic (n = 25). In the subset of 67 cases with documented initiation of infliximab therapy after the drug labeling change, 34 patients with a negative tuberculin skin test result before initiation of infliximab therapy developed tuberculosis after receiving infliximab.
Limitation: Conclusions from spontaneous case reports may not be generalizable to the entire infliximab-receiving population.
Conclusion: Clinicians should be vigilant in screening and monitoring for tuberculosis in patients receiving infliximab
Monday, 12 November 2007
Aftermath report on the Speaker fiasco
Breaches in security that allowed a U.S. tuberculosis patient to defy health officials and fly to Europe and back in May can be at least partly fixed with faster communication and better training, according to a federal government report.A report from the U.S. Centers for Disease Control and Prevention on its handling of the matter shows a need for more coordination between airlines and federal agencies in such emergencies, including quick transmission of passenger information.A copy of the "After Action Report" obtained by Reuters on Thursday shows a lack of clear standard operating procedures allowed Atlanta lawyer Andrew Speaker to fly to Greece and Italy for his wedding and honeymoon against direct advice from authorities and then sneak back into the United States. .The report, which has been circulating among congressional staffers, says local officials also need to be told of new, flexible CDC powers to stop people from traveling. Local officials in Georgia said they could not legally act until Speaker had already disobeyed their orders.Better and faster tests for TB are also needed. Speaker did not learn that he had anything but ordinary TB for weeks because testing is so slow.Cetron noted that the CDC has only half the number of staff needed to properly watch travelers at ports of entry as recommended by the Institute of Medicine. A 2005 report from the Institute said CDC needed 1 inspector for every 750,000 travelers."I think there is this idea out there that somehow we will be erecting impenetrable fortresses at ports of entry that, rendered well, will leave us impervious to infectious diseases. That's just not going to happen," Cetron said in a telephone interview.
http://tinyurl.com/yufhj7
http://tinyurl.com/yufhj7
South African scientists crack drug-resistant TB code
South African scientists have sequenced the entire genome of a strain of extremely drug-resistant Mycobacterium tuberculosis (XDR-TB).
Scientists from the Nelson R. Mandela School of Medicine at the University of KwaZulu Natal, and the National Genomics Platform sequenced the genome 20 times to distinguish mutations from sequencing errors and provide a reference for further sequencing projects of XDR and multidrug-resistant TB. Lifelab, a funding mechanism of the South African Department of Science and Technology, funded the sequencing initiative. The cost of the research has not been disclosed.
James Sakwa, manager of the National Genomics Platform, told SciDev.Net that the next step will be to to develop a diagnostic kit that can quickly and efficiently diagnose this strain of XDR-TB. The breakthrough was achieved by using "pyro-sequencing" technology, where massive amounts of information are produced in parallel.
"This enabled us to sequence the whole genome within a week," he said. If the scientists had used older technologies, it would have taken about a year to achieve the same result.Proposals for the sequencing of other TB strains are currently being considered by the National Genomics Platform. "The truth is we don't know how many mutations of XDR TB there are," Sakwa said.The findings were announced at a press conference in Durban, KwaZulu Natal province, South Africa in October.
http://tinyurl.com/345l8g
Sunday, 11 November 2007
new drug, SQ109
A new tuberculosis drug given special status by both U.S. and European regulators might lead to simpler, more effective TB treatment regimens.Approximately one-third of the world’s population is infected with the tuberculosis bacterium, and approximately 1.6 million people died of the disease during 2005.Currently, TB patients must adhere to a complex treatment regimen over a six- to nine-month period. That demanding schedule, researchers said, often results in patients skipping treatment doses, which, in turn, gives rise to drug-resistant strains such as multi-drug-resistant, or MDR, tuberculosis and the recently identified extensively drug-resistant form of the disease.
The new drug, SQ109, is an antimicrobial agent developed through a partnership between the National Institute of Allergy and Infectious Diseases and the biotech company Sequella Inc.SQ109 has recently been granted "orphan drug" status by the U.S. Food and Drug Administration and the European Medicines Agency. The orphan designation involves tax reductions and marketing exclusivity to encourage development of drugs to treat diseases affecting fewer than 200,000 people.
http://tinyurl.com/yp3u6o
The new drug, SQ109, is an antimicrobial agent developed through a partnership between the National Institute of Allergy and Infectious Diseases and the biotech company Sequella Inc.SQ109 has recently been granted "orphan drug" status by the U.S. Food and Drug Administration and the European Medicines Agency. The orphan designation involves tax reductions and marketing exclusivity to encourage development of drugs to treat diseases affecting fewer than 200,000 people.
http://tinyurl.com/yp3u6o
OPEN SOCIETY INSTITUTE ON TB EPIDEMIC IN EUROPE AS INFECTION RATES
Controlling tuberculosis in Europe requires the participation of community groups and activists, according to an official “offer of partnership” to be presented to Europe’s ministers on Monday,
October 22 at the Ministerial Forum, “All Against Tuberculosis,” convened by the World Health Organization (WHO) and the German government. Ministers of health, finance, and justice from the 53 European Member States are expected to declare TB a “public health threat” and to commit new resources to tackle the epidemic in Europe.
TB is a preventable and curable disease. Yet, in 2005, 65,700 people in the European region died from TB, according to the WHO. The countries of the former Soviet Union account for 72 percent of all cases of TB reported in the European region. Greece, Sweden, and the United Kingdom also reported significant increases in TB infections in recent years.
“Rises in the rates and severities of infections make it clear that TB can no longer be dismissed as a disease of the past,” said George Soros, OSI Chairman. “I applaud the European ministers for finally recognizing TB as a regional health priority. Europe should also increase funding to fight TB in the developing world, where it continues to be one of the top killers.”
The WHO has invited Zemfira Kondur, an advocate from the Ukraine who works with marginalized Roma communities, to present civil society’s offer of partnership at the Ministerial Forum. “The burden of TB is greatest on the most marginalized communities, including Roma and other ethnic minorities,” said Kondur. “We urge our government leaders to accept our offer of partnership so we can work together to end this disease of poverty and inequality once and for all.” Most TB cases are concentrated among groups who have limited access to health care or who live in conditions that facilitate the spread of TB.
In London, TB outbreaks have disproportionately impacted homeless people, prisoners, and people who use drugs.
Cases of drug-resistant TB in Europe are among the worst in the world, and the number of people infected with both HIV and TB is also growing.
“The outbreak of HIV and TB co-infection has a devastating impact on patients, their families, and communities,” said Paul Thorn, director of the Tuberculosis Survival Project. “In order to control the spread of TB, we need health services to work with us, not just for us.”
http://tinyurl.com/29aw8s
Monday, 5 November 2007
South Africa projected increase in XDR-TB rates
Without new interventions, cases of extensively drug-resistant tuberculosis (XDR-TB) in rural South Africa will increase dramatically over the next five years, according to a study published 27 October in The Lancet. The study, which modelled the effect of various infection control measures on the spread of XDR-TB in the rural community of Tugela Ferry in KwaZulu-Natal, South Africa, suggests that infection rates will increase from 194 cases in 2007 to an estimated average of 234 cases a year by 2012. Multidrug-resistant TB will also increase from 352 cases in 2007 to 425 a year over the same period. They estimate that 72––96 per cent of all new XDR-TB cases in Tugela Ferry will occur in people infected with HIV. The study suggests that a combination of controls —— including using masks, reducing hospitalisation time, improving ventilation and rapid drug resistance testing —— could avert almost half the predicted XDR-TB cases by 2012 at Tugela Ferry and at similar resource-limited hospitals around the country.
http://tinyurl.com/2tadul
http://tinyurl.com/2tadul
Monday, 29 October 2007
Anti-TB programme 'led to resistance' in South Africa
A study has found that the WHO's tuberculosis programme in South Africa inadvertently helped a strain of TB-causing bacteria develop additional drug resistance.
Researchers from the University of KwaZulu-Natal's Nelson Mandela School of Medicine tracked the development of drug resistance in a strain of Mycobacterium tuberculosis over a 12-year period.
They found that by the time the WHO introduced their programme in South Africa in 2001 — using a second-line medication to combat multidrug-resistant strains of TB — at least one strain had already developed resistance to one or more of the second-line drugs.
But because the programme didn't conduct drug susceptibility tests, the new second-line medication was not only useless to TB patients infected with the resistant strain, but also led to the strain developing additional drug resistance. This is because when an M. tuberculosis strain is resistant to a drug, it survives and can subsequently evolve resistance to additional drugs. The strain eventually became extensively drug-resistant (XDR-TB), resistant to seven anti-TB drugs in total, including first-line and several second-line drugs.
http://tinyurl.com/2h88eo
Researchers from the University of KwaZulu-Natal's Nelson Mandela School of Medicine tracked the development of drug resistance in a strain of Mycobacterium tuberculosis over a 12-year period.
They found that by the time the WHO introduced their programme in South Africa in 2001 — using a second-line medication to combat multidrug-resistant strains of TB — at least one strain had already developed resistance to one or more of the second-line drugs.
But because the programme didn't conduct drug susceptibility tests, the new second-line medication was not only useless to TB patients infected with the resistant strain, but also led to the strain developing additional drug resistance. This is because when an M. tuberculosis strain is resistant to a drug, it survives and can subsequently evolve resistance to additional drugs. The strain eventually became extensively drug-resistant (XDR-TB), resistant to seven anti-TB drugs in total, including first-line and several second-line drugs.
http://tinyurl.com/2h88eo
Sunday, 21 October 2007
Close contact!
PHILIPSBURG, St. Maarten - Dozens of people in St. Maarten are being treated for latent tuberculosis after health officials warned that they may have been exposed to the illness by a stripper infected with an active form of the disease.
At least 40 people tested positive after the health department treated an exotic dancer from the Dominican Republic several months ago and sent her home, according to a government news release issued Friday.
Health officials struggled to identify those exposed, launching a public campaign to urge anyone who had contact with the woman to seek treatment. They now believe they have identified everyone infected.
http://www.msnbc.msn.com/id/21395893/
At least 40 people tested positive after the health department treated an exotic dancer from the Dominican Republic several months ago and sent her home, according to a government news release issued Friday.
Health officials struggled to identify those exposed, launching a public campaign to urge anyone who had contact with the woman to seek treatment. They now believe they have identified everyone infected.
http://www.msnbc.msn.com/id/21395893/
WHO EURO region's Ministerial Forum
"If the Berlin Ministerial Forum wishes to act now to eradicate tuberculosis, it must reach out far beyond the borders of Europe." The WHO EURO region's Ministerial Forum on tuberculosis on October 22, 2007, in Berlin, must take account of the threat of TB both outside as well as inside Europe if it is to be tackled adequately. These are the conclusions of authors of a Comment published in this week's edition of The Lancet. The Comment is authored by Dr Bruce Currey, Professor Quazi Quamruzzaman, and Professor Mahmuder Rahman, Dhaka Community Hospital, Dhaka, Bangladesh. They say that in a 21st century that is becoming more and more global, to reduce the incidence of tuberculosis within Europe, European ministers must act together and act now, not simply to control, but also to eradicate poverty and tuberculosis in the source communities of Europe's migrant workers and major trade partners outside Europe. The Ministerial Forum must confront the raging red bull of tuberculosis infections outside Europe. It goes on to say that the Berlin forum paper emphasises the 66 000 deaths from tuberculosis inside Europe in 2005, but overlooks the 1•6 million deaths outside Europe. It adds that radical reduction of the incidence of tuberculosis both inside and outside Europe requires prevention of the progression to new active cases as well as management of active cases. Eradication is possible, but not with drugs alone. Further, it adds: "Trade and trade embargoes affect the incidence of tuberculosis. The Centres for Disease Control and Prevention has shown how radical intervention in the Hmong refugee centres of Thailand can reduce the incidence of tuberculosis and multidrug-resistant tuberculosis in the Hmong in Fresno, California." The Comment authors propose a six-pronged approach to tackling the tuberculosis threat, including incorporating populations outside Europe, and the Forum accepting responsibility for actions such as arms trading and oil prices which increase inequality and tuberculosis incidence worldwide. The last of the six parts of the authors' suggested action calls on the Forum to get behind the UK Prime Minister's address to the UN in July 2007, to "act now" to tackle global poverty and "eradicate" the scourge of diseases such as tuberculosis, and his commitment that there are resources available to eradicate the disease. The Comment concludes: "If the Berlin Ministerial Forum wishes to act now to eradicate tuberculosis, it must reach out far beyond the borders of Europe."
http://www.medicalnewstoday.com/articles/86091.php
http://www.medicalnewstoday.com/articles/86091.php
Thursday, 18 October 2007
UN Special Envoy
The UN special envoy to stop TB visited Washington Wednesday to lobby US officials
for more funding to fight the disease. Congress is currently debating whether to double funding for TB programs to $200 million.
It’s estimated that each year, nearly nine million people develop tuberculosis, with more than one and a half million dying from the disease. That’s despite the fact that it’s both preventable and curable.
The UN special envoy to stop TB - former Portuguese president Jorge Sampaio – says there’s renewed interest and concern about the disease.
“The fact that Congress is dedicating much more attention to TB, because everyone thought that TB was finished and it was not a first-degree concern – the fact that it’s now unfortunately becoming a concern I think is a very positive step because in a way these things need to be fought against, needs to be on the agenda,” he says.
Sampaio says tuberculosis and other killer diseases are linked and often should be treated at the same time.
“Attack the three pillars - and I mean by that TB, HIV and malaria – TB now is also the main killer of HIV people on AIDS treatment – another thing is that it’s developing new strains which are resistant to the well-known treatment. So, TB presents new facets of danger, considering globalization, considering that it is a very quickly transmissible disease,” he says.
Those newer strains are called MDR and XDR-TB. The UN special envoy agrees with the description that TB is the Achilles Heel of AIDS treatment.
He says, “It’s an Achilles Heel simply because of the fact that there’s a dramatic irony in all this. Because you don’t have the cure for AIDS, but you do have anti-retrovirals, but of course people with AIDS a great percentage of them simply die because they catch TB, which is not diagnosed on time, which is in fact not controlled in time. They die because they are not treated carefully and in time for a curable disease.”
He says if all countries and health and aid agencies work together, it is possible to achieve the Millennium Development Goal of saving up to 14 million additional lives by 2015.
http://www.voanews.com/english/Africa/2007-10-17-voa37.cfm
for more funding to fight the disease. Congress is currently debating whether to double funding for TB programs to $200 million.
It’s estimated that each year, nearly nine million people develop tuberculosis, with more than one and a half million dying from the disease. That’s despite the fact that it’s both preventable and curable.
The UN special envoy to stop TB - former Portuguese president Jorge Sampaio – says there’s renewed interest and concern about the disease.
“The fact that Congress is dedicating much more attention to TB, because everyone thought that TB was finished and it was not a first-degree concern – the fact that it’s now unfortunately becoming a concern I think is a very positive step because in a way these things need to be fought against, needs to be on the agenda,” he says.
Sampaio says tuberculosis and other killer diseases are linked and often should be treated at the same time.
“Attack the three pillars - and I mean by that TB, HIV and malaria – TB now is also the main killer of HIV people on AIDS treatment – another thing is that it’s developing new strains which are resistant to the well-known treatment. So, TB presents new facets of danger, considering globalization, considering that it is a very quickly transmissible disease,” he says.
Those newer strains are called MDR and XDR-TB. The UN special envoy agrees with the description that TB is the Achilles Heel of AIDS treatment.
He says, “It’s an Achilles Heel simply because of the fact that there’s a dramatic irony in all this. Because you don’t have the cure for AIDS, but you do have anti-retrovirals, but of course people with AIDS a great percentage of them simply die because they catch TB, which is not diagnosed on time, which is in fact not controlled in time. They die because they are not treated carefully and in time for a curable disease.”
He says if all countries and health and aid agencies work together, it is possible to achieve the Millennium Development Goal of saving up to 14 million additional lives by 2015.
http://www.voanews.com/english/Africa/2007-10-17-voa37.cfm
Blood tests for TB
Physicians & TB controllers around the country can now quickly and accurately detect M. tuberculosis infection with today's U.S. Food and Drug Administration (FDA) approval of QuantiFERON(R)-TB Gold In-Tube (QFT(TM)). This blood test detects cellular immune responses to proteins specifically associated with tuberculosis (TB) infection. It replaces the original QuantiFERON(R)-TB Gold, and offers the same specificity and accuracy advantages. In addition, the new In-Tube format, already widely used in Europe and Asia, simplifies testing and fits with existing laboratory equipment, giving convenient TB testing from Kalispell to Key West. Both tests replace the 100-year-old tuberculin skin test (TST).
CEO of Cellestis, Dr Tony Radford, comments, "With the In-Tube system, the blood incubation requires virtually no labor and no set-up time. It makes a QFT(TM) test as simple as a routine antibody test and extends the availability of QFT(TM) testing by streamlining logistics to allow the initial incubation process to be done almost anywhere. The FDA approval now permits our U.S. customers to enjoy the cost-savings, and quality result of In-Tube, as well as a better process fit with hospitals and labs."
The TST, which involves a crude tuberculosis extract injected into the skin, is over 100 years old. Despite its limitations, it is widely used for detecting TB infection. Significantly, the TST is often confounded in persons vaccinated with Bacillus Calmette-Guerin (BCG) (TB vaccination), as well as those exposed to some environmental bacteria, giving many people a false- positive TST results. The TST has poor reproducibility and requires two patient encounters; one to inject the subject and a second, 2-3 days later, to read the inflammation it may produce. Measuring the inflammation requires trained medical personnel but is still highly subjective, and is notorious for inaccuracy. This leads to poor use of valuable medical resources, and the need for a second clinic visit means many people fail to have their TST read.
QFT(TM) is supported by data from over 100 clinical publications, requires a single blood test, and gives objective and reproducible results. The In-tube format simplifies testing logistics, enabling remote location blood collection. It measures immune responses to peptides that simulate M. tuberculosis proteins, which are not present in the BCG vaccine or most non- tuberculosis mycobacteria. Thus, QFT(TM) is 99% specific and a positive test result is strongly predictive of true infection with M. tuberculosis. As people suspected of TB infection are normally recommended for TB therapy, which carries risks of liver toxicity and nerve damage, use of the highly specific QFT(TM) test will reduce unnecessary therapy and overtreatment, therefore having significant medical benefit.
QFT(TM) provides a new standard for TB control and gives the US TB control community an effective, reliable and accurate screening method. In addition, QFT(TM) yields dramatic cost savings in medical staff time and by eliminating the common false-positive results of the TST. For TB control programs across the nation, QFT(TM) can relieve the medical, logistic, administrative and cost burden associated with TB testing compliance.
About Cellestis:
Cellestis is a listed Australian biotechnology company commercialising QuantiFERON(R) technology for diagnosing TB and other diseases worldwide. QuantiFERON(R)-TB Gold tests for the presence or absence of a protein (gamma- interferon) produced by a patient's white blood cells after stimulation with specific TB proteins. The test has received regulatory and policy approvals in the USA, Japan, Europe and elsewhere. The Company operates through subsidiaries in the USA, Europe and Australia Physicians & TB controllers around the country can now quickly and accurately detect M. tuberculosis infection with today's U.S. Food and Drug Administration (FDA) approval of QuantiFERON(R)-TB Gold In-Tube (QFT(TM)). This blood test detects cellular immune responses to proteins specifically associated with tuberculosis (TB) infection. It replaces the original QuantiFERON(R)-TB Gold, and offers the same specificity and accuracy advantages. In addition, the new In-Tube format, already widely used in Europe and Asia, simplifies testing and fits with existing laboratory equipment, giving convenient TB testing from Kalispell to Key West. Both tests replace the 100-year-old tuberculin skin test (TST).
CEO of Cellestis, Dr Tony Radford, comments, "With the In-Tube system, the blood incubation requires virtually no labor and no set-up time. It makes a QFT(TM) test as simple as a routine antibody test and extends the availability of QFT(TM) testing by streamlining logistics to allow the initial incubation process to be done almost anywhere. The FDA approval now permits our U.S. customers to enjoy the cost-savings, and quality result of In-Tube, as well as a better process fit with hospitals and labs."
The TST, which involves a crude tuberculosis extract injected into the skin, is over 100 years old. Despite its limitations, it is widely used for detecting TB infection. Significantly, the TST is often confounded in persons vaccinated with Bacillus Calmette-Guerin (BCG) (TB vaccination), as well as those exposed to some environmental bacteria, giving many people a false- positive TST results. The TST has poor reproducibility and requires two patient encounters; one to inject the subject and a second, 2-3 days later, to read the inflammation it may produce. Measuring the inflammation requires trained medical personnel but is still highly subjective, and is notorious for inaccuracy. This leads to poor use of valuable medical resources, and the need for a second clinic visit means many people fail to have their TST read.
QFT(TM) is supported by data from over 100 clinical publications, requires a single blood test, and gives objective and reproducible results. The In-tube format simplifies testing logistics, enabling remote location blood collection. It measures immune responses to peptides that simulate M. tuberculosis proteins, which are not present in the BCG vaccine or most non- tuberculosis mycobacteria. Thus, QFT(TM) is 99% specific and a positive test result is strongly predictive of true infection with M. tuberculosis. As people suspected of TB infection are normally recommended for TB therapy, which carries risks of liver toxicity and nerve damage, use of the highly specific QFT(TM) test will reduce unnecessary therapy and overtreatment, therefore having significant medical benefit.
QFT(TM) provides a new standard for TB control and gives the US TB control community an effective, reliable and accurate screening method. In addition, QFT(TM) yields dramatic cost savings in medical staff time and by eliminating the common false-positive results of the TST. For TB control programs across the nation, QFT(TM) can relieve the medical, logistic, administrative and cost burden associated with TB testing compliance.
About Cellestis:
Cellestis is a listed Australian biotechnology company commercialising QuantiFERON(R) technology for diagnosing TB and other diseases worldwide. QuantiFERON(R)-TB Gold tests for the presence or absence of a protein (gamma- interferon) produced by a patient's white blood cells after stimulation with specific TB proteins. The test has received regulatory and policy approvals in the USA, Japan, Europe and elsewhere. The Company operates through subsidiaries in the USA, Europe and Australia
http://sev.prnewswire.com/health-care-hospitals/20071012/LNF50012102007-1.html
CEO of Cellestis, Dr Tony Radford, comments, "With the In-Tube system, the blood incubation requires virtually no labor and no set-up time. It makes a QFT(TM) test as simple as a routine antibody test and extends the availability of QFT(TM) testing by streamlining logistics to allow the initial incubation process to be done almost anywhere. The FDA approval now permits our U.S. customers to enjoy the cost-savings, and quality result of In-Tube, as well as a better process fit with hospitals and labs."
The TST, which involves a crude tuberculosis extract injected into the skin, is over 100 years old. Despite its limitations, it is widely used for detecting TB infection. Significantly, the TST is often confounded in persons vaccinated with Bacillus Calmette-Guerin (BCG) (TB vaccination), as well as those exposed to some environmental bacteria, giving many people a false- positive TST results. The TST has poor reproducibility and requires two patient encounters; one to inject the subject and a second, 2-3 days later, to read the inflammation it may produce. Measuring the inflammation requires trained medical personnel but is still highly subjective, and is notorious for inaccuracy. This leads to poor use of valuable medical resources, and the need for a second clinic visit means many people fail to have their TST read.
QFT(TM) is supported by data from over 100 clinical publications, requires a single blood test, and gives objective and reproducible results. The In-tube format simplifies testing logistics, enabling remote location blood collection. It measures immune responses to peptides that simulate M. tuberculosis proteins, which are not present in the BCG vaccine or most non- tuberculosis mycobacteria. Thus, QFT(TM) is 99% specific and a positive test result is strongly predictive of true infection with M. tuberculosis. As people suspected of TB infection are normally recommended for TB therapy, which carries risks of liver toxicity and nerve damage, use of the highly specific QFT(TM) test will reduce unnecessary therapy and overtreatment, therefore having significant medical benefit.
QFT(TM) provides a new standard for TB control and gives the US TB control community an effective, reliable and accurate screening method. In addition, QFT(TM) yields dramatic cost savings in medical staff time and by eliminating the common false-positive results of the TST. For TB control programs across the nation, QFT(TM) can relieve the medical, logistic, administrative and cost burden associated with TB testing compliance.
About Cellestis:
Cellestis is a listed Australian biotechnology company commercialising QuantiFERON(R) technology for diagnosing TB and other diseases worldwide. QuantiFERON(R)-TB Gold tests for the presence or absence of a protein (gamma- interferon) produced by a patient's white blood cells after stimulation with specific TB proteins. The test has received regulatory and policy approvals in the USA, Japan, Europe and elsewhere. The Company operates through subsidiaries in the USA, Europe and Australia Physicians & TB controllers around the country can now quickly and accurately detect M. tuberculosis infection with today's U.S. Food and Drug Administration (FDA) approval of QuantiFERON(R)-TB Gold In-Tube (QFT(TM)). This blood test detects cellular immune responses to proteins specifically associated with tuberculosis (TB) infection. It replaces the original QuantiFERON(R)-TB Gold, and offers the same specificity and accuracy advantages. In addition, the new In-Tube format, already widely used in Europe and Asia, simplifies testing and fits with existing laboratory equipment, giving convenient TB testing from Kalispell to Key West. Both tests replace the 100-year-old tuberculin skin test (TST).
CEO of Cellestis, Dr Tony Radford, comments, "With the In-Tube system, the blood incubation requires virtually no labor and no set-up time. It makes a QFT(TM) test as simple as a routine antibody test and extends the availability of QFT(TM) testing by streamlining logistics to allow the initial incubation process to be done almost anywhere. The FDA approval now permits our U.S. customers to enjoy the cost-savings, and quality result of In-Tube, as well as a better process fit with hospitals and labs."
The TST, which involves a crude tuberculosis extract injected into the skin, is over 100 years old. Despite its limitations, it is widely used for detecting TB infection. Significantly, the TST is often confounded in persons vaccinated with Bacillus Calmette-Guerin (BCG) (TB vaccination), as well as those exposed to some environmental bacteria, giving many people a false- positive TST results. The TST has poor reproducibility and requires two patient encounters; one to inject the subject and a second, 2-3 days later, to read the inflammation it may produce. Measuring the inflammation requires trained medical personnel but is still highly subjective, and is notorious for inaccuracy. This leads to poor use of valuable medical resources, and the need for a second clinic visit means many people fail to have their TST read.
QFT(TM) is supported by data from over 100 clinical publications, requires a single blood test, and gives objective and reproducible results. The In-tube format simplifies testing logistics, enabling remote location blood collection. It measures immune responses to peptides that simulate M. tuberculosis proteins, which are not present in the BCG vaccine or most non- tuberculosis mycobacteria. Thus, QFT(TM) is 99% specific and a positive test result is strongly predictive of true infection with M. tuberculosis. As people suspected of TB infection are normally recommended for TB therapy, which carries risks of liver toxicity and nerve damage, use of the highly specific QFT(TM) test will reduce unnecessary therapy and overtreatment, therefore having significant medical benefit.
QFT(TM) provides a new standard for TB control and gives the US TB control community an effective, reliable and accurate screening method. In addition, QFT(TM) yields dramatic cost savings in medical staff time and by eliminating the common false-positive results of the TST. For TB control programs across the nation, QFT(TM) can relieve the medical, logistic, administrative and cost burden associated with TB testing compliance.
About Cellestis:
Cellestis is a listed Australian biotechnology company commercialising QuantiFERON(R) technology for diagnosing TB and other diseases worldwide. QuantiFERON(R)-TB Gold tests for the presence or absence of a protein (gamma- interferon) produced by a patient's white blood cells after stimulation with specific TB proteins. The test has received regulatory and policy approvals in the USA, Japan, Europe and elsewhere. The Company operates through subsidiaries in the USA, Europe and Australia
http://sev.prnewswire.com/health-care-hospitals/20071012/LNF50012102007-1.html
TB in YEMEN
A Sana’a University study has shown that there is a high rate of extra pulmonary tuberculosis cases among Yemeni tuberculosis patients, when compared to other Arab states. The study titled, Patterns of TB among patients attending the National TB Institute, was conducted by researchers at the university’s Faculty of Medicine and Health Sciences and supervised by Dr. Abdullah Moharram. Researchers studied 479 TB patients from different Yemeni governorates who received treatment at the National Tuberculosis Institute between September 2005 and January 2006. The study found that about 54 percent of patients attending the institute had pulmonary TB while the remaining 47 percent had extra-pulmonary TB. The rate of extra-pulmonary TB cases is higher than that of other Arab countries such as Egypt (28 percent), Saudi Arabia (27 percent) and Somalia (16 percent). TB produces lesions on bodily organs, especially the lungs. It can involve the central nervous system, lymphatic system, circulatory system, genitourinary system, bones and joints. About 40,000 infectious particles can be produced by a single sneeze. One cough from a pulmonary TB patient produces up to 3,000 infectious particles. People with prolonged, frequent, or intense contact with the disease face the highest risk of becoming infected, with an estimated 22 percent infection rate. A person with untreated, active TB can infect 10 to 15 people each year. If untreated, the death rate for these active TB cases is more than 50 percent. The risk of contracting TB increases with the frequency of contact with people who have the disease, with crowded or unsanitary living conditions and with poor nutrition. “This disease is an economic one. It is influenced by the economic state of the patient,” said Hamood Mahyub, a doctor and manager at the NTBI. TB is considered to be one of the major public health problems in Yemen, according to the 2004 World Health Organization report. Yemen registered 9,063 cases of TB at the NTBI in 2005, according to Abdul-Bari al-Hammadi, statistics officer at the NTBI. “351 have had a relapse after being treated because of their ignorance and misuse of the medication,” he said. “The Hodeidah Governorate has 603 cases, the highest number of cases in the country and Sayoun has the fewest number of recorded cases, with only ten. This means that for every 100,000 people in Yemen, there are 40 TB cases,” he said. According to the report, the number of pulmonary cases at the NTBI was 7, 691, compared with 9,466 extra pulmonary cases. Moreover, the report recorded 2,500 cases resulted in the patients death.The most common types of extra pulmonary TB were found in the lymph node, (33 percent), in the pleura (21 percent), and in the abdomen & bones (16 percent). The study found that 55 percent of adults who participated in the study were pulmonary TB cases while about 58 percent of children and 52 percent of elderly people had extra pulmonary TB. The study also found that almost half the patients (48 percent) were illiterate and 75 percent were living in low economic conditions. Doctors in the NTBI complain about the neglect shown by many patients’ towards their state of health. “They do not continue their Directly Observed Treatment Short-course program treatment once they start feeling better. They are often illiterate, which makes our work more difficult,” said Dr. Mahyub. “The media does not help to illuminate people about the dangers of this disease, its causes and means of avoiding infection.” The overall objective of global TB control is to reduce deaths due to the disease, to lower the occurrence of the disease itself, and finally to drastically reduce the transmission of infection. The Bacillus Calmette-Guerin vaccination is the most widely used vaccine in the world, but it has virtually no impact on the transmission of TB because its preventive effect on the infectious forms of TB is very limited. Nevertheless, because it is effective in preventing serious and life-threatening forms of TB in infants and young children, BCG vaccination continues to be recommended in countries where TB is common. In the 172 countries where BCG is used, around 85 percent of newborn babies are vaccinated with protective efficacy up to 80 percent for 10 to 15 years. 89 percent of the patients who attended the NTBI were found to be unvaccinated compared to just 11 percent who were vaccinated. It was also found that 50 percent of vaccinated patients and 46 percent of unvaccinated patients were infected with extra-pulmonary TB. Most TB patients suffered from fever, loss of weight, night sweats, chronic coughing, sputum and hemoptysis, the study found. TB patient may also suffer from other diseases affecting the immune system. The study found that 11 percent of patients had diabetes and there were two cases of chronic renal failure. The study found that about 16 percent of patients treated in the institute were completely cured, while 25 percent were undergoing treatment. Alarmingly, 58 percent of patients had failed to continue treatment and one percent had died. According to the World Health Organization, 8 million people become ill with TB and 2 million people die from the disease worldwide every year. In 2004, around 14.6 million people had active TB with 9 million new cases reported. The WHO estimated that 1.7 million deaths resulted from TB in 2004. TB is the world’s greatest infectious killer of women of reproductive age and the leading cause of death among people with HIV/ AIDS. The study recommended increasing the coverage of DOTS program to include all TB patients; providing TB treatment centers with the necessary equipment; providing patients with good knowledge of TB; and encouraging the Ministry of Public Health and Population to increase the coverage of BCG to include all children in their first months as can as possible.
http://www.yobserver.com/sports-health-and-lifestyle/10013081.html
http://www.yobserver.com/sports-health-and-lifestyle/10013081.html
Tuesday, 16 October 2007
TB in Nepal
After a decade of the introduction of DOTS (Directly Observed Treatment Short-Course) the graph for TB notification rate has started to look downward. The rate which was 112 per 100,000 population in 1999/00 had risen to 123 in 2004/05 has come down to 119 in 2005/06.It takes two decades or more to see the result of the treatment of TB and the country already achieved the global targets, said director at the National Tuberculosis Centre Dr. Pushpa Malla.Nepal has achieved the global targets in TB control ? with the detection rate of 70 per cent and the treatment success rate of 88 per cent, Dr. Malla told The Rising Nepal. She said that after DOTS was started in the country the number of deaths has reduced to around 7,000 from 10,000 annually.Forty-five per cent of the total population is infected with Tuberculosis (TB) and mostly those who die are of economically active age group. According to the National TB control Programme, 40,000 people get TB every year of them half of them are new cases identified through sputum tests.Dr. Malla said that DOTS services were being provided from 4,000 places, including public health institution and sub-health posts. She said that 60 per cent of all health institutions have been providing DOTS and the government aims at expanding the services to all public health institutions from the current fiscal year.The government has also been providing DOTS Plus for multi-drug resistance patients, in which the patients should take medicines regularly for two years. The DOTS Plus scheme was started two years ago. Of those who are under the DOTS Plus course, 70 per cent of them have been found to be negative after six months of taking the medicine. More than 20 patients have already completed the two-year course and they are hail and hearty now.The DOTS Plus is being provided from five centres, one each in the five development regions and more than 20 sub-centres. The government is planning to expand the service to Dhangadi, Chitwan and Tanahu from this fiscal year and to reach to several districts of the mid-western region in the near future.The National TB control Programme was started in 1996 aiming to reduce mortality, morbidity and transmission of tuberculosis so that it does not pose a public health problem, Dr. Malla said. The Nepal Stop TB Strategy was adopted in 2006 to address TB among people living with HIV/AIDS and MDR-TB.Dr. Malla said that people those living with HIV/AIDS are highly prone to TB and they could develop complications at any time but that could be prevented like other TB patients if they take regular DOTS."There are challenges for long-term sustainability of the DOTS scheme as we depend on the donors for 70 per cent of the funding," she said. Even now, TB patients especially those with HIV and MDR require more nutrition and social support, which we have not been able to provide. Again, many patients have to come to the centres regularly for DOTS from their villages walking several days and that could be one of the reasons for the irregularity of the intake of medicines. This problem is being tackled by utilizing female health volunteers, who reach medicines to the patients at their doorsteps, Dr. Malla said.
http://www.gorkhapatra.org.np/content.php?nid=28261
http://www.gorkhapatra.org.np/content.php?nid=28261
TB in Australia
THE killer disease tuberculosis, not seen in Australia for decades, has been reintroduced by migrants - largely refugees from Africa.
TB, which like the common cold is spread through the air, is on the increase in Victoria.
There were 352 cases of tuberculosis reported to the Department of Human Services in 2005 - a 7 per cent increase on the 2004 figure.
And a 26 per cent increase on 2002 figures.
The numbers have remained high with 353 cases last year.
And already there have been 89 cases in the first quarter of this year.
Much of the increase has been attributed to newly arrived refugees.
Africa has the highest incidence and mortality rate from tuberculosis in the world.
"As the geographic focus of Australia's humanitarian programs have changed in recent years, an increase in the number of notified tuberculosis cases have been observed," a report from the Public Health Branch on surveillance of infectious diseases stated.
"The most significant risk factor for tuberculosis in Victoria is having migrated from a high prevalence country.
"Health care workers should be aware of the increased risk of tuberculosis in newly arrived refugees and migrants and of the cultural issues that influence their health seeking behaviour."
Most notified cases, 93 per cent, were residents of metropolitan Melbourne mostly in the north and west.
And the highest number of cases were reported for the 20 to 30 year age group.
All refugees have health check screenings on entry to Australia.
Individuals who are suspected of tuberculosis sign a health undertaking (TBU) for follow-up screening. But a study found the numbers going for follow-up screening was low with fewer than half completing their TBU assessment.
It is estimated 1.6 million deaths resulted from TB in 2005 worldwide.
http://www.news.com.au/heraldsun/story/0,21985,22542632-662,00.html
TB, which like the common cold is spread through the air, is on the increase in Victoria.
There were 352 cases of tuberculosis reported to the Department of Human Services in 2005 - a 7 per cent increase on the 2004 figure.
And a 26 per cent increase on 2002 figures.
The numbers have remained high with 353 cases last year.
And already there have been 89 cases in the first quarter of this year.
Much of the increase has been attributed to newly arrived refugees.
Africa has the highest incidence and mortality rate from tuberculosis in the world.
"As the geographic focus of Australia's humanitarian programs have changed in recent years, an increase in the number of notified tuberculosis cases have been observed," a report from the Public Health Branch on surveillance of infectious diseases stated.
"The most significant risk factor for tuberculosis in Victoria is having migrated from a high prevalence country.
"Health care workers should be aware of the increased risk of tuberculosis in newly arrived refugees and migrants and of the cultural issues that influence their health seeking behaviour."
Most notified cases, 93 per cent, were residents of metropolitan Melbourne mostly in the north and west.
And the highest number of cases were reported for the 20 to 30 year age group.
All refugees have health check screenings on entry to Australia.
Individuals who are suspected of tuberculosis sign a health undertaking (TBU) for follow-up screening. But a study found the numbers going for follow-up screening was low with fewer than half completing their TBU assessment.
It is estimated 1.6 million deaths resulted from TB in 2005 worldwide.
http://www.news.com.au/heraldsun/story/0,21985,22542632-662,00.html
TB in Myanmar
The regime is reckoned to spend less than 2% of its budget on health care, but over 40% on the armed forces. Infectious diseases are as widespread as in poor African countries. Myanmar has one of the world’s highest rates of tuberculosis and drug-resistant forms of both tuberculosis and malaria are spreading. HIV infection is also growing in the general population. But government restrictions on aid workers’ movements forced the Global Fund to Fight AIDS, Tuberculosis and Malaria to pull out in 2005. Aid groups have also been forced to restrict their operations.
http://www.economist.com/world/asia/displaystory.cfm?story_id=9897689
http://www.economist.com/world/asia/displaystory.cfm?story_id=9897689
TB in Pakistan
In a country with a population of 164,741,924 it is astounding to note that about 1.5 million people are currently affected by Tuberculosis (TB) .The worst part of the whole situation is that the number is constantly increasing due to the lack of adequate precautionary measures in, a study reveals this week. This is mainly arising out of the supposed insufficient medical education of doctors, the study adds. “The core obstacle to effective TB control in Pakistan is inadequate medical education,” according to the study conducted by Aga Khan University Hospital (AKUH) in which 460 medical interns were surveyed. The study was conducted by employing researchers at five teaching hospitals of the city (Aga Khan Hospital, Liaquat National Hospital, Jinnah Post-Graduate Medical Centre, Ayub Medical College and Lady Reading Hospital). The researchers assessed the knowledge and practices of recently graduated medical interns (house officers) about TB.
http://www.thenews.com.pk/print1.asp?id=74470
http://www.thenews.com.pk/print1.asp?id=74470
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