Vitamin D may help fight tuberculosis, study finds

By, Reuters, January 28, 2008

African immigrants with low levels of vitamin D are much more likely to be infected with tuberculosis, a finding that suggests the vitamin may help prevent and treat TB, Australian researchers said on Monday.

Their study of all 375 African immigrants treated at one Melbourne hospital showed that those who had low vitamin D levels were far more likely to have TB infections than those with adequate levels.

They found moderate to severe vitamin D deficiency in 78 percent of patients with past or present tuberculosis.

"Low vitamin D levels are associated with an increased likelihood of primary infection with Mycobacterium tuberculosis and also, once infected, are associated with increased likelihood of having active TB," Dr. Katherine Gibney of the Royal Melbourne Hospital said in a statement.

Writing in the journal Clinical Infectious Diseases, Gibney and colleagues said they tested everyone from sub-Saharan Africa treated at the hospital between 2003 and 2006.

Previous studies have shown that people with vitamin D deficiencies are more likely to have active TB. The researchers said theirs is the first to show this is true of latent TB as well.

TB affects up to a third of the world's population. Most cases are latent, meaning patients are infected but have no symptoms and are very unlikely to infect anyone else.

The disease takes months to cure with a cocktail of antibiotics and kills 1.6 million people a year, according to the World Health Organization.

Vitamin D is made when sunlight hits the skin, and food is often supplemented with the vitamin.

Gibney's team said doctors might consider vitamin D supplements as a treatment for TB, or a way to prevent it. (Reporting by Maggie Fox, editing by Will Dunham and Todd Eastham)

Source: http://www.reuters.com/article/latestCrisis/idUSN28469425

Vietnam meets WHO’s tuberculosis treatment target

By, Nhan Dan, January 18, 2008

Vietnam has, over the past 9 years, constantly obtained the World Health Organisation (WHO) targets of detecting 70 percent of tuberculosis cases and curing 85 percent of the patients.

The statistics were released at a conference in Hanoi on January 17 to review a national project on TB prevention and control and the Global Fund for TB Prevention. The event was hosted by the National Anti-Tuberculosis Programme and the Ministry of Public Health.

However, participants at the conference were told that TB infection rate remains high in Vietnam, with that among young people at the age of 15- 24 being on the rise.

Vietnam now ranks 13th among the 22 countries with the highest number of TB patients in the world.

According to WHO, in 2007, the newly-contracted case rate per 100,000 people was 175 in Vietnam, with the mortality rate per 100,000 people being 23.

The national anti-TB programme up to 2011 aims to lower the death, infection and spread rates in the community, while increasing the opportunities to access health care services for poor and ethnic minority people.

Under the programme, a strategy will be mapped out to increase co-ordination between the public and private health care sectors in the fight against TB in urban areas in 12 provinces and cities.

According to Dr Dinh Ngoc Si, head of the anti TB project’s steering board and director of the National Hospital of Tuberculosis and Respiratory Diseases, the State will spend VND 70 billon, or 10 percent increase, on anti-TB programme in 2008.

The programme will continue to receive financial and technical assistances from governmental and non-governmental organisations as well as financial resources from the Dutch government and the Global Fund for anti-TB/HIV prevention programme. (VNA)


Source: http://www.nhandan.com.vn/english/life/180108/life_tb.htm

XDR-TB may be bigger risk than Aids

By, Louise Flanagan, Pretoria News, January 11, 2008

Extensively drug-resistant tuberculosis (XDR-TB) could become a more serious public health risk than HIV and Aids because of government inaction.

That's the warning from a team of health researchers who assessed the risk of the usually fatal illness. They concluded that health authorities were not doing enough to combat it.

"The government's initial lethargic reaction to the crisis and uncertainty among health professionals concerning the ... implications of effectively tackling this outbreak highlight the urgent need to address these issues, lest inaction spawn a full-blown XDR-TB epidemic," said Jerome Amir Singh, Ross Upshur and Nesri Padayatchi in their paper, titled XDR-TB in South Africa: No time for denial or complacency.

The research is published in the January issue of PLoS Medicine.

XDR-TB is a strain of multi-drug-resistant TB (MDR-TB) that is infectious, extremely difficult and expensive to treat. It has a high death rate.

The researchers' warnings were underlined by recent problems in the Eastern Cape when dozens of patients with XDR-TB and MDR-TB broke out of two hospitals where they had been living in enforced isolation for months so they could go home for Christmas.

Authorities spent weeks searching for them. Some are still missing.

XDR-TB was first identified in South Africa in rural KwaZulu-Natal, but has since been found in all provinces; MDR-TB emerged before that and in January 2006 the Medical Research Council estimated that there were 6 000 cases a year.

The researchers warned that XDR-TB was now considered endemic to KwaZulu-Natal with at least 30 new cases reported there each month and 300 cases nationally.

"Diagnosed cases of XDR-TB likely represent a small proportion of the extent of the problem."

In November the health department confirmed 481 cases of XDR-TB and 216 of those patients had died.

"XDR-TB is a serious global health threat.

"It has the potential to derail the global efforts to contain HIV/Aids, as broadly disseminated XDR-TB will prove to be a much more serious public health threat owing to its mode of transmission."

The researchers said the emergence of MDR- and XDR-TB was an indication of the poor implementation of the TB control programme.

This was fuelled by lack of infection control in hospitals and clinics.

They said South Africa should reduce overcrowding in hospitals, expand disease surveillance "and rethink its counselling, treatment and tracing strategies".

The government's social policy was making it difficult for some to get treatment, so grant policies should be reviewed, they said.

TB thrives in the crowded social conditions of the poor, who are often dependent on social grants. They also get free hospital treatment.

"Current government policy stipulates that those who are hospitalised at state expense lose their social welfare benefits for the duration of their hospitalisation.

"Faced with the prospect of being deprived of their gainful employment and/or having their welfare benefits suspended for the duration of hospitalisation - which in the case of MDR-TB or XDR-TB could last 18 to 24 months - many opt not to stay in hospitals."

Instead they mix with non-infected people, use public transport and continue working, posing a significant health risk to others.

Source: http://www.pretorianews.co.za/index.php?fSectionId=672&fArticleId=vn20080111033336532C636940

GlaxoSmithKline and TB Alliance renew tuberculosis drug discovery program

By, Businesswire.com, January 24, 2008

GlaxoSmithKline (GSK) and the Global Alliance for TB Drug Development (TB Alliance) have renewed their joint research program with the goal to improve the treatment of tuberculosis (TB), which is caused by the bacillus Mycobacterium tuberculosis (M.tb). The research collaboration, initiated in 2004, currently includes a portfolio of early projects which may ultimately yield new medicines that attack M.tb, including drug-resistance strains.

Under the agreement which has been extended for a further three years, GSK and the TB Alliance jointly fund 15 to 25 fully dedicated scientists at GSK’s Tres Cantos facility in Spain where GSK has a team of scientists committed to TB and malaria research — two of the three major communicable diseases affecting the developing world.

"We are encouraged by the success of our pioneering work with GSK, which has nearly doubled the number of TB drug discovery projects in our pipeline,” said Dr. Mel Spigelman, TB Alliance Director of Research and Development. “This collaboration is advancing the TB Alliance’s mission to develop revolutionary, faster and better TB treatment regimens by exploring new ways to attack the disease.“

“While we still have a considerable amount of work ahead, the progress achieved so far demonstrates how this type of alliance can speed the discovery and development of new therapies,” said Dr. Zhi Hong, Senior Vice President of the Infectious Diseases Center of Excellence for Drug Discovery (ID CEDD) at GSK. “The worsening TB epidemic and emerging multi-drug resistant TB demand a new treatment paradigm, one which GSK is committed to find through this collaboration.”

The joint research program currently consists of a portfolio of five projects with promise in fighting TB. The two most advanced drug discovery projects, which are still at the discovery stage, explore two classes of novel antibiotics with unprecedented anti-tubercular mechanisms of action. They have been shown in non-clinical studies to have potential benefits in fighting persistent forms of M.tb and thereby might offer better chances of shortening treatment duration, which currently takes about six months to complete.

Additional projects seek to identify and attack novel mycobacterium enzymes/targets. By inhibiting enzymes critical to the functioning of M.tb, these approaches may disable the bacterium without harming the human host and may also significantly shorten the duration of treatment.

New drugs are critical to ending the needless burden of TB. The current TB drug regimen works for active, drug-susceptible TB, as long as patients complete the six- to nine-month treatment. A shorter TB regimen that is effective against all strains of TB is expected to increase the number of patients who complete treatment, increase cure rates, and lower toxic side effects, thereby limiting the rise of new resistant strains. A novel TB regimen that is also compatible with antiretroviral treatments would improve TB control and help in the fight against HIV/AIDS. Completely novel drugs in the TB Alliance portfolio offer potential for treating multi and extensively drug-resistant TB (MDR- and XDR-TB).

Notes for editors:

About the Global Alliance for TB Drug Development

The TB Alliance is a not-for-profit, product development partnership accelerating the discovery and development of new TB drugs that will shorten treatment, be effective against susceptible and resistant strains, be compatible with antiretroviral therapies for those HIV-TB patients currently on such therapies, and improve treatment of latent infection.

Working with public and private partners worldwide, the TB Alliance is leading the development of the most comprehensive portfolio of TB drug candidates in history, and is committed to ensuring that approved new regimens are affordable, adopted and available to those who need them.

The TB Alliance operates with funding from the Bill & Melinda Gates Foundation, the Rockefeller Foundation, Irish Aid, the Netherlands Ministry of Foreign Affairs (DGIS), the United Kingdom Department for International Development (DFID), and the United States Agency for International Development (USAID). For more information on TB drug development and the TB Alliance, please visit www.tballiance.org

About GlaxoSmithKline

GlaxoSmithKline – one of the world’s leading research-based pharmaceutical and healthcare companies – is committed to improving the quality of human life by enabling people to do more, feel better and live longer. For more information and the company’s product development pipeline, visit GSK at www.gsk.com.

GlaxoSmithKline has dedicated one of our Centers for Excellence in Drug Discovery to finding therapies for infectious diseases. Research into bacterial infections figures importantly in the scope of this center, as does research on diseases endemic in poor countries. Where market incentives are lacking, we engage with academia, government, and philanthropies to meet our common responsibilities. We have formed alliances with both the Global Alliance for TB Drug Development and the Medicines for Malaria Venture, which help to support 55 scientists working exclusively on tuberculosis and malaria drugs. GSK has devoted a like number of scientists, our laboratories, and our drug discovery and development experience and will make resulting medicines affordable to those most in need.

Source: http://www.businesswire.com/portal/site/google/index.jsp?ndmViewId=news_view&newsId=20080124005047&newsLang=en

TB kills 66,000 Pakistanis every year

By, Jamila Achakzai, Daily Times, January 22, 2008

ISLAMABAD: Tuberculosis (TB), which is claiming over 66,000 lives in Pakistan annually, can be controlled if patients prompt access to the nearest health facility is ensured on appearance of symptoms of the disease, says National Manager for National TB Control Programme (NTBCP) Dr Hassan Sadiq.

Dr Sadiq told the concluding session of a two-day workshop, Communicating for Tuberculosis Control, Strategies, Actions and Outcomes, here in Islamabad that diagnosis and treatment services, which were free of cost at all public health facilities, could save the life of TB patient in eight months duration if they were benefited from in time.

He recommended that by covering mouth, avoiding spitting everywhere and clean lifestyle for the TB patients could help others remained safe from the mycobacterium, the bacteria causing TB. He said that the best prevention was however the early diagnosis and treatment for TB patients. He emphasised that any person with cough more than three weeks must get his/ her sputum examined from the nearest health facility, which was free of cost.

He said that Pakistan was still ranked 6th among 22 high burden countries with incidence of 181 per 100,000 population. He said that TB shares 5.1 per cent of the total national disease burden.

Dr Sadiq said that the federal government run NTBCP with its provincial supporting departments in all four provinces, Azad Jammu & Kashmir and Northern Areas were ensuring free diagnosis and treatment facilities at all public health centres. He said that since the revival of National Programme in 2000, more than 600,000 patients had been registered for treatment, of which 85 per cent successfully completed their treatment.

He said that the NTBCP managed to raise its absorption capacity to Rs 126 million in 2006-07 from mere Rs 26 million in previous year from PSDP allocations.

He said that Advocacy, Communication and Social Mobilisation (ACSM) was an essential component of the TB control design in Pakistan which is helping us in setting agendas, raising awareness of specific behavioural issues, increasing knowledge and changing public attitudes toward risk patterns associated with the disease of TB.

The NTBCP chief emphasised the importance of ACSM, saying ACSM can play a critical role in mobilizing communities and individuals to encourage behavioral intentions toward early health seeking behavior and treatment adherence.

He said that the focus of TB control intervention to date in Pakistan had been towards the establishment and strengthening of clinical services around the country.

Dr Sadiq said that Directly Observed Treatment Short Course (DOTS), the WHO recommended treatment therapy, had expanded countrywide and 100 per cent coverage of DOTS had been achieved in public sector facilities.

He said that the stage is now set for planning and implementation of a large scale, multi-level, integrated communication intervention to support the increase and sustain resource base at national, provincial and district level, help create and sustain demand and mobilize action at the community level.

Other speakers of the workshop included renowned professionals from public health and corporate communication sectors. The designed curriculum of the workshop uniquely matched good practices of the corporate sector with the public & private sector requirements in health promotion. The participants were presented with case studies from successful communication campaigns for drawing inspiration and improving understanding of how to market social services or actually conduct social marketing.

Source: http://www.dailytimes.com.pk/default.asp?page=2008%5C01%5C22%5Cstory_22-1-2008_pg7_55

Uganda: HIV/AIDS triggers rise in TB infections

By, IRIN PlusNews, January 22, 2008

Tuberculosis infection rates in Uganda have increased due to the HIV/AIDS pandemic in the country, but the scarcity of health centres and over-crowding in camps are also to blame, officials said.

The Ugandan health ministry said it had recorded an increase of almost 12 percent between 2001 and 2005, with the country registering up to 80,000 new infections every year. The total number of TB patients was 500,000, according to the study, but only half the cases were being tracked.

"The rise in the infection rate is mainly because of HIV. In many countries with a high prevalence of HIV/AIDS, TB cases have gone up because HIV has attacked and weakened the body's defence systems, which would keep at bay widespread TB infections," Joseph Imoko, the World Health Organisation (WHO) national professional officer for TB in Uganda, told IRIN.

He said increased numbers were registered in the early 1990s because reporting of cases had been low but when access to medical services improved, more cases were reported. However, the numbers stabilised in 1995.

"But when the HIV/AIDS pandemic intensified, we noticed a rapid increase in the number of cases. At present an estimated 70 percent of TB patients in the country are also infected with HIV," Imoko said.

"Poor nutrition among the people has also worked at weakening people's immune systems, leaving people susceptible to TB infections," he said.

Imoko said the country had started a three-year, US-funded US$3 million Tuberculosis Control Assistance Programme (TBCAP) that will support the health ministry in a combined fight against TB and HIV. The programme has been launched in 12 districts of central, western, eastern, and southwestern regions out of 70 districts.

There are an estimated 1.2 million cases of HIV/AIDS in the country, while a million people are believed to have died of the syndrome since it was first diagnosed in Uganda in 1982.

Long trek to health centres

Imoko says the main challenge in fighting TB infections - whose main weapon should be effective and immediate treatment - has been the distance people have to cover to reach health centres.

"When a person feels really sick, he or she will struggle to reach a health centre no matter the distance, but when they feel a little better, the distance to cover determines whether they continue with the treatment and most of the time, many patients drop the treatment and in the process they continue infecting others. One person can infect up to 20 people a year and the vicious cycle leads to many infections," he said.

He said the situation had not been helped by the over-crowding in slum areas and camps for the internally displaced where most infections have been recorded. Hundreds of thousands have been displaced by two decades of conflict in northern Uganda.

Other issues blamed for the high infection rates include poor health infrastructure, lack of awareness among the public and poor sanitation.

Imoko, however, said the Ugandan health ministry had embarked on what he called "community-based dots", which involves the identification of patients, awareness-raising and giving volunteers the responsibility of ensuring that patients adhere to their treatment regime - eight months for adults and six months for children.

"Government procures these drugs free of charge and distributes them free of charge to patients either through government or non-governmental health centres. Treating patients helps the community to stem the spread of the disease," the officials added.

Tuberculosis is the leading cause of death among people living with HIV/AIDS. The number of TB patients co-infected with HIV has risen from five to seven in every 10 during the past two years, according to the health ministry. It is estimated that 30 percent of the deaths among AIDS patients are attributable to TB.

TB is a chronic disease caused by a bacterium. The symptoms include a cough lasting more than three weeks, chest pain, evening fever and night sweats.

vm/mw

TB still public health threat in Turkey despite some improvements, health official says

By, Global Health Reporting, January 8, 2008

Although an increasing number of interventions to fight tuberculosis in Turkey have been launched during the past few years, the disease continues to pose a threat to public health in the country, Ali Riza Erdogan -- secretary-general of the Federation of National Associations of the Fight Against Tuberculosis, or TUVSDF -- said recently, Today's Zaman reports.

"Turkey has conducted a successful program to counter TB in the last few years, and the measures taken to control cases of TB have yielded positive results," Erdogan said, adding that TB is "still a threat to society" and that hundreds of people contract the disease annually. About 22,000 people in Turkey are living with TB -- more than 13,200 of whom are men and about 7,300 of whom are women -- Today's Zaman reports.

Erdogan said that data from the Ministry of Health do not show an increase in the number of people living with the disease. However, it is almost certain that TB could "become a great risk for society" if the country does not continue to "pursu[e] successful policies" to fight the disease, Erdogan said. Ferit Kocoglu, chair of TUVSDF, said that health professionals and not-for-profit organizations work together to fight TB in the country and are able to treat about 88% of TB cases. He added that about 89% of people with TB are treated under the DOTS methods and that about 85% of those cases are treated successfully, which exceeds targets set by the World Health Organization.

Erdogan said there are several areas of TB control that need to be strengthened, Today's Zaman reports. "We believe that precautions taken for the control and prevention of TB will yield more effective results in the longer term" but that conditions in TB treatment facilities "should be improved," he said. Erdogan also said that the families of people who are being treated for TB should receive financial support during treatment. People who have TB, especially men, often "refuse to be hospitalized because they fear that their families will have financial difficulties if they quit working," he said. Erdogan added that it is possible to reduce TB to its "lowest rate" by earmarking more funds for health services (Today's Zaman, 1/8).