One-Third of People With TB in U.S. Unaware of HIV Status, MMWR Report Says

By, Kaisernetwork, October 29, 2007

Nearly one-third of people living with tuberculosis in the U.S. are unaware of their HIV status, according to a study published Friday in CDC's Morbidity and Mortality Weekly Report, Reuters reports (Dunham, Reuters, 10/25).

The study examined data from the National TB Surveillance System from 1993 to 2005 for 49 states and Washington, D.C. According to the study, reporting of HIV status among people living with TB increased from 35% in 1993 to 68% in 2003 and leveled off during 2004 and 2005 (Marks et al., MMWR, 10/26). Nine percent of all people with active TB in the U.S. tested positive for HIV in 2005. Thirty-one percent of those with TB were unaware of their HIV status in 2005 because they refused testing or were not offered a test, compared with 65% of people living with TB in 1993 (Reuters, 10/25). Groups of people living with TB at an increased risk of acquiring HIV include injection-drug users, noninjection-drug users, homeless people, non-Hispanic blacks, prison inmates and alcohol abusers, according to the report (MMWR, 10/26).

In addition, the report noted that nearly two-thirds of people living with both HIV and TB were black. One in six black TB patients was HIV-positive, compared with one in 20 HIV-positive white TB patients, the report said. "High rates of both HIV infection and TB disease among non-Hispanic blacks emphasize the need in this population to prevent, diagnose early and provide access to care for both conditions," the report said.

According to CDC epidemiologist and report author Suzanne Marks, "HIV increases TB progression, and TB increases HIV progression." She added that the diseases "result in a synergy that can be deadly." The agency recommends routine HIV testing among all people living with TB, according to Reuters. People with HIV/TB coinfection are five times more likely to die during TB treatment than patients who are HIV-negative, according to CDC. "Increased promotion of routine HIV testing and rapid HIV tests might increase acceptability of testing, which would allow health care providers to know the HIV status of a greater percentage of TB patients and enable them to provide optimal care," the report said.

According to CDC, 13,779 TB cases were reported in the U.S. in 2006 -- a decrease of 3% compared with 2005. Of the cases reported in 2006, 57% involved people born outside the country. There were 646 deaths from TB in the U.S. in 2005, CDC said (Reuters, 10/25).

Medical staff face increased health risk as tuberculosis links to migrants rise

By, Suellen Hinde, Herald Sun (Australia), October 07, 2007

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.


Source: http://www.news.com.au/heraldsun/story/0,21985,22542632-662,00.html

Space technology to hunt down TB

By, BBC, October 4, 2007

A device developed for a mission to Mars could help spot signs of life closer to home - by identifying the bacterium that causes TB.

The Open University and London School of Hygiene and Tropical Medicine project will use a tiny detection kit made for the Beagle 2 project.

The gas chromatograph mass spectrometer (GC-MS) can pick out the unique chemical fingerprint of TB.

An expert hoped it would boost the poor diagnosis rate in developing countries.

Space researchers were disappointed by the failure of Beagle 2, which is believed to have been destroyed as it tried to land on Mars in 2003.

A similar device to that on Beagle now forms part of the current Rosetta mission, which aims to rendezvous with a comet and send back data on its chemical structure.

The need to minimise its weight has led to a spectrometer the size of a shoebox, which could now be practical to use in developing countries where TB is rife.

Unreliable test

At the moment, phlegm samples coughed up by patients suspected of having the disease are checked under a microscope, but this is unreliable and fails to diagnose up to half the active cases.

Dr Liz Corbett, from the London School of Hygiene and Tropical Medicine, said: "We urgently need an accurate and cost-effective method of diagnosing TB.

"At the moment, because diagnosis is not accurate, people with TB may have to be seen up to 10 times before they can be started on TB treatment. They may be infectious throughout this period."

Dr Geraint Morgan from the Open University said that GC-MS could be a more accurate test, and significantly quicker than current methods.

He said: "The bacterium that causes TB has a special coating and it is the pattern of chemicals in this coating that the mass spectrometer will be searching for."

Active difference

The Wellcome Trust has provided a £1.34m grant to see if the technology works.

Its Director of Technology Transfer, Dr Ted Bianco, suggested that the device could potentially discriminate between the high numbers of people with latent TB, who simply carry the bacteria without having symptoms or being infectious, and those with "active TB", who can die from it or pass it to others.

"If you can build instruments rugged enough to look for life elsewhere in the Solar System, you should be able to crack the problem of detecting TB bacteria in the lung of a patient."

Dr Peter Davies, secretary of TB Alert, and a member of the diagnostics group of the Stop TB international campaign, welcomed the project.

He said: "We can only diagnose 50% of people using current techniques, so we have got to try any other method of diagnosis that we can.

"This could be a way of improving that low figure, so it's definitely worth a shot."

Source: http://news.bbc.co.uk/2/hi/health/7026133.stm

TB patients not taking their medicine

By, Louise Flanagan, Independent Online, September 27, 2007

Tuberculosis patients in Limpopo - many of them elderly women - are not finishing their treatment.

"Most of them stop taking the drugs before they finish them," said nurse Catherine Tshishonga, who interviewed 200 TB patients for her postgraduate research through the University of Venda.

"They feel that the TB drugs are too much."

Patients can't cope with the number or size of the tablets and also suffer worse side effects if they take the drugs without food - a huge problem in poverty-stricken households, she found.

Tshishonga wanted to know why there was such a high rate of pulmonary TB in the Thohoyandou area in Limpopo. As part of her Masters degree in public health, awarded this month, she researched the patients' attitudes.

More than half she interviewed had negative attitudes towards TB drugs and believed that they could stop treatment once they felt better.

Most of those infected were elderly women.

The oldest patient was 86 and "most were older than 40".

Tshishonga said giving patients more information was crucial.

A Joburg doctor involved in TB research, who did not want to be named, said defaulting on treatment was the main reason for South Africa's low cure rate.

Failure to complete treatment may also result in drug-resistant TB strains.

Another Venda University student found that Limpopo clinics with the best TB cure rates had patients - not nurses - with a better knowledge of their illness.

Takalani Grace Tshitangano, who also received her Masters, looked at 13 clinics with cure rates of above 85 percent and nine with lower rates.

Using questionnaires, Tshitangano assessed nurses' knowledge of the national guidelines for TB control.

"They scored below 50 percent."

Tshitangano said the nurses had to deal with all illnesses, resulting in a "supermarket" approach.

"They are not specialists in anything and that is affecting the treatment."

Tshitangano also assessed patient knowledge and found that 82 percent of patients at better-performing clinics had good knowledge, compared to 58 percent of those at poorly-performing clinics.

The most knowledgeable patients were being treated for repeat infections.

Nobody is safe from tuberculosis

By, eMaxHealth.com, September 28, 2007

“Many of us think ourselves safe from TB. This is a misconception that needs to be corrected.” This was one of the facts pointed out at a press briefing that took place today in Berlin, featuring experts from the WHO Regional Office for Europe and the German Federal Ministry of Health and a German TB patient who has been cured of the disease.

Andrea Virnich, who talked to the journalists today, fell ill with TB at the age of 30. For three years she was constantly ill. Several diseases were diagnosed, but Andrea did not respond to treatment. Then, finally, one of her doctors realized that the disease she had was TB. “TB was completely beyond my doctors’ perception. They simply couldn’t imagine that a young German woman like me could contract this illness,” she said. Andrea Virnich’s example shows that TB is a serious public health threat, both globally and on a local scale. The whole of Europe, including Germany, is vulnerable, and greater efforts and financial resources are needed to stop TB.

“TB poses a huge challenge to Europe, not only because of the significant number of new cases in the region but also because Europe has the highest rate of MDR-TB [multidrug-resistant TB] and XDR-TB [extensively drug-resistant TB],” explained Dr Risards Zaleskis, WHO Regional Adviser for TB Control at the Regional Office. “The problem with these forms of TB is that they barely respond to treatment.”

TB is far from being beaten. To ensure that TB is placed high on health agendas, and to boost financial commitments to improving its control, the Regional Office is organizing the Ministerial Forum “All Against Tuberculosis” in Berlin on 22 October 2007, hosted by the Government of Germany. The Forum will seek to:

* strengthen political commitment to implement the WHO Stop TB Strategy throughout the Region and include high quality tuberculosis control within the strengthening of health systems;

* strengthen commitment from all Member States to ensure full and appropriate financing of tuberculosis control, in line with World Health Assembly resolution WHA 58.14 on sustainable financing for tuberculosis prevention and control;

* adopt a European Regional Declaration on Tuberculosis; and

* endorse the Stop TB Partnership for Europe.


Source: http://www.emaxhealth.com/39/16543.html

Pledges to Global Fund to Fight AIDS, Tuberculosis and Malaria fall short of goal

By, Donald G. McNeil Jr., International Herald Tribune, September 28, 2007

Donors pledged $9.7 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria at a fundraising conference in Berlin - an increase over previous donations, but well short of the $15 billion to $18 billion the fund had hoped to raise.

Kofi Annan, the former UN secretary general, who led the creation of the multilateral fund in 2002, said Thursday that he was "very pleased with the pledges made." Some outside campaigners, however, expressed disappointment.

"Today's pledges are welcome, but more needs to be mobilized," said ActionAid, a coalition of groups pushing for more health care for poor countries.

It applauded the size of gifts from Spain ($600 million), Norway ($205 million), Sweden ($281 million) and the Netherlands ($326 million), while saying the largest donors, including Germany ($849 million), France ($1.3 billion) and Britain ($729 million), could have done more, given the strength of their economies.

The donations, meant to be spent over the next three years, do not include new pledges by the United States or Japan.

The United States committed only to maintain its annual contribution level, which would add up to $2.2 billion over the three years, until Congress passes a new budget. Japan wants to announce its contribution when it plays host to the Group of 8 summit meeting next year; if it stayed level, it would be $184 million.

Other big donors included the European Commission, which pledged $425 million, and the Gates Foundation, which pledged $300 million.

The fund, which has spent about $7 billion in 136 countries since 2002, is the chief source of money for the fight against the three diseases. It says it has saved two million lives so far, largely through the distribution of mosquito nets and the provision of anti-AIDS drugs.

To hope to bring the diseases under control, the fund calculates that it will need to be spending $8 billion a year by 2010.

The next biggest sources of funds are two separate programs established by the Bush administration to fight AIDS and malaria.


Source: http://www.iht.com/articles/2007/09/28/healthscience/global.php

5 things you need to know about tuberculosis

By, The Miami Herald, October 1, 2007

How you get it

When an Atlanta man honeymooned in Europe in May while infected with tuberculosis, it set off an international health scare. This disease is spread when people with TB in their lungs or throat cough, laugh, sneeze, sing or even talk, but it's not easy to become infected. Repeated contact is usually necessary in closed spaces over a long period. Transmission in an airplane, although rare, has been documented, according to the American Lung Association.

Symptoms

It's possible not to have any symptoms, but a person with TB may cough up blood or have a cough lasting three weeks or longer, fatigue, weight loss, loss of appetite, fever, night sweats or chest pain. If you think you have been exposed, get a TB skin test.

Who's at risk

People with HIV; people in close contact with TB-infected people; diabetics; people who work or live in nursing homes, prisons and other long-term-care facilities; healthcare workers; people who are malnourished; and alcoholics. Smoking more than 20 cigarettes a day also increases the risk.

Latent vs. active

Many people infected with TB bacteria don't develop TB because their immune systems protect them; the bacteria become inactive but remain alive in the body and can become active later. This is called latent TB and it's not contagious. Someone with active TB needs to see a doctor right away and can spread the disease to others.

It's on the rise

More than one-third of the world's population has TB bacteria and new infections are occurring at the rate of one per second, says the World Health Organization. Drug-resistant strains have emerged and are spreading, but new vaccines are in development.

Source: http://www.star-telegram.com/health/story/253162.html

1.5 million Pakistanis infected with tuberculosis

By, The News, October 3, 2007

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 in-sufficient 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. These hospitals were selected because of the ‘convenience and accessibility’ they provided for the researchers.

The report highlighted what it called poor awareness of and low compliance to the World Health Organisation (Who)/National Tuberculosis Programme (NTP) guidelines among interns. The study conducted by Dr Javaid Khan, Head of the Pulmonary and Critical Care Section of AKUH suggests that for effective control of TB, immediate actions to improve undergraduate and continuing medical education are essential, with special emphasis on standard national guidelines.

TB remains a major health concern globally. Each year an estimated 8.7 million cases occur worldwide with 1.7 million deaths. At this pace more than 40 million people are expected to die of TB over the next 25 years. The vast majority (90%) of TB deaths occur in developing countries. Early detection and optimal treatment are the most important measures for disease control, the report said.

WHO has declared TB to be a global emergency and has published guidelines for its control in developing countries. Factors like relatively poor knowledge and non-compliance with guidelines among practicing physicians in Paksitan, have been noted with concern.

Erroneous decisions concerning the choice of treatment regimens and lack of means for the delivery of treatment will lead to the increasing occurrence of multi-drug resisting strains, which will ultimately prove fatal for an increasing number of TB patients, the researcher said.

The report pointed out that there are around 50 medical schools (25 in the public sector and 25 in the private sector) in the country with 5,000 medical graduates each year. These new medical graduates are required to complete 12 months of internship (house job) to obtain practical work experience.

Awareness of National Health Programmes and management of common diseases is considered crucial to the successful integration of graduates into high quality practice in any community.

While highlighting the perceived “serious deficiencies” in the knowledge and practice of newly graduated physicians with respect to TB, the study suggests a systematic review of education of medical students and of practitioners to improve the current poor quality of clinical practice, and to avoid harmful consequences of poor treatment outcome and development of drug resistant TB.

The identification of infectious (smear positive) cases of active TB is of paramount importance in the control of TB. All guidelines recommend three consecutive sputum-smear examinations as the investigation of choice for the diagnosis of active TB. In this study, however, only a minority of interns used sputum smears for diagnosis, whereas the majority relied on other diagnostic procedures. Similar practices were seen among general physicians who used sputum smear microscopy in only 38 per cent of diagnoses for pulmonary TB.

“This vicious cycle of poor sputum smear microscopy facilities, poor utilisation of smear examination by established practitioners and poor education of graduating doctors is leading to poor TB control,” the report said, adding that this has to be tackled as a matter of priority.

The study makes several suggestions like giving importance to TB in the existing curriculum of medical schools on the pattern of diabetes and heart failure and its inclusion in examinations at various levels so that the students give importance to this subject of tremendous public health value.

Source: http://www.thenews.com.pk/print1.asp?id=74470