S. Africa mulls forced detention of TB patients

By, Tom Carter, THE WASHINGTON TIMES, January 29, 2007

Public health officials in South Africa are recommending the forcible quarantine of patients infected with a particularly virulent and incurable strain of tuberculosis. And though quarantine may encroach on a victim's civil liberties, it may be necessary to prevent an epidemic, said a report published last week in an Internet peer-review medical journal.

Extensive drug-resistant tuberculosis (XDR-TB) has killed at least 74 persons in South Africa. More than 400 have been diagnosed with the disease, and an estimated 30 are infected each month, according to the study in the PLoS (Public Library of Science) Medicine.

"XDR-TB represents a major threat to public health. If the only way to manage it is to forcibly confine, then it needs to be done," Jerome Singh, a co-author of the study and human rights lawyer at Durban's Center for the AIDS Program of Research in South Africa, told Reuters News Agency last week.

XDR-TB is usually fatal within days or weeks and highly contagious among those living with HIV/AIDS.

"It is here, it is really scary, and it is an emergency," said Dr. Paul Nunn, the World Health Organization's coordinator of HIV and drug-resistant tuberculosis programs.

"Drug-resistant TB is found all over the world. It has been identified in 26 countries. But in sub-Saharan Africa, we have a population that has TB and is HIV-positive. It is a combination that is explosive," Dr. Nunn told The Washington Times.

Dr. Jim Yong Kim, who founded Partners in Health with Dr. Paul Farmer, recently returned from Lesotho, where he saw the burgeoning epidemic firsthand.

"I've been to some of the worst places in the world dealing with TB -- the prisons of Russia and the slums and clinics of Haiti and Peru. This is the worst epidemic I've seen," Dr. Kim said.

He was in Lesotho to start an anti-HIV program, but his clinics were overwhelmed with HIV-positive patients who were then diagnosed with TB.

"We started seeing all these coughers. Last year, before we came, only four or five people were treated for TB. In four months, we've already identified 120, and that is in one village," Dr. Kim said.

"In the United States, the TB rate is seven per 100,000. The rate here is 400 to 500 per 100,000. Among all cases of TB, 25 percent had multidrug-resistant tuberculosis (MDR-TB).

"We don't have any idea how high the rate is of MDR-TB, but our fear is that it will be quite high," he said.

Though India, China and Russia have large TB and HIV populations, for the most part, they do not live together in close communities. South Africa is different.

As many as 5.5 million of 45 million South Africans test positive for HIV, and many more carry the latent TB bacteria.

Medical authorities had been warning that the HIV-TB combination was explosive and deadly, but health specialists worldwide sat up and took notice only last year, when 53 persons at Tugela Ferry, South Africa, were diagnosed with XDR-TB, and all but one died in 25 days.

In all, 170 XDR-TB cases have been diagnosed in that area.

"Thirteen of the people who died in South Africa had the same genetic fingerprint.

They were all taking anti-retrovirals for HIV and attending an ARV literacy class on how to take their medicines. Someone brought XDR-TB into that room, and they all died," Dr. Nunn said.

"Sixty percent had never been treated for TB. They caught it. It was like a match going off in that clinic. This is an absolutely frightening epidemic," Dr. Kim said.

And with worldwide air travel, the price of a plane ticket could easily spread XDR-TB here. Dr. Nunn cited a case the WHO is investigating but is yet to be reported: A man with XDR-TB boarded an airplane in Beirut last year and coughed blood on his flight to Paris. The man died shortly thereafter. The WHO is investigating whether he passed the disease to other passengers.

The WHO said the XDR-TB outbreak must be taken as seriously as outbreaks of bird flu and severe acute respiratory syndrome.

WHO guidelines recommend that TB-infected patients voluntarily restrict their movements and abstain from mixing with the general population. South African medical authorities are saying that may not be enough.

If voluntary "measures prove to be ineffective, then more restrictive measures may need to be contemplated. ... Rights can usually be restricted if doing so is reasonable and justifiable. ... The use of involuntary detention may legitimately be countenanced as a means to assure isolation and prevent infected individuals possibly spreading infection to others," according to the PLoS paper.

This could prove especially difficult in South Africa, where a strong code of individual rights was enshrined in the post-apartheid constitution.

Dr. Kim said it is legal in the United States to quarantine someone with TB who refuses to take medication.

More than 9 million people are infected with drug-susceptible Mycobacterium tuberculosis each year. As many as 20 percent of that population will recover without treatment, but as many as 1.7 million die because they are not diagnosed and do not get the proper drugs.

Susceptible strains of TB respond readily to first-line antibiotics, and virtually all can be cured if diagnosed and treated. A rural country lab with a simple microscope and slides can diagnose it. The disease takes about $16 worth of drugs and six months of treatment to cure, according to the WHO.

But when TB victims begin feeling better, some stop taking their antibiotics, and drug-resistant strains of tuberculosis can evolve. MDR-TB is defined as a strain that resists at least two of the four first-line TB drugs. Health officials estimate that 300,00 to 600,000 people are infected with MDR-TB each year. About 2 percent of that group contract the deadly XDR-TB strain.

Dr. Nunn said it costs about $10,000 and an average two years of treatment to cure MDR-TB. There are no estimates for treating and curing XDR-TB, because most patients die within weeks.

In November, the Centers for Disease Control and Prevention (CDC) revised its definition of XDR-TB to strains that resist two front-line drugs, as well as three or more of the six classes of second-line drugs. Complicating the problem is that, unlike drug-susceptible TB, XDR-TB takes sophisticated laboratory tests to accurately diagnose.

Dr. Kim said that because of the lack of sophisticated lab equipment, samples from his clinics in Lesotho had to be shipped to Massachusetts for diagnosis.

"We are dealing with a type of TB that is virtually untreatable," Dr. Nunn said.

"XDR-TB is obviously a very severe problem, especially when you don't have the drugs to treat it," said Dr. Anthony Fauci, director of the National Institutes of Health.

He said tuberculosis is difficult to catch unless the immune system is already compromised, by a disease such as AIDS, for example, or malnutrition. He said it takes more than a casual contact to spread TB. "You need to be very close, or living with a person. We need to pay attention to XDR-TB, but we do not need to panic," he added.

Christine Sizemore, who oversees NIH research on TB drugs, said there are "several candidates in early clinical development, and several more coming along," but even if they are successful, the new drugs are years from being available.

Dr. Ken Castro, who heads the CDC's program for TB elimination, said 47 persons have been diagnosed with MDR-TB in the United States since 1992, 15 of them since 2000.

"The growing reality is that it is here in our own midst, and it is virtually untreatable," he said in a telephone interview from Atlanta.

Which is why the PLoS Medicine report is recommending forcible isolation of XDR-TB patients.

"It is not a priori unethical to restrict the movement of those whose infection poses risks to public health. ... Ultimately in such crises, the interests of public health must prevail over the rights of the individual," the report stated.

Dr. Kim said that XDR-TB can be contained, and that small improvements in South African rural clinics -- such as ultraviolet lights to kill bacteria, and fans blowing bad air out through windows -- can accomplish a lot.

Still, hundreds of millions of dollars need to be appropriated for new drugs, new diagnostic methods and comprehensive treatment programs for infected areas, he said.

"In the mid-1980s, there were no drugs for HIV, and now look at all that we have. If there is a will -- a political will, in collaboration with scientists and researchers -- we can develop these drugs and diagnostics.

"But I worry we won't do it until there is a Rock Hudson or Magic Johnson of XDR-TB," he said.


Source: http://www.washingtontimes.com/world/20070128-104935-8507r.htm

Court order keeps Canadian TB patient in hospital

By, Leah Schnurr, Reuters, January 29, 2007

TORONTO - Canadian health officials have won a court order to keep a patient with a new, highly drug-resistant strain of tuberculosis in hospital, while the national health agency says it will start tracking rates of the disease this year.

Health officials in Toronto say the person has been confined to treatment for 11 months.

"Basically, this is someone who dropped in and out of treatment over a number of years," Elizabeth Rae, associate medical officer of health with the tuberculosis program at Toronto Public Health, said on Monday.

A court order was considered necessary given the person's history of sporadic care, Rae said. Although not currently infectious, the patient will likely stay in hospital under strict watch for another year.

Officials are monitoring a second person that had the strain, which is dangerous because conventional drugs don't work to contain it.

Tuberculosis, a bacterial disease that most commonly affects the lungs, and is passed on through coughing or sneezing, can develop into a resistant strain if the patient is treated incorrectly or erratically due to a lack of necessary drugs, or if the patient refuses or is unable to complete the treatment.

The first strain, multi-drug resistant (MDR) tuberculosis, is immune to the most common antibiotics. If improper treatment continues, it can become extensively drug-resistant (XDR), which is extremely difficult to treat and has a high mortality rate.

The Public Health Agency of Canada plans to begin tracking cases of XDR and will publish their findings this year.

The agency believes the number of XDR cases accounts for a small fraction of MDR cases. The number of MDR cases was in a range of 13 to 23 people a year from 1998 to 2005.

According to the U.S. Centers for Disease Control and Prevention, out of 17,690 tuberculosis cases around the world from 2000 to 2004, 2 percent were XDR.

Successful treatment of XDR depends on the severity of the drug resistance and usually involves giving patients large amounts of drugs to see what works.

"That becomes quite a cocktail and they all have their own side-effects," said Dr. Edward Ellis, manger of tuberculosis prevention and control at the Public Health Agency of Canada.

Putting patients into isolation to stop them from infecting others is a crucial part of treatment. However, officials note that court-ordered confinement raises ethical concerns over patient rights.

"The ethical principle of autonomy ... is certainly being violated," said Ellis.

"But the most important one in this case is social justice, because if you have infectious TB and are at large in the community, you are basically exposing (others) to risk which is involuntary."

Experts say most XDR cases in Canada are seen in foreign-born people who develop the disease in another country before traveling to Canada.

An outbreak in South Africa has caused alarm because the disease is a danger to people with HIV-AIDS, whose weakened immune systems make it more difficult to fight XDR.

Experts say people may refuse treatment out of fear, an inability to stick to a lengthy regimen of antibiotics, or because of the stigma still attached to tuberculosis.

"People shy away from you, they're afraid of you. You're sent away to hospital, sometimes you never come back," said Ellis. "It's a bad word."

XDR-TB in South Africa

By, news-medical.net, January 23, 2007

A team of medical ethics and public health experts say tough isolation measures, involuntary if need be, are justified to contain a deadly, contagious, drug-resistant strain of TB in South Africa and to prevent "a potentially explosive international health crisis."

In a policy paper in the international health journal PLoS Medicine, Dr Jerome Singh of the Centre for the AIDS Programme of Research in Durban, South Africa (who is also an Adjunct Professor at the Joint Centre for Bioethics, University of Toronto) and colleagues say that "the forced isolation and confinement of extensively drug resistant tuberculosis (XDR-TB) and multiple drug resistant tuberculosis (MDR-TB) infected individuals may be a proportionate response in defined situations given the extreme risk posed."

On September 01, 2006, the World Health Organisation announced that a deadly new strain of XDR-TB had been detected in Tugela Ferry, a rural town in the South African province of KwaZulu-Natal, the epicentre of South Africa's HIV/AIDS epidemic. Of the 544 patients studied in the area in 2005, 221 had MDR-TB (Mycobacterium tuberculosis resistant to at least rifampicin and isoniazid). Of these 221 cases, 53 were identified as XDR-TB (i.e. MDR-TB plus resistance to at least three of the six classes of second line drug treatments). Of the 53, 44 were tested for HIV and all were HIV infected.

This strain of XDR-TB in Kwazulu-Natal proved to be particularly deadly: 52 of the 53 patients died (within a median of 16 days of the initial collection of sputum for diagnostic purposes).

But the authors say that there have been a number of obstacles in the way of dealing effectively with the crisis. "The South African government's initial lethargic reaction to the crisis," they say, "and uncertainty amongst South African health professionals concerning the ethical, social and human rights implications of effectively tackling this outbreak highlights the need to address these issues as a matter of urgency lest doubt and inaction spawns a full-blown XDR-TB epidemic in South Africa and beyond." beyond."

TB strain could pose threat to millions across Africa

The New York Times, January 28, 2007

JOHANNESBURG, South Africa — More than a year after a virulent strain of tuberculosis killed 52 of 53 infected patients in a rural South African hospital, experts here and abroad say the disease has most likely spread to neighboring countries, and some say urgent action is essential to halt its advance.

Several expressed concern at what they called South Africa's sluggish response to a health emergency that, if left unchecked, could prove hugely expensive to contain and could threaten millions of Africans.

The director of the government's tuberculosis programs called those concerns unfounded and said officials were doing everything reasonable to combat the outbreak.

The form of TB, known as XDR for extensively drug-resistant, cannot be effectively treated with most first-and second-line tuberculosis drugs, and some doctors consider it incurable. The threat is exacerbated by the prevalence of HIV in South Africa.

Since it was first detected last year in KwaZulu-Natal province, additional cases have been found at 39 hospitals in South Africa's other eight provinces.

In interviews on Friday, several epidemiologists and TB experts said the disease had probably moved into Lesotho, Swaziland and Mozambique — countries that share borders and migrant work forces with South Africa — and perhaps to Zimbabwe.

But no one can say with certainty, because none of those countries have the laboratories and experts necessary to diagnose the disease. Even in South Africa, where nearly 330 cases have been documented, evidence of the disease's spread is mostly anecdotal.

Cases of XDR TB exist elsewhere — in Russia and China where inadequate treatment programs have allowed drug-resistant strains of the disease to emerge. The South African outbreak is considered far more alarming, however, because it is not only far larger, but is at the center of the world's HIV pandemic.

Tuberculosis thrives when immune systems are weakened by HIV. At least two in three South African TB sufferers are HIV-positive. Should XDR TB gain a foothold in the HIV-positive population, it could wreak havoc not only among the 5 million South Africans with the virus, but tens of millions others across sub-Saharan Africa.

Source: http://www.azstarnet.com/sn/news/166543.php

Humanity's formidable enemy

By, Belinda Bereseford, Mail & Guardian Online, January 15, 2007

Mycobacterium tuberculosis is the “mother of all pathogens”, able to create all its essential nutrients, eat its own cell wall without dying, and hide within the cells sent to kill it for decades.

Under various names, including the “white plague” and consumption, TB has been around for thousands of years, with Egyptian mummies showing traces of it.

A third of humankind is estimated to be infected by the bacillus, which is thought to kill two million people a year, with a new TB infection occurring every second.

Yet humanity confronts this talented adversary with inadequate diagnostic tests a century old, a poor vaccination developed 70 years ago, and drugs at least 35 years old.

Mycobacterium tuberculosis (Mtb) was identified by Robert Koch in 1881. It and its many relatives -- including one causing leprosy -- are thought to be descended from soil bacteria. One theory is that it made the transition via domesticated cattle.

The most common form of TB is pulmonary, but it can occur elsewhere, including the spine and the brain. Active TB eats through body tissues; patients become pale and cough up blood in a drawn-out death, usually from suffocation.

Hendrik Koornhof of the National Institute of Communicable Diseases says Mtb’s success lies partly in its ability to hijack the body’s biochemical defences. On entering the body it is met by macrophages, white blood cells that destroy intruding pathogens. But Mtb survives in the immune cells that should kill it.

It also appears to subvert the chemical message system, sending signals that dampen, rather than ratchet up, defence responses.

In 1998 the battle of science against TB took a leap forward with the deciphering of the 4 000 chemical letters making up Mtb’s genetic code. But scientists estimate they understand the use of only 40% of the genes. Some of its proteins are only known to exist in Mtb, and may help it avoid attack by the immune system.

Mtb also has ways of dealing with antibiotics. Its slow life cycle means it can take days to replicate, so that drugs that interfere in its reproduction must be present in sufficiently high levels for extended periods to be effective. Hence the six-month course of treatment.

Fat is beautiful to Mtb, described as a “wax blob” by Valerie Mizrahi of Wits university’s Molecular Mycobacteriology Research Unit. It has five times more genes for biosynthesising lipids (fats) than other bacterias. It can also synthesise all the essential amino acids, enzymes and vitamins it needs and switch its diet from fats to simple sugars if necessary. It is even believed to be able to digest its own cell wall and live.

Armed with a specialised secretion system to moderate its environment, Mtb has a highly water-resistant cell wall containing enzymes to disable toxins such as antibiotics, and appears to have an efflux system to eject them.

Under stress, the bacillus can “go to sleep”, stop metabolising and avoid taking in antibiotics. In this state it can vegetate for decades without dividing or needing to create spores for survival, as other pathogens do. When the immune system fails, it stirs back to life.

Thirty percent of people exposed to Mtb, usually through coughed droplets of sputum, become infected, but most, if not all, harbour the bacillus in a latent form.

Genetics appears to play a role in susceptibility to TB, and one mutation alone may multiply sevenfold the chances of infection. The link between immune system and pathogen is so intimate that some TB strains appear adapted to attack particular ethnic groups. Six “race-specific” strains have been identified.

The biggest driver of active TB in today’s world is the immune-destroying HIV epidemic, which helps explain why Africa carries a quarter of the global TB burden, despite having 11% of the human population.

HIV and TB are so closely linked that they have been dubbed the “ugly sisters”, and TB is the biggest killer of HIV-positive South Africans. For people with HIV, the risk of active TB infection is 10% a year, compared with 10% over a lifetime in HIV-negative people. Attempts to protect the HIV-positive from active TB by giving them prophylactic anti-TB drugs have been relatively unsuccessful, with doctors fearing the speedier development of drug resistance.

Chemotherapy emerged in the 1940s, and today antibiotic cocktails can kill active infections in six to nine months -- if patients take the drugs and they are of good quality.

Incomplete treatment, inadequate diagnosis and failed public health services are driving multi-drug resistant (MDR) TB, which the World Health Organisation estimates 4% of humans carry.

Extensively Drug Resistant (XDR) TB results from failure to treat MDR properly and is effectively immune to all locally available drugs. WHO identified it as a global health emergency 13 years ago.

Douglas Wilson, head of medicine at Edendale Hospital, said that at his facility, 11% of TB patients tested with bacterial cultures had MDR TB -- an ominous indicator that some will develop XDR. “MDR-TB will be HIV’s long-term gift,” he added.

The only widely used vaccine is the Bacille Calmette Guerin (BCG), which is useless against adult forms of TB but apparently protects children, especially from the cerebral form.

Diagnostic tests are generally slow, inaccurate and expensive, which is particularly problematic because people with advanced HIV and TB often register negative for TB on sputum tests, as their depleted immune systems fail to register the bacillus.

Money is being pumped into TB research, and more medicines, tests and vaccines are in the research pipeline. But it will take years for these to reach those in developing countries most at risk.

Science alone cannot succeed because public health failures bring rapid resistance to new drugs. MTb has been helped on its destructive course by the short-sightedness of its hosts.


Source: http://www.mg.co.za/articlePage.aspx?articleid=295706&area=/insight/insight__national/

Multi-Drug-Resistant Tuberculosis Epidemic May Be Larger Than Previously Thought

By, Joe Santangelo, Lancet, December 20, 2006

The epidemic of multidrug-resistant (MDR) tuberculosis (TB) may be larger than previously suspected, according to an Article in The Lancet. The study found anti-TB drug resistance in virtually all of the 79 countries surveyed, with particularly high levels in areas of the former Soviet Union and some provinces of China.

About a third of the world’s population is infected with Mycobacterium tuberculosis, 8.9 million people develop the disease annually, and in 2004, 1.7 million deaths occurred. The emergence of drug-resistant strains occurs with the wide misuse of antimicrobials. MDR-TB is defined as resistance to at least the two most potent anti-TB drugs, isoniazid and rifampicin. In 1994, the Global Project on Anti-Tuberculosis Drug Resistance Surveillance was set up to determine the prevalence, patterns, and trends of anti-TB drug resistance around the world.

Mario Raviglione (World Health Organization) and colleagues analysed data on susceptibility to four anti-TB drugs, gathered in the third round of the Global Project from surveys or ongoing surveillance in 79 countries. The researchers estimate that 424 000 cases of MDR-TB emerged worldwide in 2004. Three countries - China, India, and Russia - account for over half of these cases. The median prevalence of MDR-TB in new cases was 1%. Eight countries, including Kazakhstan and Latvia, reported prevalence of multidrug resistance above 6.5%. A worrying increase in the prevalence of resistance to any drug, including MDR-TB was found in Botswana and Tomsk Oblast in Russia. The investigators found decreasing trends in multidrug resistance in the USA, Hong Kong, and Cuba.

Dr Raviglione concludes: “MDR-TB is a precursor to XDR-TB, recently reported among HIV-infected people in South Africa. The findings of the Global Project emphasise the importance of implementing sound tuberculosis control activities to prevent further creation of MDR tuberculosis and the necessity of mainstreaming high-quality treatment for MDR tuberculosis into routine tuberculosis control programmes. Otherwise XDR-TB is bound to keep emerging as a fatal variant of TB, especially in high HIV prevalence settings.”


Source: http://www.medicalnewstoday.com/medicalnews.php?newsid=59123&nfid=rssfeeds

TB ANYWHERE IS TB EVERYWHERE

By, Stop TB Partnership, March 2007

TB ANYWHERE IS TB EVERYWHERE is the theme for 2007 World TB Day, March 24th, offering a message of urgency and shared responsibility. Through unified action on all levels, we can work towards a world finally free of tuberculosis.

The 2007 theme TB ANYWHERE IS TB EVERYWHERE emphasizes that although TB is a preventable and curable disease, it remains a global emergency. The theme reflects the chronically inadequate investment in TB control, surveillance, research and development as well as TB's deadly synergy with HIV.

The 2007 theme addresses the challenges to endemic country TB programme performance that affect TB control progress on a global scale. Achieving the TB-focused targets of the United Nations' Millennium Development Goals depends on effectively raising and addressing country-level challenges through a unified global campaign.

In 2007, the World Health Organization will report on whether the 2005 global TB control targets of 70% case detection and 85% treatment success have been achieved.

Fifty countries reportedly have met the 70% detection target and approximately 25 countries have met both targets. This success represents a major landmark in TB control history and proves that TB control is effective, even in countries with limited resources. The predicted global average treatment success rate of 84% in 2005 is undeniably good, and the case detection rate is likely to be 60% in 2005. However, 2 million or so active TB cases that occur each year are being missed.

To help overcome the challenges that keep TB a global threat, there is an urgent need to push for full funding of the Global Plan to Stop TB (2006-2015) and work for implementation of the Stop TB Strategy. It is time for all governments and the donor community to meet their full responsibility to Stop TB, and for decision-makers to stand alongside people and communities affected by TB.

The World TB Day theme includes a number of supporting messages which are designed to emphasize the importance of:

Improved endemic country financial contributions to TB control;
Community involvement;
Scale up of donor investment; and
The need for decision-makers to protect communities from the threat of extensively drug-resistant TB (XDR-TB) and HIV-related TB.
A strong global campaign depends on consistent delivery of cohesive messaging. Each of the supporting messages developed to address the above issues intentionally includes the "Stop TB" phrase, so that each can work as a "stand-alone" message with the TB ANYWHERE IS TB EVERYWHERE theme.

We encourage you to use the following supporting messages with the main theme in your campaigns:

Invest now to Stop TB
People can Stop TB
Pay for research now to Stop TB
Respond to threats to Stop TB
1. Invest now to Stop TB

Through intensive, immediate and generous investment from governments, multilateral agencies, foundations, businesses and individuals we have the power to Stop TB.

The Global Plan to Stop TB - if fully funded -provides the work plan for fighting TB. The Global Plan outlines how TB mortality and prevalence could be cut in half by 2015 and TB eliminated by 2050. With a total cost of US$56 billion, a funding gap of at least US$31 billion still exists, including US$22 billion for implementation and US$9 billion for the research and development of new tools.

In order to meet the funding gap and save millions of lives, endemic countries must act on commitment to control TB, including investments in health care infrastructure.

Bilateral and multilateral funding and financial initiatives must be accelerated. We look to the G8 to demonstrate their leadership, follow through on their commitments, and meet their 'Fair Share' contributions to TB control.

Donor countries outside of the G8 must increase contributions to the Stop TB Partnership technical partners for assistance to endemic countries and to the Global Fund for AIDS, Tuberculosis and Malaria which currently provides two-thirds of external funding for TB.

Businesses must also play a stronger role to stop TB at the workplace and in communities.

2. People Stop TB

People who are vulnerable to TB are the best-placed to talk about the challenges they face on a daily basis and how to improve TB programmes from their perspective. A key component of the Global Plan to Stop TB and the Stop TB Strategy is to empower people with TB, and affected communities.

Giving explicit priority to community participation in TB diagnosis and care reinforces that commitment, and is consistent with the Patient's Charter for Tuberculosis Care and the 'Call to Stop TB'.

3. Pay for research now to Stop TB

Effective TB drugs, diagnostics and vaccines are essential in the fight against TB. We must protect populations by ensuring we provide them with the best solutions possible. That is why meeting the funding gap for TB research and development is essential to provide us with new and more effective tools.

4. Respond to threats to Stop TB

XDR-TB:
Drug-resistant TB poses a grave global public health threat, especially in populations with high rates of HIV. XDR-TB requires an immediate and urgent global and country response to ensure TB control is strengthened.

Drug-resistant TB occurs primarily as a result of under funded, weak health systems leading to poor TB control programmes. Every effort must be made to fully fund TB programmes and support the implementation of the Stop TB Strategy, which will prevent the emergence of drug resistance and care for those already affected.

Substantial new investment in the development of new TB diagnostics, drugs and vaccines is fundamental to ensure that we will continue to have the capacity to protect those at risk of XDR-TB infection and cure those affected with XDR-TB.

TB/HIV:
Current global efforts to improve access to effective HIV treatment, including the scale-up of anti-retroviral therapy, will be considerably reduced in their impact if we do not reverse the spread of TB.

TB is a leading killer of people living with HIV, and causes up to half of all HIV-related deaths in hard hit settings. HIV is the primary reason for increasing global TB rates particularly through its effect in sub-Saharan Africa. This has led African Health Ministers in 2005 to declare TB an emergency across the continent. We can save lives NOW through collaborative TB/HIV activities and strengthened TB control.


Source: http://www.stoptb.org/events/world_tb_day/2007/

Alarm over rising cost from new TB cases

By, Arthit Khwankhom, The Nation, January 12, 2007

About 90,000 cases a year, with 12,000 deaths; WHO rates Thai treatment poorly.

Tuberculosis (TB) has become an alarming health threat to the country, with the number of new cases continuing to rise and the government's treatment programme unable to cope.

Dr Somchai Pinyopornpaitch, deputy director-general of the Department of Disease Control, said incidences of the disease had risen for several years regardless of how hard health officials had worked.

A higher number of new TB cases has been reported each year, while the results of the TB treatment programme remained well below the target and world standards, Somchai said.

New cases of TB now stand at about 50 per 100,000 people, or about 90,000 cases a year, and the rate of successful treatment is still far below the World Health Organisation's standard of 85 per cent.

Each year at least 12,000 people die of TB. As a result, Thailand is grouped in with the 22 "high-burden countries", Somchai said. He said it was highly worrying that Thailand was ranked alongside such impoverished countries as Mozambique, Zimbabwe, Uganda and Cambodia, which had much lower hygiene standards.

"This shows there must be some reason why we are being held back from beating this disease," Somchai said, adding that he believed the official figures were just "the tip of the iceberg".

HIV infection, a higher rate of population movement caused by economic growth and a growing intake of migrant workers are blamed for the spread of TB.

As treatment takes about six months to complete, many patients find they must move to other areas for work and lose touch with their medical caregivers, leaving their treatment unfinished, Somchai said.

TB expert Dr Daranee Viryakijja said 15 per cent of new TB cases involved HIV infections. It is well known that TB speeds up the onset of Aids and results in a higher mortality rate.

Active screening for new cases and expanding the treatment network to follow up on patients to ensure they finish their medical courses are key to fighting the disease.

Meanwhile, Thammasat University research indicates that global warming is contributing to an unseasonal rise in cholera outbreaks. A half a degree rise in temperature appeared to be causing cholera outbreaks throughout the year.


Source: http://www.nationmultimedia.com/2007/01/12/national/national_30023929.php

India may be the birthplace of tuberculosis, claim Hyderabad researchers

By, New Kerala, January 11, 2007

Washington, Jan 11: India may be the birthplace of tuberculosis, suggests a new study by researchers at the University of Hyderabad.

It is well known that mycobacterium tuberculosis that causes TB has thrived in south Asia for millennia, but none of the researches conducted so far, studied the diversity of the presence of this bacterium's strains.

In order to study this diversity, lead author Niyaz Ahmed and his colleagues collected 91 samples of TB from all over India, and analysed them by studying the number and type of short, repetitive DNA sequences within three key genes.

They discovered that the ancestral strains of the bacterium was widespread, an indication that India might be the ancient reservoir for TB, from which more recent strains evolved and spread to other countries. This might have enabled the immune systems of people living in those countries to adapt to it, providing some degree of protection.

The researchers however feel that the adaptability of people's immune systems to it might be about to change, for the Indian population is far less well adapted to a recent strain of TB, known as Beijing strain, found in India only since 2002, reports New Scientist.

Ahmed, who presented his results at a conference in Bangkok, Thailand, said Beijing was threatening to replace the ancestral strains of the bacterium.

The researchers fear that coinciding with a surge in HIV cases, this may spell disaster for the 5.7 million Indians infected with the virus.

--- ANI


Source: http://www.newkerala.com/news4.php?action=fullnews&id=78172

Tuberculosis not philanthropy's burden, experts say

By, Michelle Nichols, Reuters, January 12, 2007

NEW YORK - Philanthropists cannot win the global fight against tuberculosis alone and a "quantum leap" in funding is needed from governments, particularly in Europe, disease experts said on Friday.

A global research framework must be built and public leadership bolstered in tackling the disease through better funding and incentives for drug companies, said experts at a Medecins Sans Frontieres (Doctors Without Borders) meeting in New York.

"Today we see about $200 million spent a year for research for new tuberculosis (TB) drugs, diagnostics, and vaccines, where there is at least a necessity for $900 million a year," Tido von Schoen-Angerer of MSF told a news conference.

Tuberculosis is an airborne illness, spread through coughing or sneezing, that gradually destroys the lungs and can kill by causing multiple organ failure or bleeding in the lungs. It infects about nine million people a year and kills around two million of those.

The disease can normally be cured with several months of treatment with antibiotics, but about 500,000 people a year were now developing TB drug resistance, Schoen-Angerer said.

He said there had been a "failure" in TB research with only seven drugs to fight the disease in clinical development, compared with 149 drugs for cardiovascular disease and one new HIV drug annually for the past 25 years.

"We have a pharmaceutical market worth $600 billion a year and there's a very clear issue," he said. "Research and development is patented and profit-driven and is not delivering to the patients that are dying."

"Philanthropic efforts alone will not be enough to solve this issue," he said.

Bill Gates, the world's wealthiest man, helped launch The Global Plan to Stop Tuberculosis a year ago and has pledged more than $900 million for the campaign to treat 50 million people and prevent 14 million TB deaths by 2015.

But the fund said that to fully implement the plan it would cost an estimated $56 billion over the next decade.

The incidence of tuberculosis in developed countries dropped throughout much of last century but re-emerged as a problem about 15 years ago. Kenneth Castro, director of tuberculosis elimination at the U.S. Centers for Disease Control and Prevention, said it "never stopped being a problem of comparable magnitude in most of the world."

Mark Harrington of the Treatment Action Group said TB had effectively become a forgotten disease.

"Governments need to step up to plate and take their primary responsibility," he said, noting that Africa had the worst rate of tuberculosis, but that Europe was second.

"The European leadership still doesn't recognize the extent of the problem (and) has not taken adequate steps," he said. "The U.S. government funds 47 percent of the world's TB research. India contributes more than any European country. So we feel Europe has a lot more to do."

New Diagnostics Help Fight Tuberculosis - FIND And Hain Lifescience Plan Worldwide Demonstration Projects

By, Medical News Today, January 14, 2007

The Foundation for Innovative New Diagnostics (FIND) and Hain Lifescience (Hain) announced today that the Hain "GenoType® MTBDR plus" test, a new improved molecular test for multidrug-resistant tuberculosis (MDR-TB), has been approved in Europe and that they have signed an agreement to begin large-scale demonstration projects of the test in high burden countries.

The announcement came just two months after an initial agreement between FIND and Hain Lifescience to fast-track the development of a new tool to address the recent outbreaks of MDR-TB and extensively drug resistant tuberculosis (XDR-TB). In the case of MDR-TB, the TB-bacilli are resistant to rifampicin and isoniazid, two of the most important drugs used to treat TB. XDR-TB organisms are also resistant to at least three "second-line" TB drugs used when "first-line" treatment has failed.

The new Hain "GenoType® MTBDR plus" test, which is CE marked, can be used both on culture-based isolates and directly on smear positive sputum samples from patients with pulmonary TB. Preliminary data suggest that the test can detect at least 90% of MDR-TB cases in only a few hours. Conventional methods of detecting drug resistance can take as long as two to three months to produce results. Consequently, this new test may revolutionize TB diagnostics.

According to the World Health Organization, two billion people or one-third of the world's total population are infected with the TB bacillus. Nearly nine million people develop TB disease each year, and an estimated 5,000 people die of the disease every day. TB is also the main cause of death among persons with HIV-infection. In Africa, Asia and Eastern Europe tuberculosis is becoming a major threat to public health and economy as it affects mostly young adults in their productive years.

"Efficient medical treatment depends on rapid and reliable diagnostics at an affordable price", says David Hain, General Manager of Hain Lifescience. "With FIND we are happy to have a partner who will help us to successfully roll out our "GenoType® MTBDR plus" test in high endemic regions of the world. We are very confident that we can soon supply local TB laboratories with our new test as well as with the required training and service. It is needed."

FIND will now organize and manage the new demonstration trials planned to be implemented in South Africa, Russia, Uzbekistan and Nepal, exemplifying its role as bridge between industry and the health system of developing countries. As part of the agreement, both Hain Lifescience and FIND have worked to make this test affordable for countries who are most affected by the disease.

"It is imperative to introduce effective and inexpensive tools as soon as possible for diagnosing MDR-TB, and by extension, XDR-TB, before this epidemic reaches unfathomable proportions," said Dr Giorgio Roscigno, FIND CEO. "We look forward to collaborating with Hain Lifescience on these demonstration trials."

These projects are expected to begin in the first quarter of 2007.


About FIND

The Foundation for Innovative New Diagnostics (FIND) is a non-profit Swiss foundation based in Geneva. Its purpose is to support and promote the health of people in developing countries by sponsoring the development and introduction of new but affordable diagnostic tools for poverty related diseases. FIND's current donors include the Bill & Melinda Gates Foundation, USAID, the European Union and the Dutch Government.
For more information: http://www.finddiagnostics.org

About Hain Lifescience

Hain Lifescience GmbH is an innovative manufacturer and supplier of modern diagnostic systems. The Hain assays are based on the DNA•Strip® technology, a robust and reliable method for routine diagnostics of disease-associated polymorphisms, microbiological species differentiation and resistance determination. Founded and managed by the brothers David and Tobias Hain in 1986, Hain Lifescience has grown to 60 specialized employees in Nehren, Germany.

For more information: http://www.hain-lifescience.de


Source: http://www.medicalnewstoday.com/medicalnews.php?newsid=60673&nfid=rssfeeds

Race to accelerate tuberculosis drug development

By, www.news-medical.net, January 14, 2007

Each year, tuberculosis kills nearly two million people while an estimated nine million develop the disease -- with the hardest-hit areas in AIDS-afflicted developing nations.

One of the most pressing challenges is the increase in drug-resistant TB. "No Time to Wait: Overcoming Gaps in TB Drug R&D," a symposium -- organized by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) and supported by Howard P. Milstein and Weill Cornell Medical College's Abby and Howard P. Milstein Program in Chemical Biology -- will bring together a wide range of infectious disease experts and organizations to discuss practical ways of overcoming the current bottlenecks in TB drug research and development.

The event takes place today and tomorrow at the Cornell Club in Manhattan and will feature an introductory address by Howard P. Milstein, a member of the Board of Overseers of Weill Cornell Medical College and trustee emeritus and presidential councilor of Cornell University.

"An additional 450,000 new cases of multidrug-resistant TB are seen every year, including people recently diagnosed with particularly lethal new resistant strains," says Mr. Milstein. "We must urgently find new ways of developing new treatments, including fast-tracking clinical trials of promising anti-TB compounds as well as funding strategies for TB research and development initiatives."

The drugs in today's standard TB treatment were developed in the 1950s and 1960s, and the most commonly used TB test -- developed more than a century ago -- manages to detect TB in only about half of the cases. Existing TB drugs and tests are even less adapted for use in people who also have HIV/AIDS. To respond to the devastating impact of TB, especially in developing countries, newer medicines will urgently need to get to patients by working with regulatory agencies, drug development initiatives and pharmaceutical companies to ensure fast-track clinical development and availability of new drugs.

Other participating institutions and government agencies include the World Health Organization, National Institute of Allergy and Infectious Diseases (NIAID) /National Institutes of Health (NIH), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), GlaxoSmithKline, Novartis AG, Johns Hopkins University Bloomberg School of Public Health, Bill and Melinda Gates Foundation, Columbia University, Rockefeller Foundation, European and Developing Countries Clinical Trials Partnership (EDCTP), Brazilian Society of Respiratory Diseases, St. George's Hospital Medical School of London, Global Alliance for TB Drug Development, University of Illinois at Chicago, Institute for Tuberculosis Research University of Illinois at Chicago, Yale Law School, Drugs for Neglected Diseases Initiative (DNDi), Tibotec, Denver Health and Hospitals, Treatment Action Group, and the Consumer Project on Technology.

In June 2006, the Milsteins donated $7.25 million to Weill Cornell Medical College to establish the Abby and Howard P. Milstein Chemistry Core Facility and the Abby and Howard P. Milstein Program in Chemical Biology of Infectious Disease.

Howard Milstein is Chairman of New York Private Bank and Trust, as well as Co-Chairman, President and CEO of Emigrant Savings Bank. He serves as a Trustee of Cornell University, where he received his undergraduate degree in 1973. He has been a member of the Board of Overseers of Weill Cornell Medical College since 1989. The Milstein family has a long history of generosity in support of Weill Cornell.

http://www.med.cornell.edu


Source: http://www.news-medical.net/?id=21395