ACW: Tuberculosis Treatment and Prevention

साउथ Africa: Saving lives is not always easy

2008-05-21T20:06:00.001+07:00

By, IRIN PlusNews, May 21, 2008

To be a nurse at Sizwe Hospital, a special facility for treating patients infected with drug-resistant strains of tuberculosis (TB), requires a thick skin and a forgiving nature.

Cecelia Mngomezulu, the hospital's head matron, has been verbally abused, spat on, assaulted and held hostage in the two years that she has worked there.

"I sometimes get angry at them, but something tells you that at the end of the day this person is projecting, and then you put yourself in his shoes and you find yourself coming back," she told IRIN/PlusNews.

The hospital, housed in a sprawling, colonial-era complex in a quiet Johannesburg suburb, is the only referral centre in Gauteng Province for treating multidrug-resistant (MDR) TB, which is resistant to first-line TB medication and can take up to two years to treat. Patients with extremely drug-resistant (XDR) TB, which is resistant to most second-line drugs and can take even longer to treat, are also referred here.

Drug-resistant TB poses an especially serious public health threat in a country like South Africa, where nearly one in five people are infected with HIV: those living with HIV are 50 times more likely to get TB.

Isolation policy

The policy of South Africa's health department is to treat all MDR-TB patients at special isolation facilities like Sizwe until they are no longer infectious. The minimum period patients have to spend away from their families, their jobs and their homes is six months, but some have been at Sizwe for as long as two years. Family members are allowed to visit, and there are games, TV rooms and other activities to stave off boredom and depression, but frustrations are still often vented on the staff.

"They try to make you feel guilty, like you're holding them hostage against their will," said Mngomezulu. "They'll say, 'You can go home and see your children, what about me? Don't you have a feeling?' Yet you're thinking of their actual families, that they'll be infected if you discharge them."

They try to make you feel guilty, like you're holding them hostage against their will
The degree to which facilities like Sizwe hold patients against their will is something of a grey area. According to the hospital's CEO, Rianna Louw, patients are counselled at their local clinic and sign a consent form before being admitted.

"There are problems in terms of that, because some of the patients will say they didn't get proper information, that they weren't told they were going to be admitted for a long time," Louw told IRIN/PlusNews. "It's voluntary in the sense that we're not bringing them in with police, but in terms of the policy, all MDR patients should be admitted - it's an infectious disease."

Last week, several patients at Sizwe had to be temporarily transferred to a hospital in Pretoria after becoming aggressive. A local newspaper, The Star, reported the disgruntled patients as saying that the hospital "had broken one promise too many".

Louw attributes such incidents to patients having unrealistic expectations about the length of their stay at the hospital. "I think there is this expectation that they will only be here for six months, but that's really only a minimum. The policy is that you discharge them when they're culture-negative," meaning that they are no longer infectious.

Dr Xavier Padanilam, the hospital's chief medical officer, explained that a patient must have two culture-negative test results before they are deemed non-infectious and can be discharged and allowed to complete their treatment as out-patients. A culture test takes up to eight weeks to produce results, so a patient could be non-infectious for up to four months before being allowed to go home.

Recruitment challenge

Mngomezulu's hostage experience occurred earlier this year. "They had sticks and iron bars and bricks they picked up somewhere, and they said, 'You're not going home'. They held me from four [p.m.] until the police came at seven [p.m.]," she recalled. "Amazingly, I wasn't afraid. They try to intimidate a lot."

Most of the staff have experienced verbal or even physical abuse from patients, said Louw. "Patients most of the time respect professionals, but it sometimes happens in this hospital that that respect disappears because of the anger and frustration," she said, adding that such feelings often stem from not being able to support their families at home.

The hospital has a full staff complement of seven doctors, but about 20 percent of professional nursing posts remain vacant, despite the special allowance the provincial health department recently started offering as an incentive to work there.

"It's a very big challenge to recruit," said Mngomezulu. "Knowing it's an MDR hospital, there's that fear of the unknown. Yet because we're in here we don't have a problem; we know what we're dealing with."

The staff all wear protective masks and have access to an employee wellness clinic that is open daily. "In terms of education to staff, they know if they're HIV positive there's a higher risk [of contracting TB]," said Louw. "Because of confidentiality, we can't exclude people living with HIV from working here, but we encourage them to test and then declare to us."

Nurses occasionally contract TB despite these precautions, but none have had MDR-TB.

Mngomezulu had TB before she came to Sizwe, but was not deterred by the risk of contracting it again. "Coming here was a way of being a role model, to show you can get cured if you comply with your treatment," she said. "Because I suffered, I know how it feels to have those night sweats and chest pains, and to have to remember to swallow those tablets."

ks/he

Source: http://www.plusnews.org/Report.aspx?ReportId=78313

Drug resistant TB on rise in UK

2008-05-06T16:13:00.000+07:00

By, NHS Choices, May 2, 2008

“Cases of drug-resistant tuberculosis are on the rise”, the Daily Mail reported today. The Guardian also says that a study published in the British Medical Journal has found that cases of drug resistant TB in the UK nearly doubled between 1998 and 2005. They report that rising immigration and inadequate measures to control outbreaks “among prisoners and drug users” could be to blame. The Daily Mail also says the increase is thought to be linked to immigrants, particularly from sub-Saharan Africa and the Indian subcontinent, contracting drug-resistant TB abroad before moving to Britain.

Cases of TB have been occurring with increasing frequency over recent decades. As with other bacterial infections, drug resistant forms of TB will develop over time as bacteria adapt to overcome the actions of commonly used antibiotics. The increase in resistance to one first-line drug treatment for TB (isoniazid) has been small, but significant, since 1998. There are still treatment options for which resistance has not increased.

As the researchers behind this study point out, this highlights the need for early diagnosis of suspected cases, the rapid testing for the types of antibiotic to which the particular strain of TB is susceptible and ensuring that patients complete their course of treatment.

Where did the story come from?

Michelle E. Kruijshaar and colleagues from the Health Protection Agency and Queen Mary’s School of Medicine and Dentistry, London, Newcastle General Hospital, the Heart of England NHS Foundation Trust, Birmingham, and the University of East Anglia, carried out the research. The researchers received no funding for this study. The study was published in the peer-reviewed medical journal: British Medical Journal.

What kind of scientific study was this?

In this time-trend study, the researchers investigated trends in the UK for antibiotic resistance to tuberculosis (TB) between 1998 and 2005. The study also investigated possible causes for any changes in resistance.

The researchers wanted to include cases of TB that were reported between 1998 and 2005 and the antibiotics they had proved susceptible to. In order to do this, they combined data from two databases, the Mycobacterial Surveillance Network (MycobNet), which collects information about the drug susceptibility of circulating strains of TB, and the national enhanced tuberculosis surveillance database, which provided clinical information on the cases.

The cases in the databases were either confirmed by a laboratory culture or by a doctor’s diagnosis and decision to treat as TB based on clinical and radiological findings (non-culture confirmation). For this analysis, the researchers only included those cases confirmed by a culture.

The researchers examined trends in the resistance of TB to antituberculous drugs over the eight-year period. They saw how these were affected by individual variables such as age, sex, ethnicity, place of birth, region of habitation in the UK, previous diagnoses and site of disease (e.g. TB just affecting the lungs or with involvement of other parts of the body).

Multidrug resistance was defined as a case of TB that was resistant to two of the most commonly used drugs (isoniazid and rifampicin).

What were the results of the study?

Between 1998 and 2005, there were a total of 28,620 cases of TB in the UK confirmed by bacterial culture. The average age of TB patients in this period was 35 and 57% were male. Forty two per cent of the cases occurred in London and 69% of the patients had been born outside of the UK and of those, the average time that they had been in the UK before diagnosis was four years. There were 25,117 identified cases not confirmed by culture.

Results of drug susceptibility testing were available for nearly 100% of the culture-confirmed cases and this showed that the proportion of cases resistant to first line drugs rose from 5.6% in 1998 to 7.5% in 2005. Looking at the individual antibiotics separately, there were rises in resistance to isoniazid (5.0 to 6.9%) and rifampicin (1.0 to 1.2%), but not for two other drugs (ethambutol and pyrazinamide).

When the researchers looked at factors associated with the trends, they found there was a significant increase in isoniazid resistance within London over time. This was of borderline statistical significance (OR 1.04, 95% CI 1.00 to 1.07). There was no increase in isoniazid resistance over time outside of London. These measures were adjusted for ethnicity, place of birth and age. There were no significant increases in rifampicin or multidrug resistance when adjusted for other variables.

Those younger and born outside of the UK had a higher risk of drug resistance outside of London, but being born outside of the UK was linked with lower risk of isoniazid resistance within London. Those with a previous diagnosis were significantly more likely to be resistant to isoniazid. There were differences in risk of isoniazid resistance both within and outside of London between ethnic groups.

Resistance to other second and third line drug options was found to be low.

What interpretations did the researchers draw from these results?

The authors conclude that the proportion of cases of TB that were resistant to isoniazid increased from 1998 to 2005 and that this ‘reflects the increasing proportion of patients with tuberculosis who are not born in the UK and who are from certain ethnic minority groups, as well as inadequate control of transmission in London’.

They say this highlights the need for completing the recommended drug courses and instituting measures to control outbreaks in London.

What does the NHS Knowledge Service make of this study?

Cases of tuberculosis have been occurring with increasing frequency over recent decades and a higher proportion of cases occur in those who were born outside of the UK. However, as the authors say, it is “failures in management of patients in the UK [that] are contributing to the occurrence of multidrug resistance”.

As with other bacterial infections, the development of drug resistant forms of TB over time will invariably happen as antibiotics are used more regularly and bacteria adapt to overcome their actions. London is a large city with a high population density and is therefore going to take a large burden of these cases.

The method of data collection does have some limitations as the researchers acknowledge. For example:

Drug-resistant TB may be particularly prevalent among people living in relative poverty, the homeless or illicit drug users with whom the surveillance databases may have failed to identify. This would mean that the prevalence of TB in urban areas such as London is even higher than that found by this study.
The data does not account for other diseases or conditions that TB patients may have that could affect drug resistance, e.g. HIV.
The researchers only included cases of TB that could be found in both databases. There could have been inaccuracies in the matching of the cases between the two databases.

Cases of TB that had not been confirmed by a bacterial culture were not included in analyses. As there were a large number of these (25,117 cases), the patterns in this group could have swayed the overall findings, i.e. if resistance had not increased or had even reduced over time in this group, the overall result is unlikely to be significant considering how borderline the results are in the culture-confirmed cases.

There was less information on the use of second and third line drugs. However, the finding that resistance was low when they were used, suggests that cases can still be managed effectively. Similarly with rifampicin (another first line option for TB in the UK), there was no increase in resistance over time. This study highlights the need for early diagnosis of suspected cases, rapid testing for the types of antibiotic to which the tuberculosis strain is susceptible, and the importance of ensuring that patients complete their treatment courses. Continued surveillance is important in order to try prevent drug resistance from developing into the future.

Source: http://www.nhs.uk/news/2008/05May/Pages/DrugresistantTBonriseinUK.aspx

TB Fatally Stalking Southeast Asia's HIV Patients

2008-04-16T17:33:00.001+07:00

By, News Post India, April 12, 2008

India, Myanmar, Nepal and Thailand have some of the highest rates of tuberculosis (TB)-HIV co-infection in Southeast Asia, says a World Health Organisation (WHO) report.

The prevalence rate of TB among people living with HIV has been estimated as 5.2 percent in India, 7.1 percent in Myanmar, 3.1 percent in Nepal and 7.6 percent in Thailand, says the report on tuberculosis in the region.

Patients with their immune systems disabled by HIV/AIDS face a 30 times greater risk than others of contracting TB.

And for HIV/AIDS patients in India, that's bad news because the country has the highest incidence of TB in the world. India is home to over 3.4 million TB patients - about one-fifth of the global figure.

For the WHO, India is part of the Southeast Asia region along with Bhutan, Bangladesh, Indonesia, Myanmar, Thailand, the Maldives, Sri Lanka, Nepal, Timor-Leste and North Korea. The region has 25 percent of the world's population but accounts for more than one-third of the global burden of TB, the report said.

'TB is the single most life-threatening infection and the leading cause of mortality among people living with HIV infection in the region,' it added.

'The rapidly expanding HIV epidemic in the region is a growing concern. The HIV epidemic has reached a generalised stage in Thailand, Myanmar and in six states in India,' the report pointed out.

The six high-prevalence states in India are Andhra Pradesh, Karnataka, Manipur, Maharashtra, Nagaland and Tamil Nadu.

India has 2.5 million plus HIV patients.

The report said during 2006 in 14 states in India, 25,055 HIV infected TB suspects were referred to the Revised National TB Control Programme (RNTCP) services. Of these, 4,829 were diagnosed as HIV infected TB cases.

'The course of the TB/HIV epidemic in Southeast Asia will depend heavily on efforts to prevent and control both TB and HIV, and decisive steps must be taken now to combat the dual epidemics,' the WHO report said.

Of the 38.6 million people estimated to be living with HIV in the world at the end of 2005, more than four million are in Southeast Asia, said the recently released report on tuberculosis in the region.

Source: http://newspostindia.com/report-48024

TB still big public health problem

2008-04-15T14:47:00.001+07:00

By, Charles Mpaka, The Daily Times, April 14, 2008

National Tuberculosis Control Programme (NTP) said last Friday that TB was still a big public health problem in Malawi inspite of successes the country has registered in the fight against the disease.

NTP said this in Blantyre at a briefing intended to enable the media come to grips with technical issues about TB.

NTP said from 2003, the number of TB cases from the districts has not gone up or down.

“This does not mean that TB has become a less problem,” said NTP Director Felix Salaniponi.

“It is still a big public health problem. It is killing people. Because of its chronic nature and the length of time it takes to cure it, time is being spent on caring for patients.”

Salaniponi reported that 75 people develop the disease everyday while 15 others die from TB every day.

“The major challenge is that we are not finding many cases that should have been coming to us. In that case, the TB situation will not go down because these cases we have not detected could be spreading the disease to others. This contributes to TB being an emergency case in Malawi,” Salaniponi said.

The World Health Organisation ranks Malawi as achieving a low detection rate of less than 50 percent, especially among the poor who are underserved and face problems such as geographical distance and high opportunity costs to access TB diagnostic and treatment.

Malawi recorded a 98 percent cure rate between 1984 and 1987 but that was eroded by HIV/Aids, which constitutes another big challenge in the fight. According to NTP, 70 out of every 100 TB patients are HIV positive.

The WHO recently ranked Malawi as second best in Africa after Rwanda HIV testing rates in TB settings.

In terms of cure rate, Malawi recorded a 74 percent rate in 2005. This rose to 76 percent in 2006. This, however, was 19 percent lower than the cure rate WHO requires.

The NTP director said Malawi’s efforts on TB were also being threatened by the presence of the multi-drug resistant TB (MDR-TB).

He said although there are very low MDR-TB cases in Malawi currently, its scale of devastation could not be ignored.

If the current MDR-TB situation is mismanaged, it could lead to development of the almost incurable extensively drug resistant TB (XDR-TB).

“It takes too long to treat, about 24 months and the drugs are toxic. A patient will have to get an injection every day for six months. And it is like bush fire that could go wild to become XDR-TB,” Salaniponi said.

According to NTP, it takes up to K3 million to treat an MDR-TB patient, a condition that often results from default of ordinary TB treatment.

In response to the emergency status of TB in the country, government last year developed a two-year plan of action for TB.

The plan, motivated by the low detection rates, seeks to bring universal access to TB diagnosis.

Through the plan, NTP will, among other things, expand community response and establish TB corners in all health facilities where people can easily access or demand for TB related services.

The plan will intensify TB detection and screening of high-risk groups like prisoners.

It is reported that between 8 and 10 percent of TB cases in Malawi come out of prisons and that prisoners are 10 to 15 times more susceptible to contract the disease than the outside society.

Source: http://www.dailytimes.bppmw.com/article.asp?ArticleID=9078

TB fatally stalking Southeast Asia's HIV patients

2008-04-14T11:42:00.000+07:00

By, Thaindia, April 12, 2008

India, and Thailand along with Myanmar and Nepal have some of the highest rates of tuberculosis (TB)-HIV co-infection in Southeast Asia, says a World Health Organisation (WHO) report. The prevalence rate of TB among people living with HIV has been estimated as 5.2 percent in India, 7.1 percent in Myanmar, 3.1 percent in Nepal and 7.6 percent in Thailand, says the report on tuberculosis in the region.

Patients with their immune systems disabled by HIV/AIDS face a 30 times greater risk than others of contracting TB. And for HIV/AIDS patients in India, that’s bad news because the country has the highest incidence of TB in the world. India is home to over 3.4 million TB patients - about one-fifth of the global figure.

For the WHO, India is part of the Southeast Asia region along with Bhutan, Bangladesh, Indonesia, Myanmar, Thailand, the Maldives, Sri Lanka, Nepal, Timor-Leste and North Korea. The region has 25 percent of the world’s population but accounts for more than one-third of the global burden of TB, the report said.

“TB is the single most life-threatening infection and the leading cause of mortality among people living with HIV infection in the region,” it added.

“The rapidly expanding HIV epidemic in the region is a growing concern. The HIV epidemic has reached a generalised stage in Thailand, Myanmar and in six states in India,” the report pointed out.

The six high-prevalence states in India are Andhra Pradesh, Karnataka, Manipur, Maharashtra, Nagaland and Tamil Nadu. India has 2.5 million plus HIV patients.

The report said during 2006 in 14 states in India, 25,055 HIV infected TB suspects were referred to the Revised National TB Control Programme (RNTCP) services. Of these, 4,829 were diagnosed as HIV infected TB cases.

“The course of the TB/HIV epidemic in Southeast Asia will depend heavily on efforts to prevent and control both TB and HIV, and decisive steps must be taken now to combat the dual epidemics,” the WHO report said.

Of the 38.6 million people estimated to be living with HIV in the world at the end of 2005, more than four million are in Southeast Asia, said the recently released report on tuberculosis in the region.

Source: http://www.thaindian.com/news-snippet/tb-fatally-stalking-southeast-asias-hiv-patients-4729.html

Lethal TB strain now in Namibia

2008-04-03T12:02:00.000+07:00

By, Christof Maletsky, Namibian News, April 2, 2008

Health professionals are quietly treating up to 24 confirmed cases of extensively drug-resistant tuberculosis (XDR-TB) - the worst form of TB with seriously limited treatment options and chances of cure - in Namibian hospitals.

Well-placed health sources have confirmed to The Namibian that the extreme form of TB is currently under control, but expressed fears that the country does not have the capacity to deal with a major outbreak of XDR-TB.

The Namibian had been aware of at least one case being treated at Walvis Bay since December, but health sources said this week that the situation was worse than initially thought.

On Friday, Health Minister Dr Richard Kamwi only expressed fears that Namibia was about to record its first cases of XDR-TB.

TB can usually be treated with a course of four standard, or first-line, anti-TB drugs.

However, if the drugs are misused or mismanaged, multi-drug-resistant TB (MDR-TB) develops and later progresses to extensively drug-resistant TB (XDR-TB).

"There are currently 254 cases of multi-drug-resistant TB under treatment throughout the country.

This is a great concern and is a clear indication that it is only a matter of time before we will have extremely drug-resistant cases, known as XDR Tuberculosis, in Namibia," Kamwi said at the World TB Day event staged at Mariental on Friday.

He said experts in the Ministry of Health were busy reviewing all TB cases with drug resistance to verify the extent of the problem.

"Given the large number of cases, we may well find some incurable XDR-TB amongst this group," Kamwi said.

Kamwi confirmed that Namibia was the country with the second highest TB incidence in the world after Swaziland, with 15 244 cases reported last year alone.

The host region of this year's TB Day event, Hardap, had the highest incidence of TB in Namibia last year, reporting a worrying 1 294 cases per 100 000 people, Kamwi said.

The TB situation is exacerbated by the HIV-AIDS epidemic in the country.

"HIV infection is the major known individual risk factor for the development of TB disease.

Last year 8 186 TB patients representing 54 per cent of the total notified patients were tested for HIV and 59 per cent were HIV positive," Kamwi said.

He said the impact of the dual infection of TB with HIV-AIDS was a major cause for concern, in particular as it affected the Namibian workforce.

"We are experiencing a decline in work productivity; this then results in a decrease in household income, which jeopardises health, nutrition, sanitation, safety, education and care in our nation.

The effect of disease burdens on the workforce can essentially stunt the necessary socio-economic growth on our path toward Vision 2030," the Minister warned.

He called on health workers to be proactive, focused, tireless and united in their responses against the two diseases.

"Clearly, if we are to make an impact in the control of TB, and considering the reported MDR-TB and the concern related to the XDR-TB, we need more skilled healthcare workers," Kamwi said, appealing for more donor assistance to scale up the procurement of medicines, strengthening hospital infrastructure and enhancing control in TB wards.

Source: http://www.namibian.com.na/2008/April/national/08F606ADE1.html

Nearly 1000 people die of Tuberculosis in India everyday

2008-03-25T09:53:00.000+07:00

By, CNN-IBN, Ginny Narula, March 24, 2008

New Delhi: Nearly a 1000 people die of Tuberculosis in India every day which is more than the number of deaths caused by Malaria, HIV and Hepatitis combined.

Sushil Kumar has been suffering from tuberculosis and has come all the way from Jharkhand to Delhi to get himself treated.

“I had a bad cough, doctors asked me to go in for a sputum test and I was diagnosed with tuberculosis,” says Kumar.

While incidence of TB has dropped in countries like the US, the increase in drug resistant strains is a huge cause of worry for doctors, especially in countries in Asia and Africa, where 83 per cent of the world's cases of tuberculosis are reported.

Another trend that has doctors worried is that TB is no longer a poor man's disease. Affluent urban India is adding to the number of deaths caused by Tuberculosis.

Even though there has been a decline in numbers. India continues to have the highest number of TB cases followed by China, Indonesia, South Africa and Nigeria.

According to WHO report 2007, in India the death rates due to TB have declined from 42 per 100,000 population in 1990 to 29 per 100,000 population in 2005.

However, the rate of detection of new cases has fallen to 3 per cent from an average of 6 per cent in the preceding five years. This is despite India boasting of the biggest TB detection programme in the world.

Initially these DOT centers were very active however, with time they are not that pro-active due to which there is a decline in rate of detection.

These statistics are worrisome as the higher the cases of early detection, the lower the chance of transmission of the disease and gives a better chance to cure.

Source: http://www.ibnlive.com/news/nearly-1000-people-die-of-tuberculosis-in-india-everyday/61843-17.html

1/5th of drug resistant TB patients live in India

2008-03-25T09:47:00.001+07:00

By, Howrah News Service, March 24, 2008

Nearly one-fifth of the world’s TB patients, who have acquired multi drug resistant tuberculosis, are in India.

Presenting a bleak picture of the country’s national TB control programme, the latest World Health Organisation (WHO) report released on Monday has warned that ‘’rising multi drug resistant TB’’ could ‘’ruin’’ India’s efforts to control tuberculosis.

According to the report, India and China record the highest number of TB cases globally. The other high-burden countries are Bangladesh, Indonesia, Burma and Thailand.

Out of the 22 countries that record TB globally, these five countries together have over two million cases or 95 per cent of all cases globally, the report has said.

Commenting on India’s performance in the fight against TB, the report said, "The data for the cohort of infectious TB patients completing their treatments in 2006 for the first time or repeating it after previous failures or defaults shows less than optimal results."

It said that defaults and treatment failures, both among first time treatment seekers and among re-treatment cases raises the probability of multi drug resistance.

"Achieving universal coverage of treatment services is not enough; it needs to be matched by consistent, universally accepted standards of treatment outcomes," said the report.

India has continued to report high morbidity and mortality due to tuberculosis and as many as 1.39 million cases were reported in 2006, said the report on tuberculosis in the South East Asia region.

In 2005, more than 3.2 lakh deaths were reported due to tuberculosis in the country, it said.

The region, with 4.97 million TB cases, carries over one-third of the global burden of TB, said the report. It was revealed that most cases occur in the age group of 15-54 years.

Source: http://howrah.org/india_news/7917.html

http://www.timesonline.co.uk/tol/news/uk/health/article3599420.ece

2008-03-24T09:49:00.001+07:00

By, Melanie Reid, Timesonline, March 22, 2008

Health officials are screening the close contacts of a man who has become Britain’s first case of a virtually untreatable form of drug-resistant tuberculosis.

The man, believed to be a Somali asylum-seeker in his thirties, has a rare strain, Extremely Drug Resistant TB (XDR-TB), which has a high mortality rate.

The World Health Organisation (WHO) says that XDR-TB accounts for possibly only 2 per cent of the 9 million cases of tuberculosis in the world, but that it poses a grave public health threat, especially in populations with high rates of HIV and where there are few healthcare resources.

Health chiefs said yesterday that close contacts of the patient, who is in isolation at Gartnavel General Hospital, Glasgow, were being screened. He has been in the hospital since January.

Dr Oliver Blatchford, consultant in public health medicine in Glasgow, said yesterday: “It is no more infectious than ordinary TB but it does require different treatment. The contacts of this case are being screened in the same way as ordinary TB contacts. They will be monitored closely to ensure that any further cases are identified early and treated quickly.”

A health board spokesman added that the man had been admitted to hospital at the end of January but was unable to give any personal details or provide information about his condition.

It is understood that the man arrived at Heathrow last November and when screened for infectious diseases was found to have TB scarring on his lungs.

The condition was not active, however, and the man told doctors he had recently had a six-month course of treatment for TB. After an immigration interview, he was allowed to go to Scotland, where the disease became reactivated.

XDR-TB poses a far greater challenge to doctors than MDR-TB (Multidrug Resistant TB), which is resistant to at least the two main first-line tuberculosis drugs, isoniazid and rifampicin. XDR-TB is a form of MDR-TB that is also resistant to three or more of the six classes of second-line drugs. Doctors can only try to contain the disease with a cocktail of second-line drugs. In some cases, part of the lung can be cut out.

This is the first case reported in Britain since the revised definition of XDR-TB was published by the World Health Oorganisation in 2006. Recent findings from a survey of data from 2000-04 found that XDR-TB had been identified in all regions of the world but was most frequent in the former Soviet Union and Asia.

Professor Peter David, the secretary of TB Alert in Britain, said that drugs could contain the disease but not cure it. Treatment takes 12-18 months and is estimated to cost more than £100,000 per patient.

Global killer

— Skeletal remains show that prehistoric human beings had the disease in 4000BC, and tubercular decay has been found in mummies from 3000-2400BC

— Two billion people, one third of the world’s population, are infected with the bacterium that causes TB

— Every 15 seconds someone dies from TB. Two million people die from it each year

— Eighty per cent of TB cases are concentrated in 22 “high-burden” developing countries, but no corner of the world is safe. The WHO declared TB a global emergency in 1992

Source: Times database : http://www.timesonline.co.uk/tol/news/uk/health/article3599420.ece

WHO warns more TB cases slipping through detection

2008-03-19T12:05:00.000+07:00

By, The China Post, March 19, 2008

The World Health Organization warned Monday that more new tuberculosis cases are slipping through the detection net, as countries fail to keep up with rapid progress made in earlier years.

"After some years of good trends for tuberculosis control, 2006 documents a slowing of progress -- the rate at which new cases were detected increased only slightly compared to recent years," WHO director-general Margaret Chan told journalists.

"This slowdown in progress comes at a time when numbers are still way too high," she added.

The WHO estimates that only 61 percent of all TB cases worldwide are registered.

In 2006, some 9.2 million new cases of TB were detected against 9.1 million in 2005, said the WHO in its annual report on TB control.

The WHO estimates that, including non-detected cases, there were 14.4 million cases of the disease worldwide in 2006.

Between 2001 and 2005, detection rates were increasing by six percent a year, but in 2006, this rate was halved to three percent.

"This is not a good sign because our target is to detect all cases that exist. There is 39 percent that we are unable to find, but which we think is there," said Mario Raviglione, who is director of the WHO's Stop TB department.

The slowdown was attributed to the fact that some national programs that were making steady progress during the last five years have not been able to continue at the same pace in 2006, said the WHO.

In addition, in many African countries, there has not been any increase in the detection of TB cases through national programs.

Others are slipping out of the detection net as they are treated by private care providers, and by NGOs or community groups, added the WHO.

"We've entered a new era. To make progress, firstly public programs must be further strengthened. Secondly we need to fully tap the potential of other service providers," said Chan.

In 2006, 200,000 TB deaths were recorded among people who were infected with HIV, while an estimated 1.5 million people without HIV also succumbed to tuberculosis.

Nearly a half million new cases of multi-drug resistant tuberculosis occur each year worldwide, or around five percent of the nine million new cases in total, the WHO said then.

Source: http://www.chinapost.com.tw/health/infectious%20diseases/2008/03/19/147825/WHO-warns.htm

Vitamin D may help fight tuberculosis, study finds

2008-01-29T09:14:00.000+07:00

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

2008-01-28T11:03:00.000+07:00

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

2008-01-28T09:13:00.000+07:00

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

2008-01-25T13:18:00.000+07:00

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

2008-01-24T14:43:00.000+07:00

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

2008-01-23T09:51:00.000+07:00

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

2008-01-11T11:54:00.000+07:00

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).

Children neglected in response to TB

2007-11-21T13:49:00.001+07:00

By, Kakaire Kirunda (Uganda), HDN Key Correspondent Team, November 13, 2007

Visiting the Mbale Regional Referral Hospital, which serves more than a dozen districts in eastern Uganda, in late July, opened my eyes to the plight of children with tuberculosis (TB).

The hospital has no pediatric TB treatment formulations and medical workers at the facility kept advising mothers to take their children elsewhere, while a senior medical officer argued that the adult drugs could be used to treat children as long as trained health workers administered the right dosage.

Soon it emerged that the problem was not only limited to the eastern part of the country but was occurring in other regions as well. The drug shortage continues and hospital managers have been crying for help in vain, with some resorting to sending anonymous letters to the press to raise awareness.

Some hope for children with TB remains as delegates at the 38th World Union Conference on Lung Health work to find solutions to these problems, though representatives at the meeting have also expressed concern that the number of pediatric TB cases is rising around the world.

According to Professor Anthony D Harries, a technical assistant in HIV care and support under Malawi's Ministry of Health, the situation for children is made worse by the widespread thinking that TB and HIV are adult problems. Harries says that treating children with TB, particularly those who are living with HIV, is also made difficult by a variety of other factors.

"It is extremely difficult because we are dealing with unconfirmed tuberculosis in children. You can't get sputum smears. And of course testing very young children for HIV has problems as well," said Harries.

"And studies have shown all over Africa that you if you don't pick up those children before the age of two years then many will die before that age. So it is full of technical problems."

Statistics indicate that more than 250,000 children die of TB each year. Many of these deaths are believed to result from a lack of diagnosis. The current diagnostic methods are not effective in children and according to the Executive Secretary of the Stop TB Partnership, new diagnostic tests are desperately need to identify children with the disease.

"We are trying to do this through the Stop TB Partnership Working Group on New Diagnostics coordinated by FIND (the Foundation for Innovative New Diagnostics) … Not many children are diagnosed, they die with a diagnosis of coughing, pneumonia," Dr Marcos Espinal told Health & Development Networks (HDN).

But as the world waits for technologies that will help, there are a growing number of calls for universal access to treatment. As UNAIDS' HIV-TB advisor Dr Alasdair Reid says "I think we should be a lot more willing to treat . . . And there hasn't been a lot of advocacy."

Some scientists are suggesting that infants exposed to an adult with TB should be started on treatment. But Executive Director of the International Union Against Tuberculosis and Lung Disease, Dr Nils E Billo says that access rates to pediatric anti-TB medication are beginning to stabilize.

"You may have heard that UNITAID, the fund that was created with a levy on air tickets originating in some countries, has now got quite a substantial amount of funding. They are now in a position to fund pediatric formulations and the global facility is providing these. There are pediatric formulations now," Billo said during the conference.

In 2006, France, Brazil, Chile, Norway and the United Kingdom decided to create an international drug purchase facility called UNITAID to be financed with sustainable, predictable resources. As an economically neutral tool, taxing air tickets was considered the most suitable instrument.

According to UNITAID’s website, by the end of the year the facility will have provided TB treatment to 150,000 children in 19 countries and will support the provision of drugs to fight multi-drug resistant TB (MDR-TB) in 17 low-income countries.

However, as experts stated during several conference discussions, bureaucratic tendencies, poor distribution systems and a lack of coordination between TB and HIV service providers can make it difficult to implement such interventions.

Health & Development Networks 2007

Source: http://www.thecorrespondent.org/main.aspx

Global: Simple measures could radically reduce TB

2007-11-15T13:29:00.000+07:00

By, IRIN PlusNews, November 14, 2007

Better healthcare measures could curb the tide of tuberculosis (TB) and other lung diseases, even with existing drugs and technology. This was the final message from the 38th World Conference on Lung Health, in Cape Town.

At the conclusion of the 4-day meeting this week, Nils Billo, executive director of the International Union against Tuberculosis and Lung Diseases (The Union), said that improving infection control, even using simple and cheap methods, could significantly reduce the spread of tuberculosis (TB) and its death toll, especially among people with HIV.

However, the 3,000 delegates heard that better drugs and vaccines for treating and preventing TB, and faster and more accurate diagnostics were needed if the disease were to be eradicated. Much of the research into finding effective, practical and affordable technologies is being done by not-for-profit partnerships, funded by government, donors and the private sector.

TB has suffered from a lack of attention by policy-makers and funders for decades because the disease was relatively well contained in developed countries. However, an outbreak of TB in New York in the 1990s, combined with the growing toll of TB among people with HIV/AIDS, has been putting the disease on policy and research agendas.

Diagnosing TB can be difficult, especially where healthcare facilities have limited or no access to expensive machinery such as x-ray machines, or laboratories capable of the lengthy culturing of sputum samples to detect the bacillus.

Better diagnostic tools, like fluorescent microscopes, are already available but have not been widely adopted because they require expensive lamps and a stable power supply, but researchers have successfully experimented with substituting the lamps with 1-watt light-emitting diodes.

Six promising TB vaccines are also being shepherded towards human clinical trials within the next year, but even if one of them proves sufficiently effective, it is unlikely to be available for worldwide use before 2015.

The Global Alliance for TB Drug Research announced that it has two new drugs for treating TB in development; one of them, moxifloxacin, is among the most advanced potential new TB drugs, and is about to go into a phase 3 clinical trial involving more than 2000 volunteers in Kenya, South Africa, Tanzania and Zambia.

The organisation hopes its new antibiotic will eventually be used as a substitute for existing medications, and help shorten the current 6-month treatment period with first-line drugs.

Unfortunately, moxifloxacin is not effective against highly drug-resistant forms of TB. The rising number of drug-resistant cases was a focus of this year's Lung Conference, along with the spread of TB among HIV-positive people.

TB cure rates are low worldwide, but particularly in developing countries with high burdens of the disease, often fuelled by HIV/AIDS. In South Africa, successful treatment for TB varies widely across provinces and districts: one district in Mpumalanga Province has reported cure rates of just 12 percent, compared to a national success rate of just under 58 percent, which is already well below the target of 85 percent recommended by the WHO.

Drug-resistant forms of TB have been driven by unsuccessful first-line TB treatment, with many patients failing to complete the 6-month course of medication. Much of the transmission of resistant strains of TB occurs in healthcare settings.

Multidrug-resistant (MDR) TB is resistant to at least two of the most effective and commonly used first-line treatments for the disease, while extensively drug-resistant (XDR) TB is also impervious to at least one of the second-line drugs. Worldwide, it is estimated that four percent of TB infections are resistant to multiple drugs, although the figure is as high as 20 percent in some areas.

The WHO says it needs US$2.15 billion to fully implement its MDR-TB and XDR-TB Response Plan 2007-2008. This could potentially save 134,000 lives over the 2-year period by treating 160,000 people with MDR forms of the disease, and another 16,000 with XDR-TB.

An estimated 14 million people worldwide are co-infected with TB and HIV, while more than two-thirds of people infected with TB in sub-Saharan Africa are also living with HIV/AIDS. The two diseases reinforce each other in the body, each weakening the immune system's defences against the other.

Conference delegates heard of the critical need to co-ordinate action against both diseases, to create an effective response to what some presenters characterised as an epidemic of co-infection. Speakers repeatedly pointed out that the fight against TB has been relatively poorly resourced, compared to the more high-profile HIV/AIDS fight.

On the day the Lung Conference ended, the Global Fund to Fight Aids, TB and Malaria announced US$1.1 billion in new grants, but TB accounted for only 10 percent of funding, compared to 48 percent for HIV/AIDS and 42 percent for malaria.

Among the calls for action at the conference was to make greater use of one of the most effective anti-TB drugs, Isoniazid, (also called isonicotinyl hydrazine, or INH). Research in Brazil found that it could prevent TB infection in HIV-positive patients by up to 75 percent, if used in conjunction with antiretroviral therapy.

But presenters also emphasised the positive impact that better healthcare management could make, including basic steps to prevent the spread of TB in healthcare settings: opening windows, reducing the number of TB patients in a ward, and even simply separating coughing - and therefore potentially infectious TB patients - from others.

The 2008 World Conference on Lung Health will take place in Paris.

bb/ks/he
[ENDS]

South Africa: TB and Aids Campaigns Urged to Co-Operate

2007-11-12T16:14:00.000+07:00

By, Miriam Mannak, Inter Press Service (Johannesburg), November 10, 2007

Tuberculosis (TB) in Africa cannot be dealt with while TB and HIV/AIDS organisations refuse to set aside their differences, health experts said Friday during the 38th Union World Conference on Lung Health, underway in Cape Town, South Africa.

"So far, many TB and HIV programmes in Africa - or anywhere in the world - do not co-operate with one another, despite the strong connection that exists between HIV and TB," noted Paula Fujiwara, senior technical advisor and director of the HIV department of the Union Against Tuberculosis and Lung Disease, the international coalition that has organised the Nov. 8-12 meeting, held annually.

"In some African countries for instance, 75 percent to 80 percent of the people living with TB are co-infected with HIV."

Fujiwara said jealousy was one of the major factors in the lack of collaboration between the two camps: "HIV has always been the big kid on the block, with TB being the little brother. HIV programmes and organisations seem to be afraid that TB takes away attention and funding."

TB is an airborne disease that principally affects the lungs; it is passed on, in part, through coughing and sneezing. Tuberculosis bacteria are able to remain dormant in a person, becoming active again in the event that the patient's immune system is weakened, as in the case of HIV infection.

Active TB is highly contagious and although treatable, potentially deadly -- especially for those who have AIDS. The disease is the leading cause of death among Africans infected with HIV: according to statistics from the World Health Organisation, 90 percent of people living with HIV/AIDS in Africa die within months of contracting TB.

It is estimated that 590,000 people die of TB each year in Africa, the only continent where TB rates are rapidly increasing. This is partially due to the high numbers of HIV infections in this region. Sub-Saharan Africa is home to more than 60 percent of HIV positive people worldwide.

In a bid to prompt HIV and TB activists to join hands, the Union Against Tuberculosis and Lung Disease has drawn up a strategy that allows the diseases to be tackled simultaneously -- termed 'Integrated Care for TB Patients Living with HIV/AIDS' (IHC).

Collaboration in addressing TB and HIV and cross-testing of HIV and TB patients are central to the strategy, which is being tested in various countries, including the Democratic Republic of Congo, Zimbabwe and Uganda.

"In 2005, only seven percent of HIV patients worldwide were tested for TB," said Alasdair Reid, HIV/TB advisor to the Joint United Nations Programme on HIV/AIDS.

"That is shocking. By testing people living with HIV for TB we can save thousands and thousands of lives each year. And, it is feasible. The problem is the lack of co-operation between the different organisations that deal with TB or HIV."

A new model for distribution of funds is also required, Reid added. "Currently, money is raised for either HIV or TB, and funds dedicated for HIV can't be used for TB or vice versa."

"This has to change. When you want to tackle HIV you need to tackle TB, especially in Africa where so many people are co-infected."

Winstone Zulu, an activist from Zambia who is living with HIV/AIDS, said the time had come for organisations to work together.

"We cannot successfully fight AIDS when we don't fight TB," he noted. "Unfortunately many people still don't seem to understand the necessity of combating TB, especially in Africa. They do not see the connection between both diseases."

"One needs to understand that in Africa, people are not dying because of HIV or AIDS. They are dying of TB," Zulu added.

"I contracted TB in 1996 and it was truly the only disease in my entire life that nearly killed me. I have been living with HIV for 17 years and I have always been fine, due to the anti-retroviral treatment that I am taking. This all changed when TB hit me. The chest pains, the night sweats, the fatigue were unbearable."

Anti-retrovial treatment comprises various drugs that prolong the lives of people who have contracted HIV.

"Luckily I received treatment on time and after a few weeks I felt much better," said Zulu. "For four of my brothers, however, help came too late."

The Cape Town meeting has as its theme 'Confronting the challenges of HIV and MDR in TB control and care'.

MDR - multi-drug resistance - of TB is a source of growing concern among health workers and researchers, as is extensive drug-resistant tuberculosis (XDR-TB).

While Multidrug Resistant TB can withstand at least two of the main drugs used in initial treatment of the disease (termed "first-line drugs"), XDR-TB is also resistant to various second-line drugs.

Source: http://allafrica.com/stories/200711110002.html

TB-HIV deadly combo threatens Africa

2007-11-05T11:06:00.000+07:00

By, The Times of India, November 4, 2007

Drug-resistant tuberculosis and HIV have merged into a double-barreled epidemic that is sweeping across sub-Saharan Africa and threatening global efforts to eradicate both diseases, according to a report released on Friday.

Over-burdened health systems are unable to cope with the epidemic and risk collapse, said the report, which calls for urgent measures to curb its spread.

A third of the world’s 40 million HIV/AIDS sufferers also have TB, and the death rate for people infected with both is five times higher than that for tuberculosis alone.

The situation is aggravated by surging rates of multi-drug resistant (MDR) and extensively drug-resistant (XDR) TB precisely in those areas where the rates of HIV infection are highest. MDR and XDR tuberculosis are resistant to some or all of the standard drugs used to fight the disease.

"Now the eye of the storm is in sub-Saharan Africa, where half of new TB cases are HIV co-infected," said Veronica Miller, co-author of the report and director of The Forum for Collaborative HIV Research, which issued the study. "Unlike bird flu, the global threat of HIV/TB is not hypothetical — it is here now," she said.

One third of the world’s population carries the tuberculosis bacterium, but the disease remains latent in nine out of 10.

HIV, however, changes the equation: Of those whose immune systems have been compromised by HIV, 10% will develop active tuberculosis each year, according to the report.

"In today’s world, a new TB infection occurs every second. When one considers that much of this transmission occurs in areas with high HIV prevalence, the imminent danger of a global co-epidemic is clear," said Diane Havlir, head of the World Health Organisation’s TB/HIV working group.

TB control has been severely destabilised in regions with high rates of HIV, the study says.

In one community of 13,000 people outside of Cape Town, South Africa, the TB patient case load increased six-fold between 1996 and 2004, the researchers reported.

"There has been a staggering increase in TB in this community, and this has been replicated right across southern Africa," Stephan Lawn, a medical researcher at the University of Cape Town, said in a statement.

Source: http://timesofindia.indiatimes.com/TB-HIV_deadly_combo_threatens_Africa/articleshow/2515583.cms

TB vaccine sickens HIV-infected children: report

2007-11-05T10:16:00.000+07:00

By, Maggie Fox, Reuters, November 2, 2007

WASHINGTON (Reuters) - A vaccine aimed at protecting children in developing countries from deadly tuberculosis may be killing and sickening some vulnerable infants infected with the AIDS virus, researchers said on Friday.

They said the Bacille Calmette-Guerin or BCG vaccine, which is made using a bovine version of tuberculosis, appeared to be causing serious infections in some babies and young children who are HIV-infected.

"One study found a 75-percent mortality rate in children with BCG disease, and 70 percent of those children were HIV-infected. Clearly, this is a problem in need of immediate attention," said Dr. Mark Cotton, a pediatrician and HIV researcher at Stellenbosch University in South Africa.

Cotton's findings are part of a report issued on Friday about the health emergency caused globally by the double whammy of HIV and TB.

The AIDS virus destroys the immune system, and tuberculosis has made a return globally because of this. Usually a latent infection, activated TB can kill quickly.

"Now the eye of the storm is in sub-Saharan Africa, where half of new TB cases are HIV co-infected, and where drug-resistant TB is silently spreading," said Veronica Miller, director of The Forum for Collaborative HIV Research, a global independent public-private group that includes researchers, patient advocates, and government and industry.

"It is here now. But the science and coordination needed to stop it are utterly insufficient."

The human immunodeficiency virus infects an estimated 40 million people globally. There is no cure and when untreated, it steadily destroys the immune system. Patients are vulnerable to a range of infections including TB.

BILLIONS INFECTED

TB infects one-third of the world's population. Without proper treatment, 90 percent of people infected with both die within months.

Usually, tuberculosis only becomes an active infection in one out of 10 people over a lifetime. But 10 percent of HIV patients who also have TB develop activated tuberculosis every year.

The BCG vaccine is given at birth in most developing countries. But because it uses a live microbe, in people with weakened immune systems it can itself cause disease.

"It is especially a problem where they have delayed access to diagnosis of HIV or delayed access to antiretroviral therapy," Cotton said in a telephone interview.

"It also is quite hard to diagnose it," he added. "We don't know how widespread it is across Africa."

Cotton said an estimated 400 per 100,000 HIV-infected infants in the Western Cape of South Africa had become sick from the BCG vaccine.

"The problem is the vaccine is usually given within the first few days of life," Cotton said. But babies are not tested for HIV infection until about 6 weeks of age, meaning many infants are unknowingly being given a vaccine that is dangerous for them.

Cotton said it might be possible to simply vaccinate children with BCG after it is known whether they are HIV-infected.

"But once you interfere with a program and make it a bit complicated, it can have repercussions as well, so it is a bit of a dilemma," he said.

The best result would be to have earlier diagnosis and treatment of HIV. Children infected with HIV can be given an antibiotic, isoniazid, to prevent TB infection, Cotton said.

South Africa: Govt Comes Under Fire for Failing to Stem XDR-TB

2007-11-02T10:52:00.000+07:00

By, Anso Thom, Health-e (Cape Town), November 1, 2007

South Africa's health department has come under fire from activists and HIV/tuberculosis experts for its failure to respond to extensively drug resistant (XDR) TB with claims that one of the critical drugs to stem this epidemic is not available in KwaZulu-Natal, the hotbed of the outbreak.

The criticism has come in the run-up to the 38th Union World Conference on Lung Health starting in Cape Town next week.

"Almost nothing has happened," said Dr Nesri Padayatchi, Site Manager of the Centre for the AIDS Program of Research in South Africa (CAPRISA) and former head of King George Hospital where KwaZulu-Natal's multi-drug resistant (MDR) and XDR TB patients are treated.

Padayatchi said that despite being alerted to the XDR strain as far back as 1995 and again in May 2005, the response from the provincial and national health department was "nothing".

She said that since the global spotlight turned to Tugela Ferry, where the XDR outbreak was first reported, the national health minister called a World Health Organisation meeting and committed to a seven point plan.

"To date, three points have been addressed, and only in Tugela Ferry. Because of the media and civil society attention more money and staff has been sent to Tugela Ferry. But what about the rest of the country? Almost nothing has happened and we really have not made any progress," said Padayatchi.

She said a visit to King George Hospital had confirmed that more beds had been made available, but that staff had informed her that PAS, one of two drugs used to treat XDR, was no longer available from the supplier.

This year, 2 500 MDR cases have been diagnosed in the province while only 600 of these have been treated at King George.

"The national community may be concerned, but the national health department has done very little to address what is a global problem," said Padayatchi.

Stephen Lewis, former United Nations Special Envoy for HIV/AIDS in Africa and currently co-director of AIDS-Free World said the MDR and XDR epidemics spoke of "extraordinary negligence".

"It's a global health scandal of monumental proportions," said Lewis.

Figures released during the teleconference revealed that each year, nearly two million people die of TB, a curable disease.

Failure to properly address TB has led to deadly, drug-resistant strains.

"Despite global commitment to treat 1.6 million people with drug-resistant TB by 2015, little progress has been made," said a statement from the Open Society Institute's Public Health Programme.

Today, of the more than 420 000 new cases of drug-resistant TB annually, only 2 percent are receiving treatment.

Drug-resistant TB is more complicated and expensive to diagnose and treat, especially for HIV-positive people.

South Africa is grappling with ways in which to treat the growing and slowly overwhelming number of MDR TB patients.

On Tuesday, a patient was shot and wounded and a security guard stabbed at the Sizwe Tropical Disease hospital in Edenvale, east of Johannesburg, after a protest by TB patients turned violent.

Newspaper reports said the drama started when about 50 MDR TB patients blocked the hospital's entrance, demanding better treatment and an end to what they called prison-like conditions.

Patients said they were being treated like prisoners while their families were only informed of their condition once they had died.

Brooklyn Hospital, the main treatment centre for MDR-TB treatment in the Western Cape, is bursting at the seams, with patients forced to wait weeks for a bed.

Dr Paul Farmer, Founding Director of Partners In Health, shared "the cheerful part of the story".

He revealed that community based interventions introduced in Peru 12 years ago had led to 10 000 MDR TB patients accessing effective treatment.

Farmer is currently assisting with the introduction of a similar intervention in Lesotho whereby community health workers assist MDR patients at home and address issues such as adherence and infection control.

"We need to get our act together before turning to the global community," said Padayatchi. "There are a lot of simple things we can do right away."

Source: http://allafrica.com/stories/200711010718.html

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

2007-10-30T11:37:00.000+07:00

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

2007-10-08T10:53:00.001+07:00

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

2007-10-05T10:09:00.000+07:00

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

2007-10-04T16:05:00.000+07:00

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

2007-10-03T14:13:00.000+07:00

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

2007-10-03T13:47:00.000+07:00

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

2007-10-03T13:40:00.000+07:00

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

2007-10-03T13:29:00.000+07:00

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

Drugs are not enough for extreme TB - doctors

2007-09-20T10:56:00.000+07:00

By, The Star, March 6, 2007

Multi-drug-resistant tuberculosis (MDR-TB) needs a proactive networked response, particularly when it appears together with HIV infection, an international discussion on MDR-TB heard in Johannesburg on Monday.

"It is one disease where there are more questions than answers," said Dr Norbert Ndjeka from Limpopo - part of a group of South African doctors who travelled to Latvia for training in MDR-TB management.

MDR-TB is TB which does not respond to standard TB treatment, and extreme drug resistant TB (XDR-TB) is even more resistant to treatment. The combination of XDR-TB and HIV infection in South Africa has been proving deadly.

The Johannesburg meeting, organised by the international Lilly MDR-TB Partnership brought South Africans together with Lilly affiliates from Europe.

This partnership is underwritten by international pharmaceutical company Lilly to the tune of $70-million and brings together public and private partners, health professionals, business and communities to address MDR-TB around the world. It was the partnership's first global study tour.

"Drugs are not enough," said partnership project head, Dr Patrizia Carlevaro.

The partnership aims to combat the growing MDR-TB pandemic and support the World Health Organisation's goal of treating 800 000 patients by 2015.

Ndjeka said 13 medical professionals from eight provinces - excluding the Eastern Cape - attended the Latvia training, which included monitoring and management, MDR-TB and HIV co-infection, infection control and drug management.

Ndjeka told the Johannesburg meeting that the training they received was "superb" and said South Africa could learn a lot from Latvia's management of MDR-TB.

"Their cure rate is above 66 percent... Ours is below 50 percent."

Ndjeka said Latvia had good methods of networking on patient difficulties.

"We do not have all the information around resistance patterns in the South African population."

He said South Africa also did not have all the drugs - XDR-TB treatment required six or seven drugs.

Latvia has policies on infection control in place, runs effective isolation of XDR-TB patients, has masks and special lights to kill TB germs through radiation, and screens health care workers annually for infection.

The South African team trained in Latvia recommended to the health department that the national MDR-TB protocol be updated and encouraged research and networking on the MDR-TB problem, including HIV and TB collaboration.

"As government alone we cannot make it.

"Involvement of all stakeholders is essential to achieve better outcomes for our national TB control programme," said Ndjeka.

"The growing incidence of extreme drug resistant TB in South Africa is highlighting the urgent need for more effective measures for preventing, detecting, diagnosing and managing TB," said Dr Kgosi Letlape, chairman of the South African Medical Association (Sama).

Letlape said South Africa ranked seventh in the world in reported TB cases and was among the 22 high-burden countries targeted as part of the WHO's Stop TB campaign.

He said Sama aimed to help develop the capacity of health professionals to deal with TB. He said TB and HIV care should be integrated and commented that HIV-positive patients were generally better informed than those with TB, which impacted on their treatment.

"You have got much higher compliance among HIV patients than among TB patients."

Sama is developing an online training course for physicians on MDR-TB which will include the WHO guidelines on combating the disease.

The course aims to provide doctors with the skills to diagnose, prevent, detect and manage TB, including promoting education and self-care, promoting therapy compliance and controlling associated disorders.

Letlape said 2554 health professionals had been trained in TB management since 2003, and Sama hoped to increase this to 5000 in 2007.

General secretary for the Democratic Nurses' Association of South Africa (Denosa), Thembeka Gwagwa, said Denosa aimed to empower nurses to deal with TB.

As part of this, Denosa trained a core group of 20 nurses from seven provinces in TB management, who in turn trained another 500 nationally.

Northern Cape nurses reported that during the last quarter of 2006, after their 186 nurses were trained, the TB cure rate increased from 18.7 percent to 20.1 percent, while the treatment interruption rate dropped from 21.3 percent to 14.8 percent.

Eastern Cape trained 60 nurses, and reported that the TB treatment compliance improved by 30 percent.

Mpumalanga and KwaZulu-Natal nurses reported a "sharp decrease" in the treatment interruption rate after training.

Gwagwa pointed out that some provinces had no budget for training, which "doesn't augur well".

She said poverty was a huge challenge in battling MDR-TB, as it stopped patients from getting to clinics and meant they took medication on empty stomachs.

"MDR-TB is a man-made problem," said nurse and educator Kathy Dennill, who heads the nursing leadership programme at the Foundation for Professional Development (FPD).

"It stems from bad management. And we need to look at that management."

Dennill's foundation runs training for nurses.

FPD's Dr Anton Stoltz said the links between HIV and TB were crucial.

"It is very important that we know how people with TB present with HIV."

In support of the battle against MDR-TB, Lilly has passed on the skills and technology needed to manufacture TB drugs.

"We have given away our trademark," said Carlevaro.

"Twenty years ago people were saying MDR-TB is a lost cause. Now we say it's cost-effective to treat."

In South Africa, Lilly has passed on technology, skills and capital funding to pharmaceutical company Aspen Pharmacare, to enable it to produce low-cost drugs to fight MDR-TB, including XDR-TB.

Aspen currently manufactures the oral TB drug cycloserine and within about 15 months will be able to manufacture capreomycin, thanks to Lilly's assistance, said Aspen executive director Stavros Nicolaou.

He said Aspen was developing the capacity to manufacture a dried injectable powder in a vial which required only water to be added to it, a method which kept the medicine stable. This would be used for capreomycin.

He urged support for the battle against both TB and HIV - "a potentially devastating cocktail".

Nicolaou said that thanks to Lilly's help, Aspen could sell the MDR-TB drugs "largely on a cost-recovery basis" instead of a profit-making basis. - Sapa

Source: http://www.thestar.co.za/?fSectionId=&fArticleId=nw20070305225920738C736233

Malawi: Rescuing Infants From Tuberculosis

2007-09-05T09:42:00.000+07:00

By, Moses Kaufa, The Chronicle Newspaper (Lilongwe), September 4, 2007

The call to action in Prevention of Mother to Child Transmission (PMTCT) aims to reduce the risk of mother to child transmission of HIV through integrated HIV/Aids education, routine counselling and testing as well as administration of a prophylaxis single dose Nevirapine therapy to mother and infant.

It goes without saying then, that the need to protect infants or the unborn from the possibility of contracting Tuberculosis, including the Multi-Drug Resistant (MDR) and Extremely Drug Resistant (XDR) TB, which is closely linked to the HIV epidemic, becomes of paramount importance.

During the last decade, there has been an increase of TB infections as an opportunistic infection in people with HIV because of their weakened immune systems. This is causing concern in the light of MDR and XDR-TB surfacing because interventions such as the prevention of mother to child transmission of HIV may be challenged where the mother is living with HIV and found with Tuberculosis.

Communications Officer of National TB Control Programme, Henry Chimbali, told Health Check that most healthy people do not get TB unless they are in very close contact with people infected with Tuberculosis as it is spread through droplets in the air.

"The infection of XDR-TB is transmitted the same as the standard TB and could be prevented the same way ordinary Tuberculosis is prevented," Chimbali said.

The international medical humanitarian organisation, Medicines Sans Frontieres (MSF) is quoted by Health Check calling for approaches and new tools to treat multi-drug resistant (MDR) Tuberculosis in Southern Africa.

"MDR, and now XDR-TB, are the tip of an iceberg of failing strategies to control TB," said Dr.. Eric Goemaere of MSF "We desperately need new tools and new approaches and we need them now - we cannot just sit and wait. Despite all the international fanfare created by XDR, efforts to treat drug resistant TB in high HIV prevalence settings are moving at a snail's pace and investments to develop new drugs and diagnostics to improve management of all forms of TB are terribly inadequate. This situation is unacceptable." He said

The World Health Organisation says it is important to avoid prolonged and close contact with a person who has been infected by TB, MDR-TB or XDR-TB in a place that does not have good ventilation and fresh air as one way of protecting oneself from becoming infected with the Tuberculosis.

According to the National TB Control Programme, XDR-TB patients need experts to handle their cases while they are quarantined.

Chimbali told Health Check, however, that any development of TB could be averted if regular TB is treated effectively and if Malawi succeeded in controlling the XDR-TB transmission, then the risk of infection would not be there.

Country Director for UNC Project at Kamuzu Central Hospital, Dr.. Francis Martinson, says there is need for a prophylaxis regimen to protect mother/infant pairs from tuberculosis just as there is a Nevirapine dose to facilitate the prevention of mother to child transmission of HIV.

In this regard, University of Northern Carolina (UNC) Project has embarked on a randomized, placebo-controlled trial to determine the efficacy of Isoniazid (INH), a component drug in the combination of TB treatment in preventing Tuberculosis disease and latent TB infection among South African infants with peri-natal exposure to HIV.

Dr. Martinson told Health Check that the trial would have an initial sample size of 1,300 study participants consisting of 500 infected and 800 uninfected exposed study participants.

"The objective of the trial aims to determine whether INH prophylaxis increases TB disease survival for HIV infected participants; to determine whether INH prophylaxis increases TB infection-free survival for peri-natal-exposed HIV uninfected study participants," said Dr.. Martinson.

"Among both peri-natal-exposed HIV infected and HIV uninfected study participants we are also trying to assess the toxicity and safety of INH prophylaxis."

The fact that once one is HIV positive and having Tuberculosis, one is automatically placed on antiretroviral therapy, puts the mother/infant pair at risk of not accessing medical care if they infect one another and do not get diagnosed in time.

This uncertainty surrounding lives of infants makes it clear that it is imperative for stakeholders to ensure that such cases are identified and assisted adequately in time to save mother/infant pairs' lives and to prevent the spread of both TB and HIV.

Source: http://allafrica.com/stories/200709040470.html

TB and HIV data needed for diagnosis

2007-08-02T10:49:00.000+07:00

By, Vietnam News Agency, August 1, 2007

HCM CITY — Viet Nam needs to set up a system to obtain data for research of tuberculosis so the disease can be diagnosed as early as possible, according to an epidemiologist and professor from the University of Texas.

Speaking at a training workshop on HIV research and prevention, Lu-Yu Hwang, professor of epidemiology and disease control at the University of Texas in Houston, said that even though TB was an old problem more people taking multiple drugs were becoming resistant to drugs prescribed for TB.

With such a scenario, there was a need for better data about the population and better coordination between research and laboratories, she said.

Vietnamese health officials have raised the issue recently, citing the increasing number of TB cases, especially among people with HIV/AIDS.

Treatment for people with both TB and HIV is difficult because of the patients’ low immunity and multi-drug resistance.

TB is a serious problem since the air-borne disease can spread easily without contact. In the world, as many as 2 billion, or one-third of the world’s population, suffer from TB. Every year about 8.9 million more people are infected with TB. Twelve per cent of the new adult cases are HIV carriers and about 1.8 million people die of TB every year.

Dr. Edward Graviss, associate professor of the American Baylor College of Medicine, said that timing was the key element to the treatment of TB, with early diagnosis crucial to prevent and control the disease.

In Viet Nam and some other Asian countries, like China, some physicians have the inaccurate perception that TB vaccinations in early childhood can prevent a person from contracting TB while in fact the vaccine’s potency wanes over time, according to the doctor.

In his presentation yesterday, Graviss also spoke with 80 medical workers at the districts’ clinics for HIV/AIDS prevention and control in HCM City and other neighbouring provinces about the latest testing for fast TB diagnoses in the US.

Throughout the five-day workshop that opened here on Monday, participants will learn about different research methods in epidemiology, biostatistics and behavioural research.

The workshop, organised by Ngoc Tam Hospital, the University of Texas School of Public Health and the HCM City AIDS Committee, is a follow-up to a similar programme last year in Ha Noi.

Palmer Beasley, professor of epidemiology and disease control at the University of Texas, said this annual event was part of a long-term programme of the university’s Centre for International Training and Research to educate and train outstanding Vietnamese health professionals for public health research careers in HIV and HIV-related issues. — VNS

Source: http://vietnamnews.vnagency.com.vn/showarticle.php?num=01POP010807

TB biggest threat to HIV positive

2007-07-25T10:32:00.000+07:00

By, The World Today, July 24, 2007

ELEANOR HALL: Scientists at an international AIDS conference in Sydney have warned that tuberculosis is the biggest killer of HIV-positive people and that more needs to be done to eradicate it.

While technology for HIV testing has improved over the last quarter of a century, the test for TB has not changed for a century. Yet TB remains one of the world's biggest killers. Lucinda Carter has our report.

LUCINDA CARTER: Tuberculosis has been around for thousands of years, and according to the World Health Organisation, nearly three billion people worldwide carry the disease. While most of these people do not ever develop symptoms, in 2004 alone it killed more than 1.5-million people.

And many of those are HIV-positive. UNAIDS TB/HIV advisor, Dr Alasdair Reid, says those with HIV currently develop and die from TB at an alarmingly high rate.

ALASDAIR REID: A third of the world in fact is infected with tuberculosis, but only one in 10 of them go on to have TB in their lifetime. If you get HIV, that changes to one person in 10 a year, not over their lifetime but in one year, will develop tuberculosis.

LUCINDA CARTER: TB is especially common in poor or developing regions, where testing and treatment for the disease is all but ignored. To draw attention to the issue, South African photographer and artist Damien Schumann has created a work called The Shack which is a life-size replica of a shanty dwelling filled with photographs showing the plight of families and people affected by HIV and TB.

DAMIEN SCHUMANN: The Shack has been incredible especially internationally because what we've been able to do with that is we give the viewer, like so many people who don't have the opportunity to come into the townships, with The Shack, we've got the opportunity of bringing the townships to them.

LUCINDA CARTER: Currently, the Asia Pacific region has one of the fastest growing epidemics of HIV in the world. But UNAIDS' Dr Alasdair Reid says good management of tuberculosis in that region will help these sufferers.

ALASDAIR REID: Asia Pacific has done really well in tuberculosis control. Globally, the Western Pacific region is the first to reach their international TB control targets and everybody thinks, "well TB is done and dusted", and that's not the case. And so, we can't take our eye off the ball, we have to keep our focus on major killers like tuberculosis.

LUCINDA CARTER: Organisers are hoping to take The Shack on the road, heading next to Canberra to get the attention of federal politicians. Visiting The Shack display in Sydney today, Dr Reid says he hopes it will encourage more funding of research into TB because that disease plays such an important role for HIV sufferers.

ALASDAIR REID: We really do have to spend more money on tuberculosis. We're dealing with drugs that are over 40 years old, there's been no new TB drugs for over 40 years, and the test that we use for tuberculosis is over 120 years old, and it's not very good in people living with HIV. So, we need urgent investment in research, and that's our main reason for bringing The Shack to this conference, it's to raise awareness amongst the HIV research community of the plight of tuberculosis.

ELEANOR HALL: That's United Nations' TB/HIV advisor, Dr Alasdair Reid, ending that report by Lucinda Carter.

Source: http://www.abc.net.au/worldtoday/content/2007/s1987003.htm

Malawi: Threat of Extensively Drug-Resistant TB a Reality!

2007-07-18T12:50:00.000+07:00

By, Moses Kaufa, The Chronicle Newspaper, July 16, 2007

In Malawi, Tuberculosis (TB) is closely linked to the HIV epidemic. Of the 28,000 cases of TB reported in the year 2005, approximately 70% of the patients tested HIV positive.

Although TB can be cured, the recent surfacing of an Extensively Drug Resistant-TB (XDR-TB) in South Africa is cause for concern.

With the current official rate of 14% HIV infection in Malawi and the link between HIV and TB, the need to put TB firmly on the political agenda of the country has become more necessary and urgent.

The government, through the Ministry of Health and the National TB Control Programme has committed to making sure that there a plan in place to respond effectively should any cases of XDR-TB surface in Malawi.

Advocacy, Communication and Social Mobilization (ACSM) an initiated component of the Malawi National TB Control Programme, seeks to create awareness, facilitate community involvement and participation and promote activities that will inform the public on the importance of adhering to treatment and medical advice for Tuberculosis in an effort to avoid the possible development of the fatal, Extremely Drug Resistant TB (XDR-TB).

Henry Chimbali, the Communications Officer of the National TB Control Program, ACSM has embarked on an advocacy campaign involving activities designed to place TB high on the political and development agenda.

The campaign also aims to increase financial and other resources on a sustainable basis as well as hold authorities to account. Additionally, the campaign seeks to ensure that pledges are fulfilled at the local level.

A major and very important part of the campaign is to prevent the possible development of the deadly XDR-TB in Malawi.

Reports indicate that XDR-TB probably developed because cases of normal TB are not treated properly. TB that is not effectively treated will resurface with resistance to the drugs used in the treatment and become Multi Drug Resistant - TB (MDR-TB). Concerns are high that XDR-TB could develop if patients are not aware of the importance of following the strict medical regime necessary to treat MDR- TB.

Records indicate that no one knows yet exactly how many cases of XDR-TB exist but surveillance shows that countries most affected by TB are those that are poor.

Chimbali told Health Check that XDR-TB mostly develops in patients who at one time used the drugs for other ailments or if they had defaulted in the treatment of TB.

However, the infection of XDR-TB is transmitted in the same way as the standard TB.

He says the intervention embarked on by ACSM seeks to prevent any possible occurrence of XDR-TB in this country and the further spread of infections should it occur.

"The program will be looking at adherence and compliance of treatment. This will be achieved by ensuring that all TB patients are under closely supervised treatment and all health workers have adequate knowledge on TB treatment guidelines. There will be a need to engage more health care providers in TB treatment monitoring, strengthening treatment monitoring systems at all levels and intensifying proper diagnosis of all TB suspect cases," Chimbali said.

He said the program is also focusing on prevention and control of the transmission of XDR-TB to health workers and the public.

"This will be achieved through early diagnosis of all TB treatment failures, relapses and tracing of all treatment defaulters and the establishment of special treatment centers for XDR-TB," said the Communications Officer.

XDR-TB is said to be very difficult to treat as it involves a regime that lasts for a long period of time. Drugs to treat the infection are extremely expensive making access to treatment of XDR-TB impossible for many under-privileged people.

Being diagnosed with the infection can be potentially fatal and many people risk losing their lives if diagnosed with the infection because they cannot afford to access treatment.

"Symptoms of XDR-TB are the same as those of any kind of tuberculosis; the only difference is that the particular mycobacterium cannot be killed by any drugs we have today. XDR-TB can only be determined in laboratories, but results take 6-16 weeks to obtain. The treatment is expensive because you need experts to handle the patient who will need to be quarantined," said Chimbali.

During the last decade there has been an increase of TB infections as an opportunistic infection in people with HIV because of their weakened immune systems. This is causing concern in the light of XDR-TB surfacing because interventions such as advocacy, communication and social mobilization in the prevention of the XDR-TB in Malawi, may be challenged in cases where people living with HIV are also found with Tuberculosis.

In an interview, HIV/AIDS Coordinator for Likuni Voluntary Counseling and Testing (VCT) Center, Joe Kamalizeni said one of the guidelines that helps to tell which stage a patient has reached is whether the patient has TB or has been treated for TB in the past.

"Any patient who has had Tuberculosis treatment and has HIV is placed on Stage 3 of the HIV infection and automatically goes on to Antiretroviral therapy," Kamalizeni confirmed.

Chimbali concurs and adds that being HIV positive and diagnosed with TB, the patient is placed on the first course of TB treatment that is combined with ARVs about two months later.

"The two months period is provided to avoid drug reaction which occurs when two types of drugs, Refampicin and Nevirapine are combined," he further adds: "In the first regimen of TB treatment there is a higher level of Rifampicin, which is lowered in the preceding regimen making the body to response favorably to ARV treatment."

He said that all TB patients who are HIV positive are first given Cotrimoxazole (Bactrim) before the next assessment, which determines the next stage for ARVs.

However, while normal TB can be treated with first line antibiotics, MDR-TB can be treated with two classes of second-line drugs, XDR-TB cannot be treated effectively with anything.

TB being one of the opportunistic infection related to HIV/AIDS, there is concern about the development of XDR-TB

Government, however, says people should not be worried as it is taking all steps possible to ensure that the localized TB treatment should include the advanced medication which targets the resistant ailment.

Principal Secretary for HIV/AIDS and Nutrition, Dr Mary Shaba told Health Check, "Meanwhile government is setting up special treatment centers for XDR-TB patients to protect the uninfected people from infection."

Chimbali said any development of XDR-TB could be averted if regular TB is treated effectively. He said: "Meanwhile there are about 16% TB patients who are on Antiretroviral therapy in the country and if we succeeded in controlling the XDR-TB transmission, then the risk would not be there," confirmed the Communications Officer.

He said XDR-TB could be prevented the same way ordinary tuberculosis is prevented. Most healthy people do not get tuberculosis unless they are in very close contact with people infected with TB. Tuberculosis is spread through the air on droplets. Healthcare workers and people who are in close contact with TB patients need to wear protective equipment such as masks. People in the first two weeks of tuberculosis treatment should cover their mouth when coughing and dispose of used tissues.

The World Health Organization (WHO) also recommends that healthcare workers should know their HIV status in order to avoid putting themselves at risk and if diagnosed with TB, strictly adhere to the treatment regime.

It is thought that drug resistant TB has arisen from TB that has been incompletely or improperly treated. People living with HIV/AIDS should be given a TB test, and if found to be TB positive, should start TB treatment before the disease begins to show.

According to World Health Organization, the likelihood of contracting XDR-TB is still pretty rare and in general, healthy people will not develop TB. WHO does not recommend against travel to any of the countries with tuberculosis of any kind. Healthcare workers, however, should take care to follow proper procedure to protect themselves from TB infection.

Source: http://allafrica.com/stories/200707160868.html?page=2

What is tuberculosis?

2007-07-18T11:12:00.000+07:00

By, Independent.ie, July 17, 2007

TUBERCULOSIS (TB) is a respiratory condition caused by infection by my cobacterium tuberculosis.

TB was a major public health problem in Ireland up until the 1950s, when improved living conditions and the availability of an effective vaccine and antibiotics reduced the prevalence and mortality rate of the disease.

At present there are approximately 400 cases reported annually in Ireland.

TB is a contagious disease. The bacterium is spread in the tiny droplets that come from an infected person when coughing or sneezing. When these droplets are inhaled into the lungs by another person, infection can develop, particularly in those with a weakened immune system.

It is estimated that a person with undiagnosed TB can infect 10 people each year on average. The typical symptoms of TB are persistent coughing, fatigue and weight loss.

Diagnosis can usually be made by chest X-ray and confirmed by taking a sample from the patient to determine the presence of the bacteria.

The mortality rate of TB is low (about three per cent in Ireland), when correctly treated by a combination of antibiotics. Although it is no longer universally used, the BCG vaccine is an important element in TB control, particularly when used in targeted groups.

TB occurs as an opportunistic infection in people infected with HIV. There is also a higher incidence of TB amongst immigrant communities. It is estimated that three million people die each year from the disease.

Symptoms:

Persistent coughing and sputum production. The sputum (saliva and mucus) may contain blood. Fever, fatigue, weight-loss and sweats.

Treatment:

Once contracted, TB is treated with a combination of three to four antibiotics for a period of up to six months. The choice of antibiotic may be varied to avoid drug resistance. Patient adherence to the complicated treatment regime can be poor – some patients may require intensive supervision.

Prevention:

The Bacillus Calmette-Guerin (BCG) vaccine is an injection of live, weakened bacteria that stimulates an immune response against the disease.

Source: http://www.independent.ie/health/questions-answers/what-is-tuberculosis-1038998.html

Burmese Migrants Vulnerable to Tuberculosis

2007-07-16T16:17:00.000+07:00

By, Violet Cho, The Irrawaddy, July 16, 2007

My chest is very painful when I breathe” said Paw Baw, clutching her chest while lying on a wood bed at a clinic in Mae Sot, Thailand’s border town with Burma.

“If I had followed the advice of the doctor (taking a drug treatment for six months), my disease would be cured now,” she said, regretfully, lying down on the bed of the Mae Tao Clinic.

Paw Baw, a 37-year-old ethnic Karen, is one of a growing number of tuberculosis (TB) patients diagnosed in the border area since last year. This is her second round of treatment.

“I felt better after I had taken medicine for several months,” she said. “Then I heard my eldest son was lured away to become a Karen soldier. I was so worried that I ran away from the hospital to find my son without finishing my treatment."

Thawat Sunthrajarn, the Thai Health Ministry’s director of disease control, said 58,000 tuberculosis cases have been reported so far this year in Thailand.

Two patients were confirmed with XDR-TB, a drug-resistant form, in the Mae Sot community along the border earlier this month. TB cases are likely to increase this year, according to officials.

Manoon Leechawengwong, the chairman of the Drug Resistant TB Research Fund at Bangkok’s Siriraj Foundation, said researchers started studying the drug-resistant form of TB in 2001 and had found 13 cases identified as XDR-TB, according to The Nation, an English language newspaper in Bangkok.

Burmese migrants are more vulnerable to outbreaks of tuberculosis than other nationalities and less likely to undergo full treatments, according to researchers.

Voravit Suwanvanichkij, a public health researcher at Johns Hopkins University, said “since migrants (Burmese) are often impoverished, illiterate, discriminated against, fearful of arrest—since most are undocumented— they consistently have a far higher default rate compared to Thais.”

Voravit said XDR-TB usually arises when patients get inappropriate medicines or fail to complete their treatment courses.

Burmese patients who fail to complete treatment regularly appear at the Mae Tao Clinic, said Mu Ni, a TB specialist at the clinic.

“We always have cross-border migrant TB patients who come back to get treatment at the clinic,” Mu Ni said. But, because of the obstacles, “this community will be the group which carries the most resistance cases in the coming year.”

Last year, the Mae Tao Clinic sent about 600 suspected TB patients to the French aid agency, Medicines Sans Frontiers (MSF) in Mae Sot, to be tested. About half of the patients were confirmed to have TB.

Medicines Sans Frontiers (MSF), also known as Doctors Without Borders, is the world's leading independent organization for medical aid. MSF presently treats TB patients in 39 projects in 19 countries, including Thailand.

Source: http://www.irrawaddy.org/article.php?art_id=7618

Drug-Resistant TB Surfaces in Thailand

2007-06-18T09:56:00.000+07:00

By, Sai Silp, The Irrawaddy, June 15, 2007

Thai officials have stepped up surveillance and protective measures after 13 Thai citizens and two ethnic Karen migrants from Burma were found to be carrying a dangerous and highly drug-resistant form of tuberculosis.

Dr Thawat Sunthrajarn, director-general of Thailand’s Disease Control Department, said that while infected TB patients needed to be on medication continuously for six months only 79 percent diagnosed with the disease in Thailand completed their treatment. The World Health Organization’s required standard was 85 percent, he said.

If treatment were neglected or not completed, the disease built a resistance to the medicine and most patients died, Dr Thawat warned.

Thailand’s Ministry of Public Health adopts various strategies to combat outbreaks of TB and says it insists on following up on patients and their medication closely. It is common practice to treat TB and HIV together, because 30 percent of HIV patients also have TB.

The ministry has also identified special risk groups such as migrants and people living along border areas and collaborates with international aid organizations working in those areas to tackle the problem.

Recently, the ministry also announced a campaign to promote the use of hygienic masks to prevent the spread of respiratory-transmitted diseases like the common cold, influenza, pneumonia and TB. The current annual budget for treatment of these diseases is about 5 billion baht (US $138,500,000).

The medical aid organization Médecins Sans Frontières has reported that two cases of “Extremely Drug Resistance-TB (XDR-TB)” cases had been diagnosed in Karen migrants from Burma. Dr. Thawat confirmed that one case was found in a refugee camp near Mae Sot on the Thai-Burmese border, but said it was believed that the other infected person had returned to Burma and could not be located. He said details of all cases of XDR-TB would be forwarded to the WHO.

A member of staff at the Mae Tao clinic in Mae Sot confirmed that the number of patients with TB entering the clinic has been increasing, although about a half of the people suspected of having TB have to be referred to MSF because the small clinic does not have the facilities to cater for so many patients.

Dr. Manoon Leechawengwong, chairman of the Drug Resistant TB Research Fund, said that the foundation, under the patronage of the Siriraj Foundation, began research into drug-resistant forms of TB in 2001 and had since found 13 cases identified as XDR-TB, according to a report in The Nation. Dr. Manoon warned that respiratory- transmitted diseases could spread easily, particularly in air-conditioned public places in big cities.

The worldwide spread of TB continues to cause concern. In March, the WHO reported that there were 269 XDR-TB cases in 35 countries worldwide. In Thailand, an estimated 91,000 people have TB, 40,000 of whom are contagious. So far in 2007, 10,000 new cases have been diagnosed.

Source: http://www.irrawaddy.org/article.php?art_id=7486

Tuberculosis: Old disease, new danger

2007-06-15T13:14:00.000+07:00

By, Tuscaloosa News, June 14, 2007

Last month, health officials quarantined an Atlanta man infected with a type of tuberculosis that resists multiple antibiotics.

Most people probably thought the days of quarantine were over. After all, we have highly effective antibiotics, vaccinations and other public health measures to prevent and treat infectious diseases.

This is the government’s first quarantine in more than 40 years. And it’s not a previously unknown infection. The man has an age-old disease about which we know plenty.

TB is a historic scourge of humankind. Even now, it is the leading infectious cause of death in the world, accounting for more than 2 million deaths a year.

We have been luckier in the United States than in developing countries. Starting in about 1900, improved living standards led to a decline in the disease, which dropped further after the discovery of anti-TB drugs in mid-century. But in 1984, a rise was fueled by HIV and homelessness. We also saw the first cases of multidrug-resistant TB.

Ordinary TB responds to a combination of four drugs for the first two months, followed by two drugs for four more months.

But MDR strains resist the first-line drugs, so treatment requires a complex cocktail of multiple second-line drugs.

In the United States, the risk of both forms of TB plateaued in 1992. The risk has declined steadily since, to an all-time low of about 14,000 cases a year, because of aggressive diagnosis and strict isolation of cases. Most deaths from TB occur when the condition is not diagnosed promptly or because the proper antibiotics are not started in time.

In some ways, the current case is a product of advances in science and technology.

When antibiotic use becomes widespread, bacteria may mutate into a form that resists antibiotics. When drugs for TB were first introduced, drug-resistant strains of the germ were rare. No more. And global travel can spread tough bugs, putting more people at risk.

Most people in the United States probably don’t have to take special precautions to avoid infection with TB.

Experts believe the risk to public health in the United States posed by XDR TB remains quite low.

— Harvard Medical School

Source: http://www.tuscaloosanews.com/apps/pbcs.dll/article?AID=/20070614/NEWS/706140306/1002/NEWS04

What the TB Scare Teaches Us

2007-06-15T10:49:00.000+07:00

By, Josh Ruxin, The Huffington Post, June 14, 2007

XDR-TB, or extensively drug-resistant tuberculosis, is a disease many Americans had never heard of before last week, but where I live and work in Rwanda, Multidrug Resistant TB (MDR-TB) is a persistent and growing feature of the public health landscape. While MDR-TB is resistant to at least the two most commonly used drugs, it can generally be treated and cured. XDR-TB is resistant to nearly all drugs and is considered virtually untreatable.

It should not shock Americans that this disease is making its way across the globe when every location is just a plane ride away. Yet the growth of XDR-TB has gone largely unnoticed in the US, where there have only 17 cases since 2000. In sub-Saharan Africa where roughly 25 million people are HIV positive, nearly half will develop TB. If treatment is not well administered, these cases will lead to new strains of resistant TB. There is a direct connection between the AIDS pandemic, TB, and the failure of health systems to appropriately diagnose and treat these diseases.

The good news is that the momentum to address this pandemic may be at hand. It's about time: about a year ago, the World Health Organization announced that 52 of 53 AIDS patients with XDR-TB died in South Africa. The international medical community has now acknowledged the looming problem, and, as witnessed last week, that acknowledgment occurred just when the threat to richer countries has appeared in the unlikely form of Andrew Speaker.

The recognized fact is that more funding and better research are needed now to stanch what may prove to be the next pandemic.

TB has plagued humankind since the 4th millennium BCE. While the disease only recently ceased to be a significant public health threat in the developed world, TB still claims 5,000 lives globally every day, more than SARS, Marburg, and avian flu ever have. Yet even on World TB Day, the disease rarely makes the headlines.

Lack of political and media attention has slowed scientific development. No new TB drug has been brought to market in the last 30 years (though the TB Alliance has promising candidates in the pipeline). A TB vaccine -- BCG -- is widely administered, but is ineffective in adults. Consequently, the disease has become endemic in poor countries where TB programs are underfunded. When a patient receives intermittent drug therapy or inadequate follow-up, or prematurely halts treatment, resistance can occur rapidly. Uneven treatment has resulted in drug resistant TB strains emerging globally. It's now time to address this crisis with the gravity and resources long accorded to AIDS and other diseases.

The first step is improving diagnosis and detection. In 1993, the World Health Organization recognized TB as a global health threat. Yet since then, the Geneva-based organization has continued to rely on an obsolete 125-year-old diagnostic tool -- microscopy. Over the past decade, rapid and accurate tests for TB have been developed but not widely approved. Why then do the WHO and many national TB programs keep outmoded methods as the cornerstone of their control strategies?

The simple reason is cost. Microscopy -- about 30 cents per patient -- is well-suited for most resource-limited settings. However, it cannot detect MDR-TB and XDR-TB. During the last five years, an advanced test, the line probe assay, has been proven effective. Though more expensive than microscopy -- cost estimates place the potential price around three dollars -- it can test many more people, faster, and reveals which treatment is best for their illness.

This test is desperately overdue. Of the 8.9 million new TB cases that emerged in 2004, barely half were reported at the time. An accurate, rapid diagnostic will cost money, but the result -- early treatment and cure -- will save billions of dollars and millions of lives in the long-term.

Treatment protocols also need reform. Right now, we settle for initially treating all TB the same way, shifting gears only after failure. When a person is found to be TB positive via microscopy in Rwanda, the patient receives drugs which may not work at all. It is only after several months have passed that further testing occurs and other drug regimens are applied. That's bad policy since it provides time for resistant strains of TB to spread.

A U.S. Senate committee is currently holding hearings on how health authorities handled Andrew Speaker's case. It is important that Congress and the world not miss the larger frame his case reveals: in an age of global jet travel, there is no such thing as an isolated case. TB anywhere is TB everywhere.

In the fight against XDR-TB, supporting worldwide efforts to fund improved diagnostics and treatment is the best investment we can make. Indeed, it is the only thing we can do.

Josh Ruxin, Assistant Clinical Professor of Public Health at Columbia University's Mailman School of Public Health, is Director of the Access Project in Rwanda.

Source: http://www.huffingtonpost.com/josh-ruxin/what-the-tb-scare-teaches_b_52188.html

Flight plan: TB or not TB

2007-06-14T10:48:00.000+07:00

By, James Jay Carafano, Washington Times, June 9, 2007

[Mod’s Note: The international travels of Andrew Speaker, the Georgia resident who is infected with a rare form of tuberculosis, has received wide media coverage, also raising the profile of drug resistant TB]

Washington Post - One of the great combat generals of World War II, Manton Eddy, had a favorite saying when battle reports came in: "Things are never half as good or half as bad as they look at first." Gen. Eddy believed in waiting for enough information to make a good decision. This also applies to homeland security.

Before people start assigning blame, spending money and proposing fixes, they ought to have enough facts to make a respectable guess at the right thing to do. Yet where homeland security is concerned, thinking before speaking seems to be the exception rather than the norm.

It's happening now in the wake of the story about the international travels of Andrew Speaker, the Georgia resident who is infected with a rare form of tuberculosis. His sojourn and his ability to slip past border officials have spawned thousands of newspaper articles and hours of TV coverage as well as accusations that the Departments of Homeland Security and Health and Human Services were at fault.

The only thing we don't have yet are the facts needed to make any really useful assessments about what this story might portend and how to fix the problem.

The first thing necessary to understand is what Mr. Speaker knew about his illness and what various health officials told him to do. So far, the record is contradictory and confusing. But it makes a big difference. In dealing with an infectious disease, the most important instrument of control is the voluntary behavior of individuals. Getting people to do the right thing -- what is in their own best interest and that of the community -- is paramount.

This is an important teaching moment for all Americans. They need to understand the importance of their role in public and the magnitude of their responsibility. Public health officials, must learn how to communicate to citizens so their messages are credible and understandable.

Next, we need a complete timeline of the actions taken by all officials -- not just in the U.S., but in all the countries involved. No one has all the facts yet, and we can't properly evaluate government response without them. For example, news stories have focused on Mr. Speaker's entry into the U.S. across the Canadian border. But how did he get into Canada? If a truly communicable disease crosses the ocean, and the onset of symptoms isn't visibly apparent in a few hours, then likelier than not it will reach the United States, carried by innocents infected in Canada or Mexico who have no idea they are infected.

Finally, the problem needs to be put in perspective. The U.S. already has a communicable disease problem -- big time. And the individuals entering the U.S. legally through legitimate points of entry are the least part of it.

Tuberculosis, including strains increasingly drug resistant, is one of the world's fastest-growing diseases. This is partly due to the spread of HIV/AIDS, which reduces the human immune system, leaving individuals more susceptible to TB.

The World Health Organization says more than 8 million people a year get TB, and about 98 percent live in the developing world. Most illegal migration comes from the developing world to Europe and the U.S. Many of these persons never pass through a point of entry, which is the most likely source of a human-carried pandemic. That's where the real problem is. In fact, today when the Department of Homeland Security detains an individual for removal from the United States, virtually the first step taken is to test him for TB.

That said, as the Senate considers a bill to immediately grant legal status, including the right to pass back and forth across the U.S. border, to about 12 million individuals living unlawfully in the United States -- with no health check required -- the advice to think before acting should hold special significance.

Knee-jerk responses to one individual case make for bad public policy. In evaluating homeland security, sizing up public health policies, and passing immigration laws, we ought to proceed a little more thoughtfully.

James Jay Carafano is a senior research fellow for homeland security at the Heritage Foundation (heritage.org).

Source: http://washingtontimes.com/functions/print.php?StoryID=20070609-101634-2232r

TB Testing, Treatment Should Be Linked With HIV Prevention Programs, WHO Official Says

2007-06-11T12:20:00.001+07:00

By, Kaiser Network, June 8, 2007

African countries, especially those in Southern Africa, must link tuberculosis testing and treatment with HIV prevention programs to more effectively fight HIV/AIDS, Kevin de Cock, head of the World Health Organization's HIV/AIDS department, said recently at the 3rd South African AIDS Conference in Durban, South Africa, Reuters reports. De Cock said that the continued use of traditional treatments for TB could fuel the spread of the disease and exacerbate the HIV/AIDS epidemic. "TB programs alone cannot reverse the tide" of HIV/AIDS, he said, adding that it is vital to offer those living with HIV/TB coinfection convenient and effective treatment for both diseases.

The emergence of extensively drug-resistant TB, which is resistant to the two most potent first-line treatments and some of the available second-line drugs, in South Africa's KwaZulu-Natal province, neighboring Lesotho and other parts of the world has created a more serious threat, especially in Southern Africa, where HIV/AIDS and TB are prevalent and interlinked. In South Africa, approximately 61% of the roughly 250,000 people diagnosed annually with TB have HIV, Reuters reports. XDR-TB also has led to higher mortality rates and faster deaths among HIV-positive people, according to Reuters. In addition, although people living with HIV/TB coinfection might have access to antiretroviral drugs, they often do not receive treatment simultaneously for both diseases.

Robin Wood, director of South Africa's Desmond Tutu HIV Center at the University of Cape Town, said, "HIV has caused a devastating reversal in our ability to treat TB." He added that the solution is to combine HIV and TB treatments, which will require a large investment in TB laboratories, as well as related medical infrastructure and resources, in much of Africa. Researchers are developing a urine-based dipstick test that would give TB results almost instantly. Wood said this "would be a great asset if we could get it" (Simao, Reuters, 6/7).

Source: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=45457

Traveling tuberculosis patient hits back at critics

2007-06-11T12:01:00.000+07:00

By, Denise Grady, International Herald Tribune, June 10, 2007

"TB SPREADS THROUGH THE AIR, BUT ONLY A SMALL PERCENTAGE OF PEOPLE WHO ARE EXPOSED TO THE BACTERIA ACTUALLY GET SICK. XDR-TB IS NOT MORE VIRULENT OR MORE CONTAGIOUS THAN OTHER TYPES, BUT IT IS OF GREAT CONCERN BECAUSE IT IS SO DIFFICULT TO TREAT"

"WHEN I'M DONE WITH ALL THIS, AM I GOING TO HAVE A PRACTICE [LAW] TO GET BACK TO, WITH THE IMPRESSION OUT THERE NOW THAT I'M THIS SELFISH, SELF-ABSORBED PERSON?"

By the time Andrew Speaker and his wife returned to the United States from Europe late last month, government officials and news reports had already branded him as a runaway tuberculosis patient who had deliberately evaded health officials and knowingly put other people at risk by traveling on crowded airplanes.

"This is what we're hearing on the news when we land," Speaker said Thursday from his hospital room in Denver. He called The New York Times in response to repeated requests for an interview. "My wife and I look at each other, and I said, 'They're going for our throats here.' "

Speaker and his family have been fighting back ever since, disputing the accounts of government health officials who contended he had been warned not to fly because he posed an infection risk to others.

"I think when they started all this, they forgot that I spend my whole life defending people who are seriously hurt and need help," said Speaker, 31, a personal injury lawyer. "I don't think they took that into account when they started coming after me and my family. We're not the kind of people who back down."

Speaker's father, Theodore, also a lawyer, went so far as to record conversations with health officials, and to release selected excerpts from the recordings in which a doctor from the Fulton County Health Department in Georgia can be clearly heard saying, "You're not contagious" and, "As far as we can tell you, you're not a threat to anybody else right now."

Speaker declined to release the complete recordings, saying they included personal medical details that were "none of anybody's darn business."

During the interview, Speaker spoke at length, expressing anger, frustration and worry about his reputation and career. He accused health officials of trying to destroy his credibility to cover their own mistakes in handling his case. They themselves never wore masks around him, he said, and never told him that he posed any risk to his family.

"If I'm a danger to people in close contact, shouldn't they have told me I was a threat to my wife, sleeping together?" he asked.

The convoluted tale began in January, when an X-ray taken for an injury to the left side of his rib cage picked up a shadow in his right lung.
TB was immediately suspected, and eventually diagnosed. How he contracted the disease is not known, but a trip to Vietnam is a suspected source.

It was not until May 10 that doctors realized that Speaker's TB was resistant to several widely used drugs. They asked him not to travel, but did not discourage him from going to work or tell him to wear a mask and so he saw no reason not to stick with plans to get married in Greece.

Not until May 22 did health officials know that the resistance was even worse than they had thought. The bacteria were extensively drug resistant, or XDR, meaning that nearly all the usual TB drugs were useless. By that time, Speaker was already in Europe.

TB spreads through the air, but only a small percentage of people who are exposed to the bacteria actually get sick. XDR tuberculosis is not more virulent or more contagious than other types, but it is of great concern because it is so difficult to treat.

In Rome, Speaker was notified by the Centers for Disease Control and Prevention that he had XDR TB and should not fly. At first, he said, an official told him that the CDC would help him with travel plans. But a day later, he said, he was told that he would have to pay for a special medical evaluation that would probably cost $140,000 and that his name would be on a no-fly list. The official urged him to turn himself in to the Italian health authorities.

But Speaker said he believed that his best and perhaps only hope for a cure was to get to the National Jewish Medical and Research Center in Denver, which has expertise treating this kind of TB.

Fearing that he might be quarantined indefinitely in Italy, he and his wife, Sarah, avoided the no-fly list by booking a flight to Canada and then driving into the United States, where a border guard ignored an alert triggered by his passport. He said that he wanted to dispel the news media portrayal of him and his wife as "the super-rich, globe-trotting couple" who could easily have afforded to pay $140,000 to fly home in a private plane.

He said their wedding in Greece cost less than $2,000 and they had planned to travel around Europe afterward, staying in inexpensive hotels. He recently left his father's law firm to start one of his own and had sold his house and many of his belongings to finance it.

"The long and short of it is, we don't have $140,000" he said.

Beyond getting well, he said, his main concern is his law career and that is why he was speaking out. "When I'm done with all this, am I going to have a practice to get back to, with the impression out there now that I'm this selfish, self-absorbed person? It's not how I've lived my life. When I'm done with all this, I want to make sure I still have my life to get back to."

Source: http://www.iht.com/articles/2007/06/10/frontpage/health.php

Treatment Outcomes Of Patients With HIV And Tuberculosis

2007-06-08T10:43:00.000+07:00

By, Medical News Today, June 7, 2007

In a retrospective study of 700 patients with culture-positive tuberculosis (TB), relapse rates were found to be significantly higher in HIV-infected patients compared to HIV-uninfected patients following a rifamycin-based regimen. Furthermore, TB relapse rates were higher in HIV-infected patients who received intermittent or standard 6-month therapy when compared to those receiving daily or longer treatment.

The results appear in the first issue for June 2007 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

Payam Nahid, M.D., M.P.H., of the University of California, San Francisco General Hospital, and eight associates reviewed TB cases reported to the San Francisco Tuberculosis Control Program from January 1, 1990, through December 31, 2001.

As a rationale for their study, the researchers state that the optimal duration of TB therapy in HIV-infected subjects is unknown and may differ from HIV-uninfected individuals.

According to the authors, the current preferred regimen for treating drug-susceptible TB in HIV-uninfected patients is a 6-month, rifamycine-based regimen that includes pyrazinamide during the first two months. Current guidelines for the treatment of TB do not distinguish between those infected with the virus that causes AIDS and those who are uninfected in terms of the optimum length of treatment when using rifamycine.

"Standard 6-month therapy may be insufficient to prevent relapse in patients with HIV," said Dr. Nahid.

The TB relapse rate for HIV-infected patients was found to be 6.6 percent versus 0.8 percent in uninfected/unknown patients. This finding was in contrast to other studies that did not find any significant difference between HIV-infected and HIV-uninfected/unknown patients. However, this finding was corroborated by a similar study that also used molecular genotyping as a relapse indicator.

HIV-infected patients who received 6 months of rifamycin-based TB treatment or who were treated intermittently (one to three times per week), were four times more likely to have a reoccurrence than those r who took their medicine daily or who were treated for longer periods.

The study also found that the use of highly active antiretroviral therapy (HAART) during TB treatment was associated with a faster Mycobacterium tuberculosis negative culture conversion, and an improved survival rate. Prior studies by others have shown HAART treatment beneficial in preventing TB in HIV-infected individuals, but reported no beneficial TB treatment outcomes.

HIV-infected patients were significantly more likely to develop drug resistance (4.2 percent in HIV-infected versus 0.5 percent in HIV-uninfected) to rifampin , and to experience adverse reactions to TB regimens.

The investigators noted that there is a need for large randomized clinical trials to establish the optimal duration for TB therapy in HIV-infected patients, and the timing of HAART treatment in patients with HIV-related TB.

According to an editorial commenting on the research in the same issue of the journal, future HIV-related TB treatment regimens and relapse studies should broaden their focus to include rates of acquired drug resistance. The editorial cites a report published in the Lancet of an extensively drug resistant TB strain found in a HIV co-infected South African patient as particularly worrisome.

Citing the journal article, the editorialists also cast the HAART findings (quicker reduction of mycobacterial burden) as relevant in deterring TB drug resistance. They suggest that short-course, intermittent regimens may be necessary in areas where resources are limited, and that additional research on regimens (including the use of secondline drugs) suitable for field use must continue.

This news brief is based on an article published in the American Thoracic Society's peer-reviewed journal, the American Journal of Respiratory and Critical Care Medicine. www.ajrccm.atsjournals.org

Founded in 1905, the American Thoracic Society is the world's leading medical association dedicated to advancing pulmonary, critical care and sleep medicine. The Society has more than 18,000 members who prevent and fight respiratory disease around the globe, through research, education, patient care and advocacy.

http://www.thoracic.org

Source: http://www.medicalnewstoday.com/medicalnews.php?newsid=72686&nfid=rssfeeds

TB complicates Aids treatment

2007-06-08T10:42:00.000+07:00

By, SABC News, June 07, 2007

Scientists painted a bleak picture today of the combined risk of HIV/Aids and tuberculosis (TB) in South Africa. The third national Aids conference in Durban heard that new techniques are being developed to detect TB sooner, as many patients die before they receive treatment. Six out of 10 HIV positive patients are infected with the TB bacteria.

A patient can wait up to eight weeks for a sputum test result for TB. The long wait has put a strain on Aids treatment therapy. Many patients die during this time. There have been advances in other countries, but it is technology that will not be available in South Africa for a long time. In South Africa, multi-drug resistant TB (MDR TB) is on the increase, while the extreme form, XDR TB is leading to faster deaths.

About 250 000 South Africans are diagnosed with TB each year. The preventable and treatable disease, under control in most of the world, faces severe obstacles in Africa. The World Health Organisation warned today that it would take years before a TB vaccine or new TB drugs can be developed. Some experts advocated a combined treatment, which would require huge investment in African laboratories.

When it comes to a close tomorrow, the conference hopes to reach agreement on contentious issues of male circumcision, compulsory HIV testing and breast feeding.

HIV infections declining
Meanwhile, Manto Tshababalala-Msimang, the health minister, says there has been a statistically significant decrease in one of the key measures of HIV/Aids in South Africa. This follows the release of a health department report on the latest survey of HIV prevalence among pregnant women using public health facilities.

The report states that there has been a decline from 30.2% in 2005 to 29.1% last year.

It says this is the first evidence of a decline in the epidemic after several years of stable prevalence rates.

Source: http://www.sabcnews.com/south_africa/health/0,2172,150492,00.html

Dual TB, HIV treatment key to Aids battle

2007-06-08T10:22:00.000+07:00

By, Mail & Guardian, Paul Simao, June 7, 2007

African, especially Southern African, nations must link tuberculosis (TB) testing and treatment with HIV-prevention programmes if they are to win the Aids battle, a top World Health Organisation (WHO) official said on Thursday.

Dr Kevin de Cock, head of WHO's HIV/Aids department, told the Third South African Aids Conference that traditional treatments for Africa's rampant TB problem could worsen the Aids pandemic and fuel the spread of the potentially fatal lung infection.

"TB programmes alone cannot reverse the tide," De Cock told about 4 000 Aids researchers, activists and healthcare officials at the conference in Durban.

He said it was vital to offer those infected with HIV and TB convenient and effective treatment for both diseases.

TB, which is spread through close personal contact, has long been a problem in Africa, where hundreds of millions are latent carriers of the disease. But the growing relationship between TB and HIV has made treatment of both diseases more difficult in vulnerable populations.

The emergence of extremely drug-resistant TB (XDR-TB), a strain virtually immune to traditional and modern antibiotics, has raised alarm bells since recently surfacing in South Africa's KwaZulu-Natal province and neighbouring Lesotho, where it killed up to 85% of those infected, the majority of whom also had HIV.

The strain has since spread to other parts of Africa as well as to the industrialised world, including the United States. The US government recently took the rare step of quarantining a man who had become infected with XDR-TB.

Two diseases interlinked
The prospect of a new and more virulent TB pandemic sweeping through sub-Saharan Africa is a far more serious threat because the two diseases are so prevalent and interlinked in the region.

In South Africa, 61% of the roughly 250 000 people diagnosed with TB each year have HIV.

HIV-positive people and others with weakened immune systems are particularly vulnerable to TB as well as other opportunistic infections. But XDR-TB has led to not only higher mortality rates, but also much faster deaths in HIV-positive populations.

In turn, HIV helps to spread TB in the general population. One of the paradoxes of the HIV pandemic is that the antiretroviral drugs that have saved so many lives contribute to a jump in TB because those who are co-infected are not being treated simultaneously for both diseases.

"HIV has caused a devastating reversal in our ability to treat TB," Robin Wood, director of South Africa's Desmond Tutu HIV Centre, said in a presentation to a Roche Diagnostics symposium on the sidelines of the conference. Wood said the solution was to combine treatments.

Doing so will require a huge investment in TB laboratories and related medical infrastructure in much of Africa as well as better tools to tackle the disease.

TB is still diagnosed using methods, such as skin tests, that can take days or even weeks to complete, while treatment can extend to months or sometimes more than a year, a challenge for Africa's often highly mobile population.

A urine-based dipstick test under development that gives results almost instantly could be the answer to beginning to tackle TB. "That would be a great asset if we could get it," Wood said. -- Reuters

Source: http://www.mg.co.za/articlePage.aspx?articleid=310629&area=/breaking_news/breaking_news__africa/

'Terrifying' memories of TB victim

2007-06-07T09:47:00.000+07:00

By, Channel 4 News, June 5, 2007

A British victim of multi-drug resistant tuberculosis said that the plight of the US lawyer who has been isolated with a rare strain of the disease brought back "pretty terrifying memories".

Andrew Speaker, 31, of Atlanta, was found to have extensively drug-resistant tuberculosis, or XDR-TB, which can withstand more drugs, while travelling around Europe on his honeymoon last month.

Paul Thorn, who was diagnosed with multi-drug resistant TB 12 years ago, said news of Mr Speaker's plight brought back "terrifying memories" as the World Health Organisation (WHO) called for an extra 2.1 million US dollars (£1m) to fight the disease in America over the next two years.

Mr Thorn, 36, of London, said: "I've certainly lived a lot longer than I expected to."

The author and TB activist was diagnosed HIV positive in 1990 and was regularly admitted to hospitals in the UK as he became increasingly ill with aids-related infections in 1994 and 1995.

"It was on one of these visits to hospital that I was involved in an outbreak of multi-drug resistant tuberculosis," he said. "This happened on the ward essentially because of poor infection control. Eight of us were involved in the outbreak and seven people died. I'm the only survivor from that outbreak."

He said he spent three months in isolation before being deemed "non-contagious", when he was allowed to go home and take around 30 tablets-a-day, along with three injections per week, for the next three years.

"I've been watching American news channels at home in the UK and to see Andrew Speaker sat there in that mask brought back some pretty terrifying memories for me," he said. "Because for three months I was essentially cared for by people that I didn't know. I didn't know what they looked like. All I could ever see was their eyes. The disease itself, the weight loss was dramatic to say the least."

"Perhaps harder than the actual illness itself was the isolation and the way people reacted to me. Of course, I had a disease that people were very very frightened of. Tuberculosis is a very very lonely disease.

World-wide, around 424,000 people develop multi-drug resistant TB every year, the WHO said. XDR-TB was identified last year and has since been found in 37 countries on every continent, including all G8 nations.

Source: http://www.channel4.com/news/articles/society/health/terrifying+memories+of+tb+victim/547057

New TB vaccines could protect all strains

2007-06-05T09:38:00.000+07:00

By, News-Medical.net, June 3, 2007

New tuberculosis (TB) vaccines in development have the potential to provide protection against all strains of TB, including multidrug-resistant (MDR) and extensively drug- resistant (XDR) TB, Dr. Jerald C.
Sadoff, president and CEO of the Aeras Global TB Vaccine Foundation, said at the International Conference on Global Health.

Aeras, the only non-profit organization dedicated solely to creating new TB vaccines, is working to develop at least one new TB vaccine regimen for infants and one for adolescents within seven to nine years and to ensure they are available worldwide to all who need them.

Aeras and its partners have the largest TB vaccine pipeline in the world with six vaccine candidates in or expected to be in Phase I-II trials in 2007.

Dr. Sadoff cited the rise of the new, deadlier strains of TB -- including MDR and XDR -- which are spreading around the world, including to the United States. This week the U.S. Centers for Disease Control and Prevention (CDC) quarantined a patient in Atlanta who is infected with XDR, and who had been traveling on transatlantic flights. XDR TB is resistant to many of the first and second line drugs, severely limiting treatment options. At least 37 nations have reported cases of XDR.

"TB is second only to HIV/AIDS as the world's most deadly infectious disease and is the leading cause of death among individuals infected with HIV. TB takes a victim every 20 seconds, which adds up to more than 1.5 million people every year," Dr. Sadoff said.

"The rise of MDR and XDR TB, which has a particularly high fatality rate in people with HIV, makes our mission even more critical. The vaccines under development by Aeras and its partners are intended to protect against all strains of TB and to be safe for use in people infected with HIV."

Dr. Sadoff noted that there has not been a new TB vaccine since the current vaccine, Bacille Calmette-Guerin (BCG), was developed more than 86 years ago. It provides some protection against severe forms of TB in children but is unreliable against pulmonary TB, which accounts for most TB worldwide.

"New vaccines, along with new drugs and diagnostics, are essential to the elimination of TB as a public health threat," he said. "The work that we are doing will help save millions of lives."

Aeras operates as a Product Development Partnership (PDP), developing candidate vaccines in its own laboratory and manufacturing facility and pursuing partnerships with public, private, academic and philanthropic sector organizations to promote rapid development and distribution of a more effective TB vaccine. It has a dual role -- to develop new vaccines and to ensure access to those around the world with the least ability to pay.

Aeras' largest source of funding is the Bill & Melinda Gates Foundation. It also receives support from the Dutch Ministry of Foreign Affairs, the Danish International Development Agency, and the U.S. Centers for Disease Control and Prevention.

This support has enabled Aeras to build a new facility in Rockville, MD, opened in 2006, that has the capacity to produce 150 million to 200 million vaccine doses a year of a modified BCG vaccine.

Despite the very generous contributions from the Gates Foundation and others, considerably more funding is needed to create a vaccine and bring it to market, Dr. Sadoff said.

The Global Plan to Stop TB puts the research and development costs of new vaccines, in 2006-20015, at $2.08 billion, with a current funding gap of $1.5 billion. The plan was created by the Stop TB Partnership, a network of more than 500 international organizations, countries, public and private sector donors, and nongovernmental and governmental organizations.

"We still need help from governments, foundations, other philanthropic organizations and the private sector to put a stop to this terrible disease," Dr. Sadoff said. "This is a global issue and it's going to require a global commitment to solve it."

Dr. Sadoff has worked in vaccine development for more than 30 years. He was involved in efforts to develop and obtain licensure for nine currently licensed vaccines and has been involved in the research and development of numerous other vaccines.

More information the work of the Aeras Global TB Vaccine Foundation is available at http://www.aeras.org/

Source: http://www.news-medical.net/?id=25876

The Deadly Intersection Between TB and HIV

2007-06-04T11:41:00.000+07:00

By, WebMD, June 4, 2007

Tuberculosis (TB) is a disease that is spread from person-to-person through the air, and it is particularly dangerous for people infected with HIV. Worldwide, TB is the leading cause of death among people infected with HIV.

An estimated 10-15 million Americans are infected with TB bacteria, with the potential to develop active TB disease in the future. About 10 percent of these infected individuals will develop TB at some point in their lives. However, the risk of developing TB disease is much greater for those infected with HIV and living with AIDS. Because HIV infection so severely weakens the immune system, people dually infected with HIV and TB have a 100 times greater risk of developing active TB disease and becoming infectious compared to people not infected with HIV. CDC estimates that 10 to 15 percent of all TB cases and nearly 30 percent of cases among people ages 25 to 44 are occurring in HIV-infected individuals.

This high level of risk underscores the critical need for targeted TB screening and preventive treatment programs for HIV-infected people and those at greatest risk for HIV infection. All people infected with HIV should be tested for TB, and, if infected, complete preventive therapy as soon as possible to prevent TB disease.

Intersection of Two Global Epidemics
Approximately 2 billion people (one-third of the world's population) are infected with Mycobacterium tuberculosis, the cause of TB.
TB is the cause of death for one out of every three people with AIDS worldwide.
The spread of the HIV epidemic has significantly impacted the TB epidemic - one-third of the increase in TB cases over the last five years can be attributed to the HIV epidemic (Source: UNAIDS).
The Continued Threat of Multidrug-Resistant TB
Every nation must face the challenge of combating multidrug-resistant (MDR) TB. People infected with HIV and living with AIDS are at greater risk for developing MDR TB. MDR TB is extremely difficult to treat and can be fatal. While the number of cases has remained stable in the United States over the past few years, people with MDR TB have now been reported from 43 states and the District of Columbia.

To prevent the continued emergence of drug-resistant strains of TB, treatment for TB must be improved in the United States and across the globe. Inconsistent or partial treatment is the main cause of TB that is resistant to available drugs (MDR-TB.) The most effective strategy for ensuring completion of treatment is Directly Observed Therapy, and its use must be expanded.

Another challenge that individuals co-infected with HIV and TB face is the possible complications that can occur when taking HIV treatment regimens along with drugs commonly used to treat TB. Physicians prescribing these drugs must carefully consider all potential interactions.

Addressing the Dangers of the Interconnected TB/HIV Epidemics Requires Expanded Efforts
TB control is an exercise in vigilance; the goal of controlling and eventually eliminating TB requires a targeted and continuous effort to address the prevention and treatment needs for those most at risk, including HIV-infected individuals. Efforts to eliminate TB are therefore essential to reducing the global toll of HIV.

WebMD Public Information from the CDC

SOURCE: CDC: "The Deadly Intersection Between TB and HIV." http://www.cdc.gov/hiv/resources/factsheets/hivtb.htm

Source: http://www.webmd.com/hiv-aids/intersection-between-TB?src=RSS_PUBLIC

Malaria, drug-resistant TB flourish in Myanmar

2007-05-31T17:03:00.000+07:00

By, Ed Cropley, Reuters, May 30, 2007

MAE SOT, Thailand - Simmering civil war, fake drugs and a non-existent health service in Myanmar are creating the perfect breeding ground for new, drug-resistant strains of killer diseases such as malaria and tuberculosis.

While the most immediate threat beyond Myanmar's borders is to Thailand, home to a large migrant and refugee population from the military-ruled former Burma, the long-term implications of neglect could be felt right across the globe, experts say.

At stake is a Chinese drug called artemisinin, the world's most powerful weapon against malaria, a disease that kills more than a million people a year, most of them children in sub-Saharan Africa.

The drug is most effective when used with other treatments in what are called artemisinin-based combination therapies (ACTs).

But doctors say taking ACTs incorrectly or in doses that include fake pills is one of the easiest ways of allowing the mosquito-borne parasite which causes malaria to build up immunity.

Such behavior appears to be commonplace, Thai health officials say, in Myanmar, where health spending is only a few dollars a year for each of the country's 53 million people.

Decades of civil war against ethnic militias in eastern Myanmar have worsened the situation; A study by the Thailand-based Backpack Health Worker Team showed the region's 500,000 internal refugees have malaria infection rates as high as 12 percent.

"So far, the malaria parasite has started to develop resistance to all drugs apart from those in the artemisinin family," said Francois Nosten, a French malaria expert in the northwestern Thai border town of Mae Sot.

"If this starts to happen, there is cause for real concern."

One drug-resistant strain born in southeast Asia has already made it to Africa, Nosten said. If an artemisinin-resistant variety reached the continent, the effects would be devastating.

"If we find evidence that it has changed to become resistant to artemisinin, we would have to contain it here -- but how you would do that, I just don't know," said Nosten, director of the Shoklo Malaria Research Unit, a field station attached to Bangkok's Mahidol University.

TB MAKES COMEBACK

While Nosten said there were no signs yet of malaria becoming immune to ACTs in the jungle-clad border region, the same cannot be said of tuberculosis, a disease that -- as with malaria -- had been on the retreat in Thailand.

Mae Sot general hospital, a sprawling complex overflowing with Burmese and Thai patients, has admitted 105 Thai and 38 Myanmar TB patients so far this year compared to 102 and 79 in the whole of 2006.

More worrying still, five cases were "multi-drug resistant," meaning patients have to undergo an expensive and arduous two-year course of pills and injections. Even then, there is only a 50 percent chance of survival.

Aid agency Medecins Sans Frontieres (MSF) (Doctors Without Borders), which is treating 15 "multi-drug resistant" Myanmar patients in a refugee camp in Thailand, is acutely aware of the problems of treating TB patients in fluid populations.

Treatment normally lasts six months, but many patients feel better after half way through and so stop taking the pills.

"There needs to be a huge push in TB education, in telling people the extreme importance of taking the treatment properly and not stopping as soon as you start to feel better," MSF Mae Sot's field coordinator Andres Romero said. "But with migrants, how do you follow up to ensure they have not become a defaulter? They've no mobile, no landline, no address."

STRUGGLING

Although wealthy and advanced by regional standards, Thailand's public health system in Mae Sot is struggling under the weight of dealing with an estimated 150,000 migrants from Myanmar -- and the diseases they bring with them.

Apart from a one-off payment from the Global Fund to treat TB in migrants, Mae Sot hospital gets no extra government cash for the thousands of Burmese flooding across the highly porous border, drawn by the prospect of free health care.

All the signs are of a hospital struggling to cope.

Its open-air corridors are choked with beds and patients hooked up to drips beneath whirring ceiling fans. Relatives of the sick, who range from landmine amputees to TB patients on respirators, lie curled up on reed mats beneath many of the beds.

"We treat every patient who comes here, Burmese or Thai, exactly the same. Not to do so would be completely unethical," director Kanoknart Pisultakoon said.

"Often the Burmese have tried to treat themselves and it hasn't worked so when they come to hospital they are very sick. Then, when they get better, they go back to Myanmar and tell their friends.

"The word spreads and every year, there are more migrants, more patients and more serious diseases," Kanoknart said. "It makes me worry for the future -- how we can control the migrants."

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Source: http://www.boston.com/news/world/asia/articles/2007/05/30/malaria_drug_resistant_tb_flourish_in_myanmar/

Drug Resistant TB Particularly Dangerous To People HIV-Pos.

2007-05-31T09:24:00.000+07:00

By, 365Gay.com Newscenter Staff, May 30, 2007

(New York City) The case of a man with a rare and dangerous form of tuberculosis, ordered into quarantine, is of particular concern to people who are HIV-positive.

Called Extensively Drug-Resistant Tuberculosis, or XDR TB, it resists almost all drugs used to treat TB, leaving open only less effective options, according to the Centers for Disease Control and Prevention.

Some drugs have achieved cure rates for an estimated 30 percent of affected people, CDC says.

But, in people with HIV/AIDS the infection is generally fatal - 90 per cent of these cases end in death.

That makes tracking down anyone who may have come in contact with the man particularly important. That he traveled from the US to Europe and then returned home via Canada makes the search for those people more complicated.

Like regular TB, people infected with XDR TB spew out the TB germs when they cough, sneeze or even speak or sing.

Persons who breathe in the air containing these TB germs can become infected, though it is believed people who have fleeting contact with a case aren't at much risk.

Only between five and 10 per cent of people who are infected come down with active disease, according to the CDC. The rest have what is called latent infection and they are not infectious to others.

The CDC has taken the rare step of releasing information on the infected man. The federal agency said that he may have spread the disease to passengers and crew on two trans-Atlantic flights earlier this month.

The patient flew from Atlanta to Paris on Mat 12, arriving on May 13, on Air France Flight 385. He returned to the United States on May 24, on Czech Air Flight 410, from Prague to Montreal.

The man then drove into the United States.

The hunt for people who may have come in contact with the man is underway in the US, Canada, Italy and Greece. The CDC said that anyone who may have come in contact with him should immediately see their doctor and be checked for TB.

Source: http://www.365gay.com/Newscon07/05/053007tb.htm

Scourge of TB rears its ugly head

2007-05-25T10:13:00.000+07:00

By, The Nation, May 25, 2007

Public health campaign needed to educate the public on tuberculosis and to combat rise of drug-resistant strains

A resurgence of tuberculosis (TB), which was declared a global public health emergency more than a decade ago, has focussed the world's attention on the need to redouble efforts to try to contain the spread of this deadly disease. Thailand, which had been so successful in combating TB in the past, has contributed to the widespread misconception that the disease has already been beaten.

The disease, however, has come back with a vengeance in recent years mostly in developing countries, including Thailand. Public health experts have expressed concern about the emergence of drug-resistant strains of the disease and the Aids pandemic, which, they say, could combine to bring death and suffering to millions of people worldwide.

Thailand was caught by surprise when the World Health Organisation ranked the country 17th out of 22 countries in the world with the highest rates of TB infection. According to a Public Health Ministry estimate, the TB rate in densely populated areas like Bangkok could be as high as one in every 500 people.

Most infected people are not aware of the disease, which is caused by the Mycobacterium tuberculosis bacillus and can be spread through the air like the common cold. According to the WHO, if left untreated, one person with infectious TB will pass it on to an average of 12 to 20 people, and that two to four of these will develop infectious TB.

According to the WHO, even though the global TB rate may have stabilised over the past few years due to greater awareness among public health officials and control efforts, the actual number of people with TB has increased markedly as a result of an increase in the world's population. The world health body said there were about 8.8 million new TB cases and 1.6 million deaths due to the disease in 2005.

Thailand is a classic example of how a high rate of HIV/Aids infection can fuel a TB resurgence. It has taken Thai health authorities years to shed complacency and wake up to the threat posed by the HIV/Aids-TB combination to the country's public health system.

A recently released study by Dr Amara Soonthordhada entitled "TB Policy in Thailand: A Civil Society Perspective" exposes a striking lack of social and political commitment to control tuberculosis, one of the leading causes of death in Thailand.

Due to the absence of TB awareness among members of the Thai public, there is little understanding of how TB is spread and the fact that it can be cured. According to the study, many patients do not seek treatment because of the social stigma attached to the disease, a lack of information, and the high costs of the cure.

The emergence of drug-resistant strains of TB is a great possibility in Thailand where too many people have developed the habit of self-medicating by buying medicines, like antibiotics, from local pharmacies - many of which are not staffed by qualified pharmacists - and then not bothering to complete the whole course.

Health authorities are just now beginning to encourage people with TB to come forward to seek free treatment. TB can be cured with a treatment regimen that typically takes six months to complete. The most important thing is to ensure that patients take the right dose of medicine and complete the whole course to prevent strains of TB becoming drug resistant.

The Public Health Ministry's statistics shows that while TB rates fell by 50 per cent from 1985 to 1991, the HIV/Aids epidemic may have contributed to a resurgence of TB, which kills about 12,000 people a year in this country.

Public Health officials will find it difficult to identify people with TB. The standard, error-prone procedure for diagnosing tuberculosis was developed some 100 years ago and it involves putting sputum samples under a microscope and lab technicians identifying the bacteria that cause TB. That's why a public awareness campaign is very important to alert people of the looming public health threat.

For a country like Thailand where HIV/Aids and TB tend to combine with devastating effects, public health authorities must rationalise their work by merging HIV/Aids and TB treatment programmes in order to lower the death rate from TB, which is curable.

Extremely drug resistant TB becoming 'major threat' in India

2007-05-23T11:20:00.000+07:00

By, New Kerala, May 22, 2007

A new study has found that extremely drug resistant TB, or XDR-TB, is fast on its way of becoming a 'major threat' in India.

MDR-TB (multi-drug resistant TB) describes strains of tuberculosis that are resistant to at least the two first-line TB drugs, isoniazid and rifampicin. XDR-TB is MDR-TB that is also resistant to three or more of the six classes of second-line drugs.

XDR-TB leaves patients (including many people living with HIV) virtually untreatable using currently available anti-TB drugs.

The study was conducted by a team of researchers led by Sushil Jain at the World Health Organization and the Centres for Disease Control and Prevention.

As part of the study, researchers examined 3,904 lab samples at the Hinduja National Hospital in Mumbai, India.

Researchers found that 1,274 samples were positive for Mycobacterium tuberculosis. Of these, 32 percent were found to be MDR-TB, out of which 8 percent were XDR-TB.

Tuberculosis can infect many sites in the body but most commonly affects the lungs. All XDR-TB cases were in patients with pulmonary tuberculosis, or TB found in the lungs, which can be spread by coughing, sneezing, laughing or singing. Repeated exposure to someone with TB disease is generally necessary for infection to take place.

"An important finding was that the majority of patients with XDR-TB were of younger age group (their average age was 30 years), thus posing a major threat to our economically productive population," Dr. Jain said.

"Serious efforts are needed to tackle this deadly disease which may become a global emergency," he added.

XDR-TB has long existed in India but has been under-recognized and under-treated.

"Most labs in India are not equipped to perform drug susceptibility tests so exact prevalence is difficult to ascertain, and treatment in the absence of reliable sensitivity reports is difficult. Compounding the problem is the huge costs of treating these most difficult TB patients," he said.

The findings of the study were presented at the American Thoracic Society 2007 International Conference.

--- ANI

Source: http://www.newkerala.com/news5.php?action=fullnews&id=31843

TB is not a death sentence for people living with HIV

2007-05-22T09:54:00.000+07:00

By, Kakaire A Kirunda, The Daily Monitor (uganda), May 22, 2007

"WHILE HIV PROGRAMMES HAVE ATTRACTED FUNDING, TB HAS MINIMAL FUNDING.
BUT THE INCREASING INTERACTION BETWEEN THE TWO DISEASES SHOULD HELP RAISE AWARENESS ON THE NEED FOR THE EMPOWERMENT OF COMMUNITIES TO TACKLE TB AS WELL. THERE IS NO REASON FOR PEOPLE LIVING WITH HIV/AIDS TO CONTINUE DYING OF TB"

Although preventable and curable, tuberculosis remains one of the most deadly infectious diseases in the world and it is the leading cause of mortality among people living with HIV.

When Erick Nangosya of Busiu in Mbale district discovered that he was HIV positive in 2004, he did not straight away embark on antiretroviral drugs. He was instead put on cotrimoxazole (Septrin) preventive therapy
(CPT) to ward off opportunistic infections.

But two years down the road in July 2006, Nangosya started feeling frequent fatigue and he sometimes slept without covering himself because of constant night sweatings. He even started having what he refers to as light coughs.

"I knew these were the usual treatable opportunistic infections.
However, two weeks into my leave in September, I started developing serious fever and started undergoing treatment in a clinic near home,"
Nangosya, a father of 12 children said. But his health continued to deteriorate by the day and he eventually lost appetite.

With no improvement in his health, Erick decided to seek further help from The AIDS Support Organisation (TASO) centre in Mbale where he is registered. Tests were carried out and it was discovered that he had pulmonary tuberculosis.

Although preventable and curable, tuberculosis (TB) remains one of the most deadly infectious diseases in the world. And it has turned out to be the leading cause of mortality among people living with HIV/ AIDS.

Upon being diagnosed with TB, Nangosya was in October 2006 put on critical treatment for two months. "It was really hard. TB treatment involves taking many big tablets. I was put on some capsules which were so bitter and yet I had to open the capsules and chew the powder.

It was a very hard moment. But considering that I had to secure my life, I had to persist and follow the medical advice," Nangosya recalled.

Two weeks into the eight-month road, Nangosya registered a dramatic improvement. However, worth noting is that it is usually at that stage of treatment that some TB patients start skipping daily dosages because of complacence. Some patients either interrupt their treatment because they feel better or imagine that they no longer need the drug.
This results in mutations leading to drug-resistant bacteria that complicates the recovery process and sometimes death.

STAYING ON TREATMENT

So how has Nangosya managed to hang on to treatment to date?

"I hang on for the sake of my life because I know that TB is a killer disease. I was going to die so I had to force myself back to life. I was forced to take treatment as prescribed. But all in all, I should say that adherence to treatment has played a big role in my steady recovery."

Nangosya is set to complete his treatment at the end May 2007. He said that when a person is undergoing TB treatment, family support as well as care by colleagues at the work place is vital for patients co-infected with HIV and TB. "My wife did a lot and was very courageous. You become forgetful. My wife became part of me so she kept reminding me to take my medicine. Also my workmates at TASO committed themselves towards seeing me improve."

And given that volunteers who would help people living wth TB and HIV in communities take their daily dosages were abandoning the cause, Nangosya said that the family support needed strengthening. He suggested that even if this meant the government giving handouts to families of people living with TB, so be it.

"Much as friends can help, they can't be around all the time. And it would be unfair to keep them off their work just to come and remind you to take your medicine. It would be easier done by a family member," he said.

However, Nangosya does not completely ignore the role of the community in the fight.

"What is failing the community response is funding. While HIV programmes have attracted funding, TB has minimal funding. But the increasing interaction between the two diseases should help raise awareness on the need for the empowerment of communities to tackle TB as well. There is no reason for people living with HIV/AIDS to continue dying of TB."
While Nangosyas' story raises important issues in TB management, a lot of stigma still surrounds the disease given its infectious nature.

IGNORANCE OF PEOPLE

"It is ignorance of people who have TB. What they ought to know is that once a patient finishes treatment for the first two weeks, they no longer constitute a threat to public health," he said.

"And people should also remember that thousands of others are living with the infection and are potential candidates for the disease once their immunity is compromised."

None-the-less, Nangosyas is suggestive of giving former and current patients a platform to talk about their treatment so as to convey to potential casualties that TB can be cured and that the disease does not discriminate, thus eliminating social stigmas associated with it.

Online at: http://www.monitor.co.ug/socpol/socpol05222.php

Genetic Tests May Help Improve Patients' Response To Tuberculosis Medication

2007-05-14T15:19:00.000+07:00

By, Medical News Today, May 12, 2007

Experts have today highlighted the role that genetics may play in treating the current global tuberculosis (TB) pandemic. Paul van Helden and colleagues, from Stellenbosch University in South Africa, outlined the role that different genetic mutations may play in determining how a patient will respond to the commonly used TB medication isoniazid. These observations are published in the May issue of the journal Personalized Medicine.

It is estimated that at least 8 million people develop active TB annually, of whom 2 million die. It has been the cause of a global health emergency for over 10 years owing to factors such as social stigma, patient compliance and lack of investment in a thorough TB control program. Recently, these factors have resulted in the worrying emergence of drug resistance, leading to multi-drug resistant (MDR) and extensively drug resistant (XDR) strains of TB becoming prevalent. This is a particular problem in the developing world, where the majority of patients with TB also have HIV, making effective eradication extremely difficult.

Isoniazid is an important, commonly used and relatively inexpensive first-line TB drug. It is metabolized in the liver at different speeds in different individuals, giving rise to 'fast, intermediate and slow acetylator' phenotypes. Previous work has linked these phenotypes to different genetic variants, primarily present in the NAT2 gene. The authors believe that the standard drug dose currently administered to patients, regardless of their acetylator status, may not be appropriate for certain people. Individualization of isoniazid therapy may help to prevent adverse drug reactions experienced by a small percentage of patients thought to be 'slow-acetylators' of the drug. Conversely, 'fast-acetylators' may not be receiving sufficient amounts of the drug to combat TB successfully, therefore increasing the likelihood of a relapse and development of drug resistance.

The authors underline the need for further research into this area. However, they believe that on confirmation of the importance of the genetics of isoniazid metabolism 'a simple test to determine acetylator status would be desirable' and that 'these could be located at the same laboratories that currently perform diagnostics for TB.'

About Personalized Medicine

Personalized Medicine translates recent genomic, genetic and proteomic advances into the clinical context. The journal provides an integrated forum for all players involved - academic and clinical researchers, pharmaceutical companies, regulatory authorities, healthcare management organizations, patient organizations and others in the healthcare community. Personalized Medicine assists these parties to shape the future of medicine by providing a platform for expert commentary and analysis.

About Future Science Group

Future Science Group, based in London has developed an innovative publishing portfolio to reflect post-genomic medicine. The sequencing of the human genome was a colossal milestone in the evolution of healthcare, with repercussions for all those involved in the healthcare chain. Through its imprints, Future Medicine, Future Drugs and Future Biology, the Future Science Group provides healthcare practitioners and research professionals with a unique source of objective, cutting-edge information on exciting trends emerging in the light of these advances. Our flagship title Pharmacogenomics has evolved to become a leading source of commentary and analysis from international opinion leaders. Momentum toward an individualized approach to medicine is increasing as the value of linking diagnostic and therapeutic approaches becomes ever clearer. For more information please access www.future-drugs.com, www.futuremedicine.com and www.future-biology.com

Source: http://www.medicalnewstoday.com/medicalnews.php?newsid=70620&nfid=rssfeeds

Washington Post Examines Global Spread Of XDR-TB

2007-05-09T10:11:00.000+07:00

By, Medical News Today, May 8, 2007

The Washington Post on Thursday examined how extensively drug-resistant tuberculosis -- TB that is resistant to the two most potent first-line treatments and some of the available second-line drugs -- is "raising fears" of a pandemic that could "devastate" efforts to control TB and "prove deadly" to people with HIV/AIDS and other diseases. According to the Post, XDR-TB has been detected in 37 countries. Some health experts say that at least half the people who contract XDR-TB will die of the disease. According to the Post, Russia has become a "petri dish" for TB drug resistance. About 22,000 people in the country have some form of drug-resistant TB, and an unknown number of those have XDR-TB, the Post reports. At least 30% of people receiving treatment for TB in the country do not complete their drug regimens, which increases the chance of developing resistance. Russia also has about one million people living with HIV/AIDS, which further exacerbates the TB situation, the Post reports.

HIV/TB coinfection also has helped fuel the "major TB infection zone" in South Africa, the Post reports. According to a Yale University study, 52 out of 53 people diagnosed with XDR-TB in a rural hospital in the country died. Most of those who died, including six health care workers, also were HIV-positive and died an average of 16 days after diagnosis. In addition, a study published last year in CDC's Morbidity and Mortality Weekly Report that was based on a survey of TB labs on six continents found that the prevalence of XDR-TB increased from 3% of TB cases to 11% of cases between 2000 and 2004.

Comments

According to Mario Raviglione, head of the World Health Organization's Stop TB Department, XDR-TB likely will mutate into a completely drug-resistant form of TB if it is not contained. "We will be left with surgery and prayers," he said, adding, "It's a desperate situation." Doctors and medical ethicists also are attempting to address the situation of people with XDR-TB who are not cooperative with treatment. Some have said that countries will have to consider forcing these people into isolation. "We have to face the possibility that restrictive measures may be necessary to control what could become a global pandemic," Ross Upshur, director of the University of Toronto's Joint Center for Bioethics, said. He added that although he is not advocating detention as a first response, "if voluntary measures fail, people do not have the right to infect others." Other experts have said forced isolation is impractical in poor countries and might drive the disease underground (Finn, Washington Post, 5/3).

Source: http://www.medicalnewstoday.com/medicalnews.php?newsid=69958&nfid=rssfeeds

Drug-resistant TB raises pandemic fear

2007-05-07T11:06:00.000+07:00

By, Peter Finn, Washington Post, May 4, 2007

Detected in 37 nations, the strain poses a high risk of death to people with HIV-AIDS

Evidence of TB has been found in ancient skeletons and mummified remains. From the 17th century to the 20th, it was a major killer in the United States and Europe, taking the lives of notable people such as the poet John Keats, the composer Frederic Chopin, the writer Stephen Crane and the actress Vivien Leigh. A virulent strain of tuberculosis resistant to most available drugs is surfacing around the globe, raising fears of a pandemic that could devastate efforts to contain TB and prove deadly to people with immune-deficiency diseases such as HIV-AIDS.

Known formally as extensively drug-resistant TB, or XDR-TB, the strain has been detected in 37 countries.

It arises when the bacterium that causes TB mutates because antibiotics used to combat it are carelessly administered by poorly trained doctors or patients who don't take their full course of medication. Rather than being killed by the drugs, the microbe builds up resistance to them.

At least 50 percent of those who contract this strain of TB will die of it, according to medical experts.

In trying to stop the spread of the disease, which can be transmitted through coughing, spitting or even speaking, health officials have imposed sometimes extreme controls on infected people.

Robert Daniels, a 27-year-old dual Russian-U.S. citizen, underwent months of treatment for TB in Russia, where he often led a homeless existence. After telling people that he was feeling better, he flew from Moscow to New York on Jan. 14 last year, then on to Phoenix, Ariz.

Microbe mutation

In fact, his disease had not disappeared. The microbe causing it had mutated, apparently helped by his failure to complete a drug regimen in Russia. Weeks after arriving in Phoenix, Daniels was again coughing and losing weight.

Doctors in Phoenix diagnosed his illness as the new resistant strain of TB. Daniels again failed to follow doctors' orders, authorities say.

So health officials got a court order, and he was locked up in the prison wing of a Phoenix hospital, where he has spent the past nine months in hermetically sealed isolation.

"It's not right," Daniels said in a telephone interview. "I'm not a criminal."

Two events last year alerted the medical community to a frightening new version of the disease.

The Centers for Disease Control and Prevention, drawing on a survey of TB labs on six continents, reported that the prevalence of the super strain of TB increased from 3 percent of patients to 11 percent between 2000 and 2004.

In the United States, 13,767 TB cases were recorded in 2006, the lowest rate of infection since reporting began in 1953. A retrospective analysis by the CDC found 49 cases of the new strain in the country since 1993.

The CDC survey was followed by a report from Yale University researchers that the superbug had raged through a rural hospital in South Africa in 2005 and early 2006, killing 52 of 53 who contracted it, including six health care workers.

The victims, apparently infected by airborne transmission of the virus, died on average just 16 days after diagnosis; most of them also had HIV.

"We have to come to grips with this quickly," said Vladislav Yerokhin, director of the Central Tuberculosis Research Institute in Moscow. "This is not just a threat for TB patients. This is a serious threat for the general population."

Source: http://www.chron.com/disp/story.mpl/chronicle/4774190.html

Virulent New Strain of TB Raising Fears of Pandemic

2007-05-04T09:29:00.000+07:00

By, Peter Finn, Washington Post, May 3, 2007

MOSCOW -- A virulent strain of tuberculosis resistant to most available drugs is surfacing around the globe, raising fears of a pandemic that could devastate efforts to contain TB and prove deadly to people with immune-deficiency diseases such as HIV-AIDS.

Known formally as extensively drug-resistant TB, or XDR-TB, the strain has been detected in 37 countries. It arises when the bacterium that causes TB mutates because antibiotics used to combat it are carelessly administered by poorly trained doctors or patients don't take their full course of medication. Rather than being killed by the drugs, the microbe builds up resistance to them.

At least 50 percent of those who contract this strain of TB will die of it, according to medical experts. In trying to stop the spread of the disease, which can be transmitted through coughing, spitting or even speaking, health officials have imposed sometimes extreme controls on infected people.

Robert Daniels, a 27-year-old dual Russian-U.S. citizen, underwent months of treatment for TB in Russia, where he often led a homeless existence. After telling people he was feeling better, he flew from Moscow to New York on Jan. 14 last year, then on to Phoenix.

In fact, his disease had not disappeared. The microbe causing it had mutated, apparently helped by his failure to complete a drug regimen in Russia. Weeks after arriving in Phoenix, Daniels was again coughing, feeling weak and losing weight.

Doctors in Phoenix diagnosed his illness as the new resistant strain of TB. Daniels again failed to follow doctors' orders, authorities say. So health officials got a court order, and he was locked up in the prison wing of a Phoenix hospital, where he has spent the past nine months in hermetically sealed isolation.

"It's not right," Daniels said in a telephone interview. "I'm not a criminal."

Daniels has become a case study in the bleak choices society faces in dealing with the new strain and attempting to balance protection of individual rights with protection of the public.

Evidence of TB has been found in ancient skeletons and mummified remains. From the 17th century to the 20th, it was a major killer in the United States and Europe, taking the lives of such notable people as the poet John Keats, the composer Frédéric Chopin, the writer Stephen Crane and the actress Vivien Leigh.

Even in the antibiotics age, TB has remained a scourge in poorer countries and communities. Today, one in three people globally is estimated to be infected with dormant TB, according to the World Health Organization (WHO). Most will never get sick, but in one in 10 cases the bacterium becomes active when the host's immune system is compromised. Worldwide, an estimated 1.7 million people die every year of the disease.

Two events last year alerted the medical community to a frightening new version of the disease. The Centers for Disease Control and Prevention, drawing on a survey of TB labs on six continents, reported that the prevalence of the super strain of TB increased from 3 percent of patients to 11 percent between 2000 and 2004. It reached 15 percent in South Korea and 19 percent in Latvia. There are no statistics yet about the new strain in Russia, China or Africa, areas with major TB populations .

In the United States, 13,767 TB cases were recorded in 2006, the lowest rate of infection since reporting began in 1953. A retrospective analysis by the CDC found 49 cases of the new strain in the country since 1993.

The CDC survey was followed by a report from Yale University researchers that the superbug had raged through a rural hospital in South Africa in 2005 and early 2006, killing 52 of 53 who contracted it, including six health care workers. The victims, apparently infected by airborne transmission of the virus, died on average just 16 days after diagnosis; most of them also had HIV.

"We have to come to grips with this quickly," said Vladislav Yerokhin, director of the Central Tuberculosis Research Institute in Moscow. "This is not just a threat for TB patients. This is a serious threat for the general population."

After the fall of the Soviet Union in 1991, rising poverty and a disintegrating medical system unleashed a TB epidemic in Russia and other post-communist countries. In 2005, the number of newly diagnosed cases in Russia reached 119,226, and 32,148 people died of the disease, according to the Ministry of Health and Social Development.

Up to 70 percent of TB patients in Russia are homeless, unemployed, in prison, former prisoners or alcohol abusers; 30 percent or more of patients break off their treatment, boosting resistance to anti-TB drugs.

In addition, Russia has an estimated 1 million people who are HIV-positive. That is an explosive combination, according to Murray Feshbach, an expert on Russian demography at the Woodrow Wilson International Center for Scholars in Washington. "It's potentially catastrophic for Russia," he said.

Today, South Africa is also a major TB infection zone. "The pressure of TB is enormous in our setting, and the majority of AIDS-related deaths are due to TB," said Gilles van Cutsem, medical coordinator with Doctors Without Borders in Khayelitsha, a large township on the edge of Cape Town, South Africa.

"People are wary about transmission within the community, as well as within health structures, from patients to patients and from patients to staff," van Cutsem said. "Considering that a great proportion of the health staff is also HIV-positive, this is even more of a concern."

Active TB bacteria are treated with four standard drugs. In most cases, patients quickly become non-infectious and start to feel better, although they are considered cured only after a full course of treatment, lasting about six months.

By the 1980s, doctors had begun to notice that some patients were resistant to these first-line drugs, particularly the two most potent ones, isoniazid and rifampicin. Their condition was defined as multidrug-resistant TB.

When the first line of drugs fail, doctors fall back on more expensive ones that have toxic side effects but can cure the condition after being used for 18 to 24 months. However, it is extremely difficult to keep patients taking the drugs for such a long period.

The new strain, a step up in resistance from the multidrug-resistant variety, has appeared more recently. An estimated 22,000 Russians have TB that is resistant to drug therapy to some degree. An unknown number of them have the new super strain.

If it is not contained, it will almost certainly mutate again into a completely drug-resistant TB, according to Mario Raviglione, director of WHO's Stop TB Department.

Some experts believe that may have already happened. Doctors reported this year that a 49-year-old woman in Italy died after 625 days of hospital treatment; all the drugs they tried failed.

The world is facing a return to the era before antibiotics when the white plague, as TB was known, was often a death sentence, according to Raviglione. The only treatment option then involved risky surgery in which doctors collapsed or removed an infected lung or attempted to cut out diseased tissue.

"We will be left with surgery and prayers," Raviglione said. "It's a desperate situation."

New drugs are in the pipeline but still years away, and patient non-cooperation could quickly undermine their effectiveness. "Monitoring patients is not easy when you are talking about a man who drinks a half a liter of vodka a day, or has no home or no family or no job, or all of the above. Those are our TB patients, " said Sergei Borisov, deputy director of the Phthisio-Pulmonary Institute in Moscow.

Some doctors and medical ethicists have said that countries will have to consider forced isolation of uncooperative patients, a public health strategy that evokes the sanitariums of decades ago.

"We have to face the possibility that restrictive measures may be necessary to control what could become a global pandemic," said Ross Upshur, director of the Joint Center for Bioethics at the University of Toronto. "I'm not advocating detention as a first resort," he added. "But if voluntary measures fail, people do not have the right to infect others. At the same time, people should be treated humanely, and they should have access to counsel, and they shouldn't be placed in a prison setting."

Other experts say such an approach might merely drive the disease underground and is impractical in poor countries.

"Forcing one uncooperative patient into isolation is fine, or even 10 patients or 100 patients," Borisov said. "But what about our situation in Russia, where 25 percent of the patients are uncooperative? Are we going to lock up thousands of patients? And where will we put them? Doctors cannot be prison guards."

Daniels, for instance, was often homeless when he was in Russia, according to him and his wife, Alla Danielova, an English teacher. Daniels said he bounced among friends' houses, partying and trying to ignore the bloody sputum he was coughing up. "I knew I was going to have to treat it, but I had other plans at that time," he said. "I didn't think it was a big deal. Now I know better."

Daniels acknowledged that he had visited a fast-food restaurant and stores in Phoenix without a mask but denied that he had stopped taking his medicine there. "That's a nasty lie," he said.

He said his condition is now improving. He has petitioned the court to be moved out of the prison ward and, ultimately, released. But last week a judge rejected his plea and ordered him to remain in medical confinement.

Source: http://www.washingtonpost.com/wp-dyn/content/article/2007/05/02/AR2007050202831.html

Extent of XDR-TB in South Africa unknown

2007-05-03T11:07:00.000+07:00

By, Mail & Guardian Online, May 3, 2007

The extent of multidrug-resistant (MDR-TB) and extensively drug-resistant (XDR-TB) strains of TB in South Africa was not currently known, the World Health Organisation (WHO) said on Wednesday.

"We know there are quite a lot of MDR and XDR-TB, although we don't know the extent," said Dr Fabio Scano, a tuberculosis expert from the WHO.

Scano is in South Africa as part of a two-year collaboration with the government to provide technical support and advice in the fight against the disease.

"There are a lot of interventions under way but we have yet to see the results ... the fight against TB is a marathon, not a sprint," he said.

Since TB was "magnified by" HIV, it was the biggest public health challenge both nationally and internationally, he said.

According to the Health Department's latest figures, 237 of 350 XDR-TB patients identified in South Africa so far -- 68% -- have died. A total of 112 are on treatment and one patient has defaulted on treatment.

KwaZulu-Natal has the country's largest share of cases, with 221 out of 247 patients -- 89% -- having died. The survivors are all on treatment.

Special advisor to the Health Minister, Professor Ronnie Green-Thompson, said the high number of XDR-TB cases identified in the province could be due to it being well-equipped for TB testing.

"I don't think that KwaZulu-Natal is unique," he added.

Scano said an epidemiological investigation was under way in that province and the rest of the country to better understand the extent of the disease.

While the government would provide the resources to fight the disease, its magnitude meant South Africa would have to look elsewhere for funding.

It had already approached the Global Fund to Fight Aids, TB and Malaria. The WHO had said it was "very willing" to help, said the Health Department's deputy director general, Nthari Matsau.

There was much ignorance in other Southern African Development Community (SADC) countries about the extent of the disease.

"The other countries don't know whether they have it or not. South Africa so far is the only country [in the SADC region] that has the capacity and the capability to test for XDR-TB," said Matsau.

Scano said the government was increasing the cure rate for TB. He called for a "sustained support and fight" and said suspected TB cases needed access to HIV testing.

Deputy Health Minister Nozizwe Madlala-Routledge said the department would work closely with the Home Affairs Department to try to identify patients entering the country, but acknowledged it was difficult.

"We can't just grab everybody coming into the country and put them through tests."

She said measures to control the disease would include putting ultraviolet lights in waiting rooms at hospitals to kill the bacteria that caused TB.

Radebe said locking up XDR-TB patients who refused to take steps to avoid infecting others was not yet an option.

"We feel we have not yet reached a point where we can consider those extraordinary measures."

The Associated Press reported on Tuesday that a 27-year-old XDR-TB patient was being held in a jail in the United States because he failed to take precautions to avoid infecting others. He also did not heed instructions to wear a mask in public.

Matsau said the department recognised the importance of separating patients, but said having TB was not a criminal act.

"There are much more acceptable and humane ways," she added.

In March the Health Department got an interim High Court order compelling 13 MDR-TB patients back to their beds after they forced their way out of Pretoria West Hospital. They went to the Sizwe Tropical Disease Hospital in Edenvale, east of Johannesburg, insisting they be treated as outpatients. They had received treatment there previously.

Matsau said patients might try to run away becasue treatment took a long time. Drug addicts, delinquents or breadwinners not wanting to lose money were also more likely to run away.

"An average person generally detests being controlled in that kind of situation," said Matsau.

MDR-TB could develop if standard TB drug treatment was misused or not adhered to. More expensive and harmful second-line drugs would then be required. If this course of treatment was mismanaged, XDR-TB could result, making treatment options and chances of a cure far narrower.

According to medicalnewstoday.com website, countries with good TB control programmes could cure between 50 to 60% of XDR-TB cases.

Successful treatment however depended on the extent of drug resistance, the severity of the disease and whether a patient's immune system had been compromised. - Sapa

Source: http://www.mg.co.za/articlePage.aspx?articleid=303829&area=/breaking_news/breaking_news__national/

TB is that time bomb

2007-05-03T11:05:00.000+07:00

By, Johnjoe McFadden, Mail & Guardian Online, May 1, 2007

One hundred and twenty-five years ago, a virtually unknown German country doctor called Robert Koch stood before the Physiological Society of Berlin and announced that he had discovered the cause of tuberculosis (TB). This was probably the most astonishing and significant statement in the history of medicine. Yet the disease he discovered still kills one to two million people per year and new strains of the TB bacillus threaten to undo the progress of 125 years.

TB was rife in the 19th century and responsible for about one in seven deaths. The list of famous people who fell victim to the disease, including Keats, Chopin and the Bronte family, gives a measure of its impact.

Trained as a physician, John Keats knew the significance of the drop of blood coughed on to a bed sheet: “That drop of blood is my death warrant. I must die.” And his prognosis was accurate -- he succumbed within a year.

So Koch’s claim made headline news around the world and offered hope of a cure. Early in the 20th century, Paul Ehrlich (who had TB himself) led the search for “magic bullets”. Yet, it was not until the 1950s that the antibiotic streptomycin was shown to be capable of killing the TB bacillus.

But problems emerged in the shape of resistant strains. Trials sponsored by the medical research council showed effective treatment required a combination of drugs over a six-month period.

Six months is a long time, particularly in the developing world, so it is no surprise that most deaths from TB today are in Africa and Asia. The HIV/Aids pandemic has increased the level of infection as the virus makes victims more susceptible to TB. In 1993, the situation deteriorated to the point where the World Health Organisation (WHO) declared TB a global emergency; thanks to its efforts, the incidence of disease has since levelled off and, in some places, has fallen.

But extensively drug-resistant TB (XDR-TB) is threatening to undermine these gains. The first sign of TB fighting back came in the 1990s, when there was an outbreak in New York of TB that was resistant to normal frontline drugs. There were scores of deaths and more than $1bn of spending was needed to bring it under control.

But spending at that level is not an option for developing countries. The town of Tugela Ferry in KwaZulu-Natal recently experienced an outbreak of XDR-TB among HIV-infected people. Of the 53 victims, 52 died of the disease, on average within 16 days.

XDR-TB is a product of inadequate treatment, and the key to managing it is improved infection control and new drugs. But lab resources remain basic in poor countries and, although research funding for TB has increased, it is still dwarfed by spending on other, less immediately real threats. Smallpox hasn’t killed anyone for decades but, because of its association with bioterrorism, it receives as much research funding as TB.

Most Westerners see global warming as a much bigger threat. The Global Plan to Stop TB, an international partnership backed by the WHO, would cost an extra $1,1-billion in 2007, a fraction of the cost of implementing the Kyoto agreement on carbon emissions or the £26-billion to replace Trident. The cost of providing antiretroviral drugs for the world’s estimated six million Aids victims would be about $1,5-billion.

Drug-resistant TB is already common in Asia, and some eastern European countries have the highest rates of XDR-TB. Cheap travel and increased migration ensure that it will spread. If we fail to act now, says Paul Nunn, coordinator of Stop TB, we will be faced with the “need to solve a human catastrophe at vastly greater expense”. -- © Guardian News & Media Ltd 2007

Johnjoe McFadden is professor of molecular genetics at the University of Surrey and an editor of Human Nature: Fact and Fiction

Source: http://www.mg.co.za/articlePage.aspx?articleid=306211&area=/insight/monitor/

New TB strain in South Africa a concern

2007-04-09T14:44:00.000+07:00

By, Celean Jocobson, Associated Press, April 7, 2007

JOHANNESBURG, South Africa - The extent of the deadly new strain of tuberculosis in South Africa and the region is not known and is cause for concern, an international health expert said Wednesday.

Dr Fabio Scano, a TB expert from the World Health Organization in Geneva, has been sent to South Africa at the request of the government to assist with the outbreak of the extensively drug-resistant tuberculosis strain, or XDR-TB.

"We don't know the extent of multiple drug resistant and extreme drug resistant TB in sub-Saharan Africa and the southern African region. There is not yet the capacity to test in these countries," Scano said at a news conference.

South Africa has reported 352 cases of the virulent strain since it was discovered last year in the eastern KwaZulu-Natal province. There have been 221 deaths and concerns have been raised about the strain spreading across the region.

Scano said an epidemiological investigation was under way to determine the full extent of the disease.

"I don't think the situation in KwaZulu-Natal is unique," said Professor Ronnie Green-Thompson, special adviser to the health minister. "If we test in other provinces we may well find a similar prevalence."

Multiple drug resistant TB, known as MDR-TB, does not respond to a "first line" of drugs while the extreme strain does not respond to a "second line" of drugs.

Africa is the only continent where TB rates are increasing and the disease is complicated by high rates of HIV infection, which lowers a person's immune system.

"MDR-TB and XDR-TB and the way they are magnified by HIV infection is the biggest public health challenge both nationally and internationally," Scano said.

He said that without the drug resistant strain, 12-14 percent of TB patients who have HIV die because of the "lethal combination" of the two diseases.

Scano said WHO was committed to working with South Africa to address the challenge presented by the disease.

"There are a lot of interventions under way but we have yet to see the results ... the fight against TB is a marathon, not a sprint. But there is a need for action now," he said.

Drug resistance grows when people do not complete a grueling six month regime of medication, and South Africa has a low adherence rate.

Part of the two-year collaboration between WHO and South Africa is to ensure greater adherence of patients to the treatment programs.

The health department has had to force a number of XDR-TB patients back to hospital after they tried to return to their homes and in the United States, a 27-year-old man suffering from the extreme strain has been locked up indefinitely as a danger to the public.

Nthari Matsau, Deputy Director-General of the health department, stressed that while it was important to separate TB patients, issues of discrimination and human rights had to be considered.

"Incarceration is not an ideal way of separating TB patients. There are much more acceptable and humane ways," she said.

Scano said new drugs to treat XDR-TB were now available in South Africa but he said there was a huge need for new medicines to be developed to combat the disease.

"Unless there is massive investment in new drugs, we won't make headway in the fight against TB. We have to do the best we can with what we have," he said.

Drug-resistant diseases pose civil liberties dilemmas

2007-04-09T14:40:00.000+07:00

By, Chris Kahn, Associated Press, April 7, 2007

PHOENIX - Behind the county hospital's tall cinder-block walls, a 27-year-old tuberculosis patient sits in a jail cell equipped with a ventilation system that keeps germs from escaping.

Robert Daniels has been locked up indefinitely, perhaps for the rest of his life, since July. But he has not been charged with a crime. Instead, he has an extensively drug-resistant strain of tuberculosis, or XDR-TB. It is considered virtually untreatable.

County health authorities obtained a court order to lock him up as a danger to the public because he failed to take precautions to avoid infecting others. Specifically, he said he did not heed doctors' instructions to wear a mask in public.

"I'm being treated worse than an inmate," Daniels said in a telephone interview last month. "I'm all alone. Four walls. Even the door to my room has been locked. I haven't seen my reflection in months."

Though Daniels' confinement is extremely rare, health experts say it is a situation U.S. public health officials may have to confront more and more because of the spread of drug-resistant TB and the emergence of diseases such as SARS and avian flu in this increasingly interconnected world.

"Even though the rate of TB in the U.S. is at the lowest ever this last year, we live in a globalized world where, if anything emerges anywhere, it could come to our country right away," said Mark Harrington, executive director of the Treatment Action Group, an American advocacy organization.

World Health Organization warned last year of the emergence of extensively drug-resistant TB. The new strain, which has been found throughout the world, including pockets of the former Soviet Union and Asia, is resistant not only to the first line of TB drugs but to some second-line antibiotics as well.
HIV patients with weakened immune systems are especially susceptible. In South Africa, WHO reported that 52 of 53 HIV patients died within an average of 25 days after it was discovered they also had XDR-TB.

How to deal with people infected with the new strain is a matter of debate.

Dr. Ross Upshur, director of the Joint Centre for Bioethics at the University of Toronto, said authorities should detain people with drug-resistant tuberculosis if they are uncooperative.

"We're on the verge of taking what was a curable disease, one of the best-known diseases in human endeavors, and making it incurable," Upshur said.

But a paper Upshur co-wrote on the issue in a medical journal earlier this year has been strongly criticized.

"Involuntary detention should really be your last resort," Harrington said. "There's a danger that we'll end up blaming the victim."

In the United States, which had 13,767 reported cases of tuberculosis in 2006, public health authorities only rarely have put TB patients under lock and key.

Texas has placed 17 tuberculosis patients into an involuntary quarantine facility this year in San Antonio. Public health authorities in California said they have no TB patients in custody this year, though four were detained there last year.

Upshur's paper noted that New York City forced TB patients into detention following an outbreak in the 1990s and saw a significant dip in cases.

In the Phoenix area, only one other person has been detained in the past year, said Dr. Robert England, Maricopa County's tuberculosis control officer.

Daniels has been living alone in a four-bed cell in Ward 41, a section of the hospital reserved for ailing criminals. He said sheriff's deputies will not let him take a shower - he cleans himself with wet wipes - and have taken away his television, radio, personal phone and computer. His only visitors are masked medical staff members who come in to give him his medication.

The ventilation system draws out the air and filters it to capture the bacteria-laden droplets he expels when he coughs. The filters are periodically burned.

Daniels said he is taking medication and feeling a lot better. His lawyer would not discuss his prognosis. Daniels plans to ask for his release at a court hearing late this month.

Daniels lived in Russia for 15 years and returned to the United States last year after he was diagnosed. He said he thought he would get better treatment here and hoped eventually to bring his wife and children from Russia. He said he briefly worked in an office in Arizona for a chemical company before he was put away.

He said that he lost 50 pounds and was constantly coughing, and that authorities locked him up after they discovered he had walked into a convenience store without a mask.

"Where I come from, the doctors don't wear masks," he said. "Plus, I was 26 years old, you know. Nobody told me how TB works and stuff."

County health officials and Daniels' lawyer, Robert Blecher, would not discuss details of the case. But, in general, England said the county would not force someone into quarantine unless the patient could not or would not follow doctor's orders.

"It's very uncommon that someone would both not want to take treatment and will willingly put others at risk," England said. "It's only those very uncommon incidents where we have to use legal authority through the courts to isolate somebody."

University of Pennsylvania medical ethicist Art Caplan said Maricopa County health officials were confronted with the same ethical dilemma that communities wrestled with generations ago when dealing with leprosy and smallpox.

"Drug-resistant TB, or drug-resistant staph infections, or pandemic flu will raise these questions again," Caplan said. "We may find ourselves dipping into our history to answer them."

Daniels said he realizes now that he endangered the public. But "I thought I'd come to a country where I'd finally be treated like a person, and bam, here I am"

Source: http://www.twincities.com/ci_5616093?source=rss

Deadly combination of TB and HIV

2007-04-06T10:21:00.000+07:00

By, IRIN PlusNews, March 28, 2007

The tiny mountain kingdom of Lesotho, already burdened by the third highest HIV infection rate in the world, is struggling to contain a parallel epidemic of tuberculosis (TB).

In 2006 alone, 12,000 of Lesotho's 1.8 million inhabitants were diagnosed with TB, but experts like Peter Saranchuk, of the international medical relief organisation, Medecins San Frontieres, believe the actual number of people suffering from the disease is probably much higher.

Challenges for diagnosis

It is estimated that as many as half of all adults in southern Africa carry a latent form of TB, but people with HIV-compromised immune systems are 50 times more likely to develop active TB.

The sputum tests most commonly used to detect TB often fail to recognise it in HIV-infected patients. Because the proportion of TB patients co-infected with HIV in Lesotho is one of the highest in the region - 85 percent to 92 percent - Saranchuk estimates that the amount of undiagnosed TB is "vast".

In most of the HIV-positive patients with negative sputum test results, the most reliable way to diagnose TB is by culture testing, in which samples are cultivated in a special liquid. But Lesotho has very limited capacity to do culture testing; samples must be sent to neighbouring South Africa and it takes about six weeks to get results.

A machine used to prepare the samples at the country's largest hospital, Queen Elizabeth II in Maseru, has been broken for over a year. Staff at the TB outpatient clinic at nearby Botsabelo Hospital told PlusNews they were still waiting for the results of cultures sent to Queen Elizabeth in May 2006.

Where culture testing is unavailable or simply too slow, TB in HIV-infected patients can be diagnosed by means of x-rays and clinical assessments. But this approach is relatively new and Lesotho's department of health and social development is still in the process of training health workers in the co-management of the two infections.

According to Saranchuk, many doctors will still only initiate TB treatment based on a positive sputum test. "That patient will keep getting antibiotics and keep getting sicker, even though they do have TB," he said.

"The TB world hasn't adjusted to the fact that there's this explosion of co-infection going on in Southern Africa," added Rachel Cohen, MSF's head of mission in Lesotho. "It hasn't filtered down yet to nurses at the primary care level, who are the ones faced with sputum-negative patients who are going to die of TB if they don't do something to treat them."

In one of Lesotho's 17 health districts, where MSF is managing HIV/AIDS and TB care and treatment at 14 clinics and one district hospital, nurses are being trained in how to diagnose TB using x-rays and other indicators, but elsewhere in the country only doctors can initiate treatment in sputum-negative cases.

Need for integration

Until recently, there was little coordination between Lesotho's TB and HIV/AIDS programmes. As in most countries in the region (see www.nature.com), patients accessed TB and HIV treatment at different sites and there was little collaboration between health professionals working on the twin diseases.

Now the department of health and social development has a TB/HIV strategy that includes training health workers and lay counsellors in both TB and HIV, routinely offering HIV testing to TB patients, screening HIV patients for TB, and providing TB and HIV treatment at the same site.

But, according to Dr Michael Sekokomala, head of Lesotho's largest TB outpatient clinic at Botsabelo Hospital, in the capital city of Maseru, implementing this strategy still has a long way to go. The clinic lacks enough counsellors to provide HIV testing to all patients, and those who are co-infected still have to make separate appointments to access antiretroviral (ARV) treatment at a nearby HIV/AIDS clinic.

Maneo Lesole, who works at a local garment factory to support her three children, misses up to five days of work a month to attend appointments at both clinics. "They deduct my pay for each day I miss," she said. "After deducting I get maybe 500 maluti (US$68), instead of M650 (US$88)."

Directly Observed Short-Course Treatment (DOTS), in which volunteer community health workers are trained to monitor TB patients while they take their medication, is the norm; HIV patients undergo intensive adherence counselling to make sure they understand the importance of taking their medication every day, without supervision.

Lesole, who received ARV-adherence counselling before she began TB treatment, quickly informed the community health worker assigned to monitor her TB medication that she was used to taking drugs on her own.

MSF favours a more patient-centred approach to TB-drug adherence, based on its experience of ARV treatment. Patients and their "treatment supporters", who can be family members, attend 'TB school', where they learn about possible side-effects, the consequences of not completing their treatment and what they can do to avoid infecting household members.

"We've learned that empowering patients is the key to long-term adherence," said Cohen. "When people really understand about the risks of drug resistance, they're going to take their medicines every day."

Shoeshoe Matsoele, deputy manager of Lesotho's TB control programme, believes the DOTS approach can be adapted to incorporate ARV adherence. She sees no reason why volunteers trained in DOTS, whether community health workers or family members, cannot also be trained to monitor ARV drug adherence.

Drug resistant TB threat looms

In neighbouring South Africa, multidrug-resistant TB (MDR-TB) is on the rise. MDR-TB is often the result of TB patients failing to finish their 6-month course of drugs and is particularly dangerous and difficult to treat in people living with HIV.

XDR worries us very much, because if we can't manage MDR, how can we manage XDR?
Even more alarming, virtually untreatable extremely drug-resistant (XDR) strains of TB emerged in South Africa's KwaZulu-Natal Province in 2006 and have since spread to other provinces, leaving more than 200 people dead so far, most of them HIV-positive patients.

As culture testing is the only sure way of diagnosing MDR-TB, Lesotho is at a severe disadvantage in assessing the seriousness of its MDR-TB problem and dealing with it.

"We don't know how many MDR cases we have," said Dr Sekokomala. "We just have MDR suspects, so XDR worries us very much, because if we can't even manage MDR, how can we manage XDR?"

Sekokomala is convinced that XDR-TB is already present in Lesotho because of the number of patients he has lost while they were being treated. The lack of infection control in Lesotho's TB wards and clinics is particularly worrying: staff at his clinic have now received protective masks, donated by Partners In Health (PIH), an international medical non-profit organisation, but an HIV-positive nurse died of TB before they arrived, despite being on treatment.

The Lesotho government is still finalising emergency guidelines for dealing with MDR and XDR-TB, and recently entered into an agreement with PIH to open a 40-bed isolation ward for MDR-TB cases at Botsabelo Hospital. It is expected to open in May of this year.

In the meantime, Sekokomala is forced to admit patients with suspected MDR to the TB ward at Queen Elizabeth II Hospital. "There's only a corridor separating the TB ward from the children's ward, and children play in that corridor," he said.

Dr Jennifer Furin, director of PIH in Lesotho, has been impressed by the government's rapid response to the threat of MDR and XDR-TB. Her biggest concern is not the lack of an isolation ward, but the potentially high number of unidentified MDR-TB cases: "In reality, these patients are everywhere and they're coughing, and there's really no way to isolate them."

ks/he/kn

Source: http://www.irinnews.org/Report.aspx?ReportId=70888

SWAZILAND: Tuberculosis still killer number one

2007-04-06T10:04:00.000+07:00

By, IRIN PlusNews, April 4, 2007
Tuberculosis (TB), aggravated by HIV/AIDS, remains chief cause of death in Swaziland, which holds the dubious record of having the most TB infections in the world per population.

Cesphina Mabuza, Director of Health Services for the Ministry of Health and Social Welfare, told IRIN there were 186 TB patients per 100,000 people, and "of the 8,500 reported cases in the country, all are on some form of treatment."

However, 60 cases scattered across three of Swaziland's four regions indicate that a strain of TB has developed that is resistant to normal TB medication. These multidrug-resistant tuberculosis (MDR-TB) patients are being kept in isolation for the first phase of possible treatment at government hospitals.

"Ordinarily, TB should respond to treatment within two months. If improvement is not forthcoming, that is evidence of MDR-TB presence," Mabuza said.

"What we call TB first line is the type that could be treated the ordinary way. There is also MDR, which is resistant to treatment but can be curable with stronger drugs. Then there is XDR [extremely drug-resistant], which is difficult to treat," said Themba Dlamini, Programmes Manager at the Ministry of Health.

Dlamini said no cases of XDR had been identified in Swaziland yet, but without the necessary testing facilities available in the country it was impossible to rule out the possibility. Very few countries in Africa have the technology to test for drug-resistant TB and the health ministry is liaising with its counterpart in neighbouring South Africa, where MDR-TB is on the rise, to send specimens from Swazi TB patients to Pretoria, in South Africa, for testing.

MDR-TB is often the result of TB patients failing to finish their 6-month course of drugs, and is particularly dangerous and difficult to treat in people living with HIV. Even more alarming, XDR strains of TB emerged in South Africa's KwaZulu-Natal Province in 2006 and have since spread to other provinces, leaving more than 200 people dead so far, most of them HIV-positive patients.

It is estimated that as many as half of all adults in southern Africa carry a latent form of TB, but people with HIV-compromised immune systems are 50 times more likely to develop active TB. Without sophisticated laboratory facilities, TB patients co-infected with HIV also present a diagnostic challenge.

The degree of prevalence of TB amongst people living with HIV/AIDS is not known and, despite the AIDS crisis, hard data is often lacking.

The correlation between Swaziland's record TB infection rate and its HIV-infection rate - at 36.8 percent of the sexually active population also the highest in the world - has not been lost on health officials.

Of all patients admitted to Swaziland's hospitals and private clinics, 25 percent suffer from TB, and one out of four deaths at these facilities are TB related.

Lack of space at government hospitals has led to the establishment of a TB centre at the National Psychiatric Centre in the eastern commercial town of Manzini, the country's only facility for the mentally ill. The presence of dissimilar patients in the same centre has prompted concern in parliament, increasing the pressure on health ministry officials to open a new TB Hospital in Moneni, east of downtown Manzini.

Health Minister Njabulo Mabuza told members of parliament that the hospital would soon be open, and the first functioning wards would be dedicated to patients with MDR-TB and XDR-TB.

According to recent health ministry statistics, only twelve percent of Swazis know whether they are HIV positive or not. "There is an urgent need to maximise access to knowledge of one's HIV status, and achieving universal access to HIV prevention treatment, care and support," said Rejoice Nkambule, National Coordinator of the health ministry's Health Education Unit.

Stigma against people living with HIV/AIDS remains strong. "People still do not wish to know their status because they fear being ostracised by their families, friends and co-workers. It happens. TB is a good 'cover story' for many people living with HIV and AIDS, because when they fall sick they blame it on the TB and not AIDS," said Noah Fakudze, a voluntary testing counsellor in Manzini.

At a World TB Day celebration at Manzini's public square on 24 March, people co-infected with HIV and TB testified to the crowd that they could live long and productive lives despite these diseases.

"No one should feel ashamed because they fall sick. The good news is that treatments are here. If you live right, and get tested, you might not even need those treatments," said a woman in her twenties named Rose, who said she had been HIV-positive for eight years and was recently cured of TB.

jh/tdm/he

Source: http://www.irinnews.org/Report.aspx?ReportId=71139

TB Victim Is Locked Up in Arizona

2007-04-04T12:00:00.000+07:00
By, Chris Kahn, Associated Press, April 2, 2007

Behind the county hospital's tall cinderblock walls, a 27-year-old tuberculosis patient sits in a jail cell equipped with a ventilation system that keeps germs from escaping.

Robert Daniels has been locked up indefinitely, perhaps for the rest of his life, since last July. But he has not been charged with a crime. Instead, he suffers from an extensively drug-resistant strain of tuberculosis, or XDR-TB. It is considered virtually untreatable.

County health authorities obtained a court order to lock him up as a danger to the public because he failed to take precautions to avoid infecting others. Specifically, he said he did not heed doctors' instructions to wear a mask in public.

"I'm being treated worse than an inmate," Daniels said in a telephone interview with The Associated Press last month. "I'm all alone. Four walls. Even the door to my room has been locked. I haven't seen my reflection in months."

Though Daniels' confinement is extremely rare, health experts say it is a situation that U.S. public health officials may have to confront more and more because of the spread of drug-resistant TB and the emergence of diseases such as SARS and avian flu in this increasingly interconnected world.

"Even though the rate of TB in the U.S. is at the lowest ever this last year, we live in a globalized world where, if anything emerges anywhere, it could come to our country right away," said Mark Harrington, executive director of the Treatment Action Group, an American advocacy group.

The World Health Organization warned last year of the emergence of extensively drug-resistant TB. The new strain, which has been found throughout the world, including pockets of the former Soviet Union and Asia, is resistant not only to the first line of TB drugs but to some second-line antibiotics as well.

HIV patients with weakened immune systems are especially susceptible. In South Africa, WHO reported that 52 of 53 HIV patients died within an average of 25 days after it was discovered they also had XDR-TB.

How to deal with people infected with the new strain is a matter of debate.

Dr. Ross Upshur, director of the Joint Centre for Bioethics at the University of Toronto, said authorities should detain people with drug-resistant tuberculosis if they are uncooperative.

"We're on the verge of taking what was a curable disease, one of the best known diseases in human endeavors, and making it incurable," Upshur said.

But a paper Upshur co-wrote on the issue in a medical journal earlier this year has been strongly criticized.

"Involuntary detention should really be your last resort," Harrington said. "There's a danger that we'll end up blaming the victim."

In the United States, which had a total of 13,767 reported cases of tuberculosis in 2006, public health authorities only rarely have put TB patients under lock and key.

Texas has placed 17 tuberculosis patients into an involuntary quarantine facility this year in San Antonio. Public health authorities in California said they have no TB patients in custody this year, though four were detained there last year.

Upshur's paper noted that New York City forced TB patients into detention following an outbreak in the 1990s, and saw a significant dip in cases.

In the Phoenix area, only one other person has been detained in the past year, said Dr. Robert England, Maricopa County's tuberculosis control officer.

Daniels has been living alone in a four-bed cell in Ward 41, a section of the hospital reserved for sick criminals. He said sheriff's deputies will not let him take a shower — he cleans himself with wet wipes — and have taken away his television, radio, personal phone and computer. His only visitors are masked medical staff members who come in to give him his medication.

The ventilation system draws out the air and filters it to capture the bacteria-laden droplets he expels when he coughs. The filters are periodically burned.

Daniels said he is taking medication and feeling a lot better. His lawyer would not discuss his prognosis. Daniels plans to ask for his release at a court hearing late this month.

Daniels lived in Russia for 15 years and returned to the United States last year after he was diagnosed. He said he thought he would get better treatment here, and hoped eventually to bring his wife and children from Russia. He said he briefly worked in an office in Arizona for a chemical company before he was put away.

He said that he lost 50 pounds and was constantly coughing and that authorities locked him up after they discovered he had walked into a convenience store without a mask.

"Where I come from, the doctors don't wear masks," he said. "Plus, I was 26 years old, you know. Nobody told me how TB works and stuff."

County health officials and Daniels' lawyer, Robert Blecher, would not discuss details of the case. But in general, England said the county would not force someone into quarantine unless the patient could not or would not follow doctor's orders.

"It's very uncommon that someone would both not want to take treatment and will willingly put others at risk," England said. "It's only those very uncommon incidents where we have to use legal authority through the courts to isolate somebody."

University of Pennsylvania medical ethicist Art Caplan said Maricopa County health officials were confronted with the same ethical dilemma that communities wrestled with generations ago when dealing with leprosy and smallpox.

"Drug-resistant TB, or drug-resistant staph infections, or pandemic flu will raise these questions again," Caplan said. "We may find ourselves dipping into our history to answer them."

Daniels said he realizes now that he endangered the public. But "I thought I'd come to a country where I'd finally be treated like a person, and bam, here I am."

Source: http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2007/04/02/national/a112253D39.DTL&feed=rss.news

TB cases still occur in U.S.

2007-04-02T16:52:00.000+07:00
By, Emily Berry and Mary Fortune, timesfreepress.com, April 1, 2007

Though tuberculosis largely is considered eradicated in developed countries, the airborne disease still infects thousands in the United States and millions worldwide each year, health care experts said.

“The rates of active TB in the U.S. have been steadily declining for the last 50 years, but it still occurs,” said Dr. Stephen Hawkins, a physician who specializes in infectious disease and is medical director of the tuberculosis clinic at the Chattanooga-Hamilton County Health Department.

Last week, a series of miscommunications in the investigation of a local case of tuberculosis led to about 30 workers being sent home from their second-shift jobs at the Pilgrim’s Pride chicken plant in downtown Chattanooga.

On March 8, a former worker at the plant was found to have tuberculosis, and the health department sent letters to employees Thursday who may have worked closely with the employee more than a year ago.

“We were just recommending notification and testing,” said Donna Needham, com- municable diseases program manager for the health department.

No one has been found to have contracted tuberculosis as a result of contact with the former employee, nor has anyone in the person’s home or church community, Ms. Needham said.

Dr. Hawkins said when someone in the work force tests positive for active tuberculosis, health department staff try to establish who at the person’s workplace worked most closely with the infected person.

“Tuberculosis is an airborne disease, but the bacteria does not survive well in the environment,” he said.

Dr. Allen Craig, state epidemiologist for the Tennessee Department of Health, said “the risk is greater the closer you are to a person with tuberculosis and the longer you’re there.

“It can be spread in the workplace, but it’s less common than it is in the home,” he said.

Cases of tuberculosis dropped rapidly in the 1940s and 1950s with the advent of effective antibiotic treatments. But the number of cases in the United States began to rise again in 1985, according to the U.S. Centers for Disease Control and Prevention.

The rise was caused by factors including the spread of HIV and AIDS, which compromise the immune system; increased numbers of foreign-born residents ; and increased numbers of long-term care facility residents, according to the National Institute of Allergy and Infectious Diseases.

The annual tuberculosis rate has decreased since 1992, but the rate of decrease has slowed and the proportion of tuberculosis cases among foreign-born people has increased each year since 1993, according to the CDC.

Dr. Hawkins said the high number of foreign-born tuberculosis patients has prompted the health department to start outreach to immigrant populations.

The health department has Spanish-language translators on staff, and Dr. Hawkins said he learned Spanish to serve better the Hispanic immigrants he treats.

“An increasing percentage of new cases of active TB are occurring in immigrants,” he said. “Worldwide it’s an enormous problem.”

But, Dr. Craig said, the rates of tuberculosis infections are decreasing both nationally and in Tennessee. And when infection and illness occurs, it’s easily treated with antibiotics, he said.

Erlanger spokeswoman Pat Charles said the hospital typically is only aware of patients with tuberculosis if they are being treated for the advanced stages of the disease.

Last year only one patient tested positive while still at the hospital, Ms. Charles said.

E-mail Mary Fortune at mfortune@timesfreepress.com

E-mail Emily Berry at eberry@timesfreepress.com BY THE NUMBERS

8.8 million: New tuberculosis cases reported worldwide, 2005

13,767: Tuberculosis cases reported in the United States in 2006

18: Tuberculosis cases in Tennessee reported so far in 2007

279: Total tuberculosis cases in Tennessee reported in 2006

7: Total tuberculosis cases in Hamilton County reported in 2006

504: Total tuberculosis cases in Georgia reported in 2006

196: Total tuberculosis cases in Alabama reported in 2006 Source: Tennessee Department of Health, North Georgia Health District, Centers for Disease Control and Prevention

Source: http://www.tfponline.com/QuickHeadlines.asp?sec=l&URL=http%3A%2F%2Fepaper%2Etfponline%2Ecom%2FWebChannel%2FShowStory%2Easp%3FPath%3DChatTFPress%2F2007%2F04%2F01%26ID%3DAr01304

Extensively Drug-Resistant Tuberculosis (Xdr-Tb): The Facts

2007-03-30T10:05:00.000+07:00
By, Medical News Today, March 29, 2007

What is XDR-TB?

TB can usually be treated with a course of four standard, or first-line, anti-TB drugs. If these are misused or mismanaged, multidrugresistant TB (MDR-TB) can develop. MDR-TB takes longer to treat with second-line drugs, which are more expensive and have more side-effects. If these drugs are also misused or mismanaged, extensively drug-resistant TB (XDR-TB) can develop. Because XDR-TB is resistant to first- and second-line drugs, treatment options are seriously limited and so are the chances of cure.

What is the medical definition of MDR-TB and XDR-TB?

MDR-TB is due to bacteria that are resistant to at least isoniazid and rifampicin, the two most powerful first-line anti-TB drugs. XDR-TB is due to bacteria that are resistant to any fluoroquinolone, and at least one of three injectable second-line drugs (capreomycin, kanamycin and amikacin), in addition to isoniazid and rifampicin. This is a revised definition of XDR-TB, on which the WHO GlobalTask Force on XDR-TB agreed in October 2006.

How do people develop XDR-TB?

People who are ill with pulmonary TB (TB of the lungs, the site most commonly affected) are often infectious and can spread the disease by coughing, sneezing or simply talking, as these acts propel TB bacteria into the air. Another person breathing in these bacteria may become infected with TB but without disease; only the TB skin test becomes positive. If the bacteria overcome the body's immune system, the person becomes ill with TB. A person ill with TB develops XDR-TB when first- and second-line anti-TB drugs are misused or mismanaged during the course of treatment and become ineffective (that is, when drugs are taken in the wrong combination, are fewer than those prescribed or taken in insufficient doses or insufficient time). People with XDR-TB can be infectious and pass the drug-resistant bacteria to other people.

How easily is XDR-TB spread?

There is probably no difference between the speed of transmission of XDR-TB and those of any other forms of TB. The spread of TB bacteria depends on factors such as the number and concentration of infectious people in any one place and the time of exposure, along with the presence of people with a higher risk of being infected, such as those with HIV/AIDS.

Can XDR-TB be cured or treated?

Several countries with good TB control programmes have shown that up to 50-60% of affected people can be cured. Nevertheless, successful treatment also depends greatly on the extent of the drug resistance, the severity of the disease and whether the patient's immune system is compromised.

Can vaccination prevent XDR-TB?

The TB vaccine, called the bacille Calmette- Guérin (BCG) vaccine, prevents severe forms of TB in children, such as TB meningitis. BCG would be expected to have the same effect in preventing severe forms of TB in children, even if they were exposed to XDR-TB, but it may be less effective in preventing TB in adults. New vaccines are urgently needed, and WHO and members of the Stop TB Partnership are actively working on them.

How do I know if I have TB or XDR-TB?

Symptoms of XDR-TB are no different from those of ordinary or drug-susceptible TB:
- a cough with thick, cloudy mucus (or sputum), sometimes with blood, for more than 2 weeks;
- fever, chills and night sweats;
- fatigue and muscle weakness;
- weight loss; and
- in some cases, shortness of breath and chest pain.
If you have these symptoms, you do not necessarily have XDR-TB, but you must see a doctor for a check-up. If you are already being treated for TB and at least some of these symptoms are not improving after a few weeks of treatment, you should inform your clinician or nurse.

How quickly can XDR-TB be diagnosed?

This depends on the patient's access to health care services. If TB bacteria are found in the sputum, TB can be diagnosed in a day or two, but this finding will not be able to distinguish between drug-susceptible and drug-resistant forms. To evaluate drug susceptibility, the bacteria need to be cultivated and tested in a suitable laboratory. Such a final diagnosis for TB, and especially XDR-TB, may take 6-16 weeks. To reduce this period, new tools for rapid TB diagnosis are urgently needed.

How can a person with drug-sensitive TB avoid getting XDR-TB?

The most important thing is to continue taking all treatment exactly as prescribed. No doses should be missed and treatment should be taken right through to the end. If patients suffer from side-effects - for example, the tablets make them feel sick - they should inform their clinicians or nurses, because simple solutions are often available. If they need to travel for any reason, patients should make sure they have enough tablets with them for the duration of the trip.

What is the link between XDR-TB and HIV/AIDS?

In places where XDR-TB is most common, people living with HIV are at greater risk of becoming infected with XDR-TB, owing to their weakened immunity. If many HIV-infected people live in these places, there will be a strong link between XDR-TB and HIV. Fortunately, in most places with high HIV rates, XDR-TB is not widespread. For this reason, most people with HIV who develop TB will have drug-susceptible TB, and can be treated with standard first-line anti-TB drugs.

How common is XDR-TB?

XDR-TB is rare, although numbers of cases are not yet known. WHO estimates that there were almost half a million cases of MDR-TB worldwide in 2004, however, with the highest rates in Europe. Wherever second-line drugs to treat MDR-TB are being misused, the possibility of XDR-TB exists. Recent studies indicate that XDR-TB cases comprise 15% of MDR-TB cases in some areas of Europe and urgent research is under way to find out more.

Is it safe to travel to places where XDR-TB has been identified?

XDR-TB has been found in every region of the world. The people most at risk if they come into contact with someone with XDR-TB are those with reduced immunity to infectious diseases, such as those with HIV or other medical conditions that can compromise the immune system. Such people should avoid high-risk areas, where no infection control measures are in place. Air travel carries only very minimal risks of infection with TB of any kind. Travellers with concerns about visiting countries with XDR-TB, or other health risks, should seek advice from their doctors, national authorities or trusted travel web sites such as that of WHO
(http://www.who.int/topics/travel ). Why have I never heard of XDR-TB before?

For some years, isolated cases of very highly resistant TB around the world have been seen that would today be called XDR-TB. These cases have been reported in greater numbers only recently, as regular surveys of drug resistance have been made in more and more countries and laboratory capacities have improved. This has led to the closer examination and naming of the problem.

How do countries prevent XDR-TB?

Countries can prevent XDR-TB by ensuring that the work of their national TB control programmes, and all practitioners working with people with TB, is carried out according to the International standards for tuberculosis care . These emphasize:
- providing proper diagnosis and treatment to all TB patients, including those with drug-resistant TB;
- ensuring regular, timely supplies of all anti-TB drugs;
- properly managing anti-TB drugs and providing support to patients to maximize adherence to prescribed regimens; and
- caring for people with XDR-TB in centres with proper ventilation, and minimizing contact with other patients (particularly those with HIV), especially in the early stages before treatment has had a chance to reduce the infectiousness.
Meanwhile, countries should promote the wide dissemination of The patients' charter for tuberculosis care , which lists the rights and responsibilities of TB patients and their families.

What should I do after contact with a person known or suspected to have XDR-TB?

You should consult your doctor or a local TB clinic, and be screened for TB. This is most important if you have any symptoms of TB. In case of cough, you will be asked to provide a sample of sputum, which will be tested in the laboratory. Several other tests will be performed in the clinic, including a skin test and a chest radiograph.

Latest Information and regular updates
The latest information and regular updates on XDR-TB and related TB issues are available on the web sites of WHO headquarters (http://www.who.int/tb ), the WHO Regional Office for Europe (http://www.euro.who.int/tuberculosis ) and the Stop TB Partnership (http://www.stoptb.org ).

Tuberculosis
The facts

* Tuberculosis (TB) is contagious and spreads through the air; if not treated, each person with active TB infects, on average, 10-15 others every year.
* One in ten people infected with TB bacilli will become sick with active TB in his or her lifetime. People with HIV are at much greater risk.
* TB is a disease of poverty, affecting mostly young adults in their most productive years.
* In the WHO European Region, there were 445 000 new TB cases in 2005 and 66 000 deaths: an estimated 7 deaths every hour.
* TB is a leading killer among HIV-infected people with weakened immune systems. In 2005, 14 000 new TB cases are estimated to have occurred in HIV-positive adults.
* TB is a Region-wide pandemic. European Union (EU) countries report 23% of all new cases, and Kazakhstan, Romania, the Russian Federation, Turkey, Ukraine and Uzbekistan account for 73% of the total number of cases in the WHO European Region.
* Multidrug-resistant TB (MDR-TB) does not respond to the standard treatments, using first-line drugs. MDR-TB is present in virtually all countries recently surveyed by WHO and partners.
* Every year, 450 000 new MDR-TB cases are estimated to occur worldwide, including 70 000 in the European Region.
* Extensively drug-resistant TB (XDR-TB) occurs when resistance to second-line drugs develops. It is extremely difficult to treat and cases have been confirmed all over the world.

The response

* In 2005, the WHO Regional Director for Europe sent a letter to all Member States, warning of a TB emergency in the Region.
* WHO's Stop TB Strategy aims to reach all patients and ensure the achievement of the MDG target by 2015.
* The Stop TB Strategy is based on DOTS and emphasizes the need for a health system approach and effective primary health care to address the TB epidemic.
* DOTS has 5 elements:
(a) political commitment with increased and sustained financing;
(b) case detection through quality-assured bacteriology;
(c) standardized treatment with supervision and patient support;
(d) an effective drug supply and management system; and
(e) a monitoring and evaluation system, and impact measurement.
* DOTS coverage (the share of a country's population living in areas where health services adopted the strategy) reached 60% in 2005; 35 countries in the Region have declared 100% DOTS coverage, although DOTS services in many countries need to be expanded and strengthened.
* WHO, at headquarters and in regional and country offices:
(a) develops policies, strategies and standards;
(b) supports countries' efforts;
(c) measures progress towards TB targets and assesses national programmes' performance, financing and impact; and
(d) promotes research; and facilitates partnerships, advocacy and communication.
* Full funding of the Global Plan to Stop TB 2006-2015 will cost US$ 56 billion, including US$ 8.9 billion to be used in the WHO European Region.
* The Global Drug Facility, run by the Stop TB Partnership, has expanded access to drugs for TB patients in 11 out of the 18 priority countries in the Region.
* Through the Green Light Committee, projects managing MDR-TB can apply for access to quality-assured second-line anti-TB drugs at much reduced prices.
* The United Nations Secretary-General appointed the former President of Portugal, Jorge Sampaio, as the first United Nations Special Envoy to Stop Tuberculosis in 2006. His role is to strengthen political commitment at the highest levels to ensuring implementation of the Global Plan to Stop TB 2006-2015.
* Nelson Mandela, former President of South Africa, warned that, "we cannot fight AIDS unless we do much more to fight TB". WHO's global policy on collaborative TB/HIV activities and the activities of the WHO Regional Office for Europe ensure that these words are being put into action.
* A Stop TB Partnership for Europe was launched in October 2006 to engage key European stakeholders in promoting a more robust response to the Region's epidemic.
* The International standards for tuberculosis care describe a level of care that all practitioners should seek in managing TB patients. The patients' charter for tuberculosis care outlines patients' rights and responsibilities.

http://www.euro.who.int

Source: http://www.medicalnewstoday.com/medicalnews.php?newsid=66187&nfid=rssfeeds

South Africa: Acute Burden of Active TB in HIV-Positive Kids

2007-03-28T10:22:00.000+07:00
By, Khopotso Bodibe, Health-e (Cape Town), March 23, 2007

Scientists are trying to protect children born to HIV positive mothers from getting TB, the most common infection suffered by people with HIV.

Children under two born to HIV positive mothers are at high risk of getting TB, but the risk doubles if the child is also HIV positive.

This is according to a study involving 1 300 children born to HIV-infected mothers based in Johannesburg, Cape Town and Durban. The sample is divided into two groups - 800 HIV negative and 500 positive kids.

"The question that we're faced with is how to actually prevent HIV-infected children as well as children that are born to HIV-infected mothers, but that are not themselves HIV-infected from developing tuberculosis," says the study's lead scientist, Professor Shabir Madhi, Director of Wits University's Respiratory and Meningeal Pathogens Research Unit (RMPRU).

The aim of the study is to investigate the possibility of preventing primary tuberculosis by giving all the babies Isoniazid (INH), one of two first-line medicines used to treat TB.

"We've got HIV-infected children and HIV-uninfected children that were born to infected mothers Fifty percent of the children in each of these groups would receive Isoniazid (INH). The other 50% would receive a placebo," says Madhi.

"We are providing them with the drug from three months of age until two years of age. During that time period, if the child manifests any sort of symptoms of TB we would investigate the child. And obviously, we would only know at the end of the study whether this intervention of ours works or not.

"At two years of age we plan to stop the intervention drug and we would continue following up for another two years in each child just to see whether the effect of the intervention actually endures after the initial two years of prophylaxis. So, in total it would be a four-year period."

Preliminary results from the study, which started recruiting in November 2004, show that there is a huge burden of TB infection in children with HIV.

"When we started the study, our estimate was that over a two-year period about 12% of HIV-infected children would actually develop tuberculosis," says Madhi.

"But our preliminary data actually suggests that the incidence (the number of children that actually develop tuberculosis in one year in HIV-infected children) is around 20%. So, we've completely under-estimated the burden of tuberculosis that actually exists in HIV-infected children."

In the uninfected children, the incidence of tuberculosis is about half of what it is in HIV-infected children.

Until now, the strategy to prevent the development of TB, including pulmonary or lung TB in children, has been to vaccinate them early after birth with the BCG vaccine.

However, says Madhi, there are some problems with the vaccine: "We know, firstly, that it's not very effective in preventing pulmonary TB in children. It's more useful in preventing extra-pulmonary TB, that's TB meningitis and TB of other areas of the body

"The next problem is that there's emerging data which actually shows that a BCG vaccine might actually be harmful to HIV-infected children."

Even so, kids in Prof Madhi's study still receive the vaccine as routine. The professor says he has a few good reasons to suspect that the research using chemo-prophylaxis with Isoniazid will prove effective.

"There's a study that's been completed in South Africa on HIV-infected adults with a CD 4 count greater than 200 that have previous evidence of infection by TB. When these adults are actually prophylaxed with INH, we find that, actually, they have a reduced risk of developing TB subsequently.

So, at least, there's adult data to support the notion that this is the sort of strategy that might work in children. Our study is slightly different in that children that we're looking at haven't had previous infection by TB We're more interested in actually preventing the primary infection from taking place as well as the subsequent disease from developing."

Source: http://allafrica.com/stories/200703230658.html

South Africa: Drug Resistant TB Poses Greatest Risk to Healthcare Workers

2007-03-27T13:00:00.000+07:00
By, Kerry Cullinan, Health-e (Cape Town), March 23, 2007

Until recently, Mandla was a nurse at a Durban hospital. But for the past few months, he has been a patient trying to shake off multi-drug resistant (MDR) TB.

"I became sick with TB in August last year. By January, I had finished my normal TB treatment but I still wasn't cured and that is when they found I had MDR TB," says Mandla, a tall, thin man in his thirties.

"I took my treatment properly without a break and this is the first time I have had TB," adds Mandla, who said he had lost both his appetite and energy.

It is highly likely that Mandla picked up MDR TB from one of the patients he cared for.

Healthcare workers are the most at risk of getting MDR TB - and its incurable cousin, XDR TB.

"MDR and XDR TB are no more infectious than ordinary TB," says KwaZulu-Natal provincial TB manager Bruce Margo. 'These are not super-bugs that can infect people more easily.

"South Africa has a very high TB rate, and there are a lot of people with active TB coughing and sneezing in their communities. So ordinary people are most at risk of getting TB.

"But healthcare workers are most at risk of getting MDR and XDR TB as they are more likely to come into contact with them than ordinary South Africans."

Margo estimates that in KwaZulu-Natal alone, there are around 40 000 people with active, infectious TB.

"We know that we have under-estimated the cases of MDR TB, but even if we triple our figures, this would mean that there are 3 000 cases of MDR TB in KwaZulu-Natal. This poses far less of a risk than ordinary TB to ordinary people," says Margo.

However, the serious, drug-resistant cases were most likely to end up in hospitals cared for by nurses like Mandla and doctors like Dr Igbal Master, a long-term TB doctor at King George V Hospital, the Durban hospital with the greatest cases of MDR TB in the country.

"About 10% of people with normal immune systems who are exposed to the TB bacillus develop TB," says Master.

"If you are healthy, you are unlikely to get TB. I have been exposed to TB and MDR TB over many years and have not developed active TB. But there is a chance that, as I get older and my immune system weakens, MDR or XDR is waiting for me," says Master with a rueful laugh.

People with HIV are at great risk of getting TB, yet many healthworkers are reluctant to reveal their HIV status to their employers - and they thus endanger their own health by working on wards with TB patients.

Since the public outcry over XDR TB, special masks are available for health workers but only one nurse in the male TB ward at King George was wearing a mask.

Masters says that most of the doctors have stopped using the mask, which is really uncomfortable in the tropical climate and "interferes with doctor-patient relations".

Dr Shamila Maharaj, the hospital's medical manager, says that it is hard to attract doctors to work at her hospital. Nurses' salaries have been hiked to the highest grades to attract staff.

"I had a young doctor interested but then he came back and started asking many questions about his risks and compensation if he became infected," says Dr Maharaj.

"I think there should be some kind of incentive, like the inhospitable or scarce skills allowance, to attract health professionals as we are really struggling to get doctors," she said.

The many research institutes wanting to study drug-resistant TB could also help by providing sessional doctors, she adds.

At present, there are only seven doctors at King George V to oversee the 100 MDR TB patients, 30 XDR patients and 200 weekly outpatients who attend the bi-weekly clinics. These doctors are also assisting to treat patients at a new 120-bed facility opened in Durban's Clairwood area which only has one doctor at present.

Source: http://allafrica.com/stories/200703260404.html

Drug resistance and HIV-AIDS threaten anti-TB drive: WHO

2007-03-26T15:26:00.000+07:00
By, AFP, March 22, 2007

Expanding drug resistance and HIV/AIDS threaten to reverse tangible gains made in the global fight against tuberculosis, the World Health Organisation warned Thursday.

The global tuberculosis epidemic is showing signs of slowing for the first time since the WHO declared it a global health emergency in 1993, the UN's health agency said in a report on attempts to control TB.

The overall number of cases continued to increase in line with the world's population growth, reaching 8.79 million in 2005, against 8.71 million a year earlier.

Virtually no country in the world is spared, with cases reported in 199 nations, the report said. The overwhelming majority -- 7.4 million -- are found in Asia and sub Saharan Africa.

However, the proportion of the population struck by the infectious respiratory disease stayed level and even declined in some regions, the report added.

"We are currently seeing both the fruits of global action to control TB and the lethal nature of the disease's ongoing burden," said UN Secretary General Ban Ki-moon.

"Almost 60 percent of TB cases worldwide are now detected and, out of those, the vast majority are cured," he added. "But the disease still kills 4,400 people a day."

The progress identified in the report falls far short of meeting of a UN target of halving prevalence of the disease by 2015, health officials warned.

"There are serious challenges to the progress we have made. We need to redouble our efforts," WHO Director General Margaret Chan said.

More than 2.1 million people were receiving multidrug treatment recommended by the WHO (DOTS), which is regarded as highly effective but requires steady medical follow-up and patient discipline.

The "DOTS" diagnosis and treatment programme was available in 187 countries by 2005, but access was uneven, the WHO said.

Seven of the 22 countries worst affected by TB, including five African nations, had insufficient plans to expand health staff, according to the report.

"We need to tackle this problem as part of the larger challenge of increasing access to primary health care services," Chan said.

"All people, no matter who they are or where they are, should have access to TB diagnosis and treatment as part of package of general health services that bring multiple health benefits," she added.

The "DOTS" package has formed the cornerstone of efforts to prevent drug resistance in recent years and has expanded. The report said treatment and cure targets were narrowly missed in 2005, except in 26 countries in the Pacific region and in south East Asia.

The WHO also fears that "little effort" is being made to screen HIV patients for tuberculosis especially in Africa.

HIV/AIDS patients with their weakened immune systems are highly susceptible to tuberculosis infections, and accounted for 195,000 of the 1.6 million TB deaths in 2005.

"In most cases tuberculosis is both curable and preventable, (yet) certainly in Africa is the first known cause of death of people living with HIV," Peter Piot, the head of UNAIDS, told journalists.

The report also underlined that the global scale of "extensively drug resistant" strains of tuberculosis (XDR-TB) discovered last year "is not yet known."

"It is really alarming because of the high mortality rate of people infected with these strains, which are resistant to all known anti-TB drugs. It is a serious threat to the global response," Piot said.

Health officials underlined that drug resistance thrived on inadequate investment and poor health services.

"Beyond that, because of the threat of XDR-TB, research to identify new diagnostics, drugs and medicines is more vital than ever," said Mauro Raviglione, head of the WHO's anti-TB programme.

WHO TB Strategy out of reach for many endemic countries

2007-03-26T09:36:00.000+07:00
By, Bobby John and Tim France, March 24, 2007

On the occasion of World TB Day (Saturday March 24), it is important to recognise that resistance to TB drugs has assumed very serious proportions. New global data on TB, published this week by the World Health Organisation (WHO), highlights weaknesses in many national TB programmes, which raises the potential for widespread TB drug resistance. How did the world reach this precarious state?

A WHO expert would argue that increasing levels of TB drug resistance "reflects a failure to implement the WHO Stop TB Strategy". The strategy hopefully maps out the steps that national TB control programmes need to take.

By all accounts then, national TB programmes are not living up to expectations.

The bacterium that causes tuberculosis (TB), Mycobacterium tuberculosis, is naturally sensitive to antibiotic drugs used to treat the disease.
The accepted truth about how TB drug resistance starts is that it is mostly 'acquired' in individual patients, because of inadequate treatment with TB drugs, which are now at least 40 years old.

Poor patient drug adherence, or the use of too few drugs leads - the story goes - to various forms of drug-resistant TB. Multidrug-resistant TB (MDR-TB) is a specific type that does not respond to the two most powerful anti-TB drugs. Latest estimates are that MDR-TB makes up about
4 per cent of all new and previously treated TB globally. Apparently, the antiquated TB drugs are also failing.

Drug-resistant TB is already geographically widespread, which includes places where TB control programmes have been in place for many years.
But incredibly little is known about just how much TB drug resistance there is outside of capital cities, for example, and even in some entire countries where drug resistance may be common because of historically poor TB control.

No progress can be made if TB clinics are there but patients are not.
Today's standard test for TB relies on a technique (sputum microscopy) invented over a hundred years ago. It provides no information about drug resistance. Apparently TB diagnosis is also failing us.

There seem to be too many weak links. A further litany of vital TB programme components has also been ignored for years, in favour of a single jewel in the TB strategy's crown: directly-observed treatment short course, or DOTS.

In many places, a consistent lack of focus and investment has led to chronically weak TB diagnostic and laboratory services; infrequent and incomplete TB drug resistance surveillance; inadequate management of individual drug resistant TB cases; and paltry TB infection control measures, including in health care settings.

Predictably, many TB-endemic countries have indeed failed to meet the exacting standards of the WHO Stop TB Strategy. Given the circumstances in many countries where TB is rife, what is surprising is that they should be asked to pursue such a pipe dream.

DOTS was supposed to stem TB drug resistance. Because of sloppy and unimaginative implementation, it is evidently failing us. As the full extent of TB drug resistance comes to light, prioritising TB drug delivery above all other areas of TB diagnosis and care looks increasingly like WHO has been building a house, just without foundations. We cannot now claim to be surprised when a decade of overlooking the systemic challenges faced by countries with high incidence of TB brings the entire house down.

Promoting policy frameworks is no replacement for working together to achieve what needs to be done to address TB. The Global Plan to Stop TB, (2006-2015), launched by the Stop TB Partnership just over a year ago, is a road map for such a coordinated action. WHO urgently needs to look beyond 'their' Stop TB Strategy to help promote and coordinate the comprehensive range of actions set out in the plan and to recognise the track record of over 500 global partners who put their name behind it.

When she took office just a few months ago, the new WHO director-general, Margaret Chan, identified the organisation's many partnerships as one of her immediate priorities. "Either the partnerships have to change or we have to change or both of us have to change to be more relevant", she said. "What is important to me is, are we getting the results that matter?"

In the case of controlling TB drug resistance, the answer is an unequivocal 'no'.

-----

**About the Authors:

Dr Bobby John, is the Executive Director of the Center for Sustainable Health & Development, India, and President of Global Health Advocates
(www.ghadvocates.org)

Tim France, PhD is Technical and Policy Adviser at Health & Development Networks (www.hdnet.org), and Chair of the Stop TB Partnership Media and Events Task Force (www.stoptb.org)

Drug resistant TB: the 'forgotten disease' fights back

2007-03-22T16:27:00.000+07:00
By, Agence Presse France, Marts 20, 2007

PARIS (AFP) - In the time it takes you to read this sentence out loud, someone somewhere in the world will have died of an illness that has been readily curable for half a century.

That relentless tally will rise to 1.6 million people over the course of a year, making tuberculosis the deadliest infectious disease on the planet after AIDS and ahead of malaria, according to the UN's World Health Organisation (WHO).

On Thursday, the WHO will release a major report on tuberculosis two days ahead of World TB Day, with a special focus on 22 "high burden countries," eight of them in Africa.

There will be some good news.

The worldwide epidemic of TB seems to have peaked; new, more effective drugs are in the pipeline; and many countries have met 10-year targets for detection and treatment.

India and China in particular, experts say, have made measurable strides in curbing infection and reducing mortality.

But progress in checking the disease's spread is severely threatened, the same health officials add, by new strains impervious to some or all of the arsenal of drugs currently available.

Another peril is the HIV/AIDS epidemic, which weakens the human immune system, creating a hospitable environment for what was once aptly called the "wasting disease" or "consumption."

The number of countries in which so-called extensively drug resistant TB -- XDR-TB for short -- has surfaced nearly doubled from 19 to 35 in only a year, including newly reported outbreaks in South Africa and ten nations in Europe.

"The level of resistance in XDR-TB seriously reduces treatment options, resulting in high rates of treatment failure and consequent mortality," Paul Nunn, coordinator of the WHO's TB/HIV and Drug Resistance programme, said recently.

If the problem is not tackled now, he warned, the world will witness "the replacement of the current global epidemic of mostly drug-susceptible TB with multi-drug resistant or XDR disease, and the need to solve a human catastrophe at vastly greater expense."

While the numbers remain paltry compared to the incidence of tuberculosis as a whole, of the 27,000 confirmed cases of XDR-TB reported in 2005, 16,000 -- 60 percent -- proved fatal.

Of the 420,000 cases of the somewhat less virulent multi-drug resistant TB (MDR-TB), almost one in four was mortal.

Overall, there are eight to nine million new cases of tuberculosis, all types combined, every year.

Current treatment for TB, developed more than four decades ago, is difficult to administer and requires six to nine months of therapy.

When patients fail to complete a treatment, the germ Mycobacterium tuberculosis that causes the disease develops a resistance to the drugs to which it has been exposed.

With an estimated two billion people carrying a latent form of the infection -- one out of every three people on the planet -- the risk of exposing vulnerable populations to highly pathogenic forms of a disease that spreads through the air, as with the common cold, has sounded alarms among health professionals.

"The fact that there are essentially untreatable forms of TB in the community is very worrisome," Richard Chaisson, a professor at John Hopkins University in Baltimore and a leading authority on XDR-TB, commented by e-mail.

"Urgent measures are needed."

Posing an additional challenge is the overlay of TB and HIV/AIDS, especially in sub-Saharan Africa.

"Africa has the highest rates in the world of HIV/AIDS infection, and those rates have fuelled the TB resurgence. People who have compromised immune systems are much more vulnerable," said Melvin Spigelman, Head of Research and Development at the New York-based TB Alliance, which leads the world in developing new drugs to fight the disease.

Nearly 200,000 people living with HIV died for TB in 2005 alone, he pointed out.

Curing patients who have both diseases is hampered by the incompatibility of drugs considered essential for each illness, giving rise to a highly dangerous condition known as IRIS, for immune-reconstitution inflammatory syndrome.

If tuberculosis seems like a 19th-century illness to many people in the West, it is partly the dated association with artists and writers taking cures in Alpine sanatoria.

The main reason, though, is that the disease was largely eradicated in industrialized nations by antibiotics after World War II.

But it has never ceased to plague the developing world. "It is the quintessential disease of the poor," said Spigelman.

"It is the poor nations in general that have the highest incidence of the disease, and even in developed countries -- the US and Britain, for example -- it is the poor who are affected," he said.

And because society's most impoverished members do not have the clout to plead their case, Spigelman added, "it has become a forgotten disease."

Source: http://news.yahoo.com/s/afp/20070321/hl_afp/healthdiseasetuberculosis_070321023941

Eastern Cape confirms two more XDR-TB cases

2007-03-21T10:17:00.000+07:00
By, Independent Online, March 19, 2007

Two more cases of killer XDR-TB have been diagnosed in the Eastern Cape, the provincial health department said on Monday.

Spokesperson Sizwe Kupelo said the two patients were diagnosed with extreme drug resistant tuberculosis (XDR-TB) on Thursday of last week at the Jose Pearson TB Hospital in Port Elizabeth.

The two were subsequently transferred to the Fort Grey TB hospital in East London where they were isolated from ordinary TB patients.

Forty-three patients in the Eastern Cape have been diagnosed with the deadly strain of the infectious disease since its emergence in the province in November 2006. According to the department, six people have died.

Source: http://www.iol.co.za/index.php?from=rss_South%20Africa&set_id=1&click_id=13&art_id=nw20070319224404772C571161

TB Second Biggest Infectious Killer Worldwide

2007-03-20T11:43:00.000+07:00
By, Catharine Paddock, Medical News Today, March 19, 2007

TB, the infectious lung disease, is a leading cause of death from infectious diseases worldwide, second only to HIV/AIDS.

The airborne disease that we all thought had been eliminated by the 1960s, is now killing nearly 2 million people worldwide every year. According to the World Health Organization (WHO), new infections of tuberculosis, or TB, occur at the rate of one per second.

And also of increasing concern to health professionals and organizations worldwide is the sharp rise in drug-resistant strains of TB.

Of these, extremely drug-resistant tuberculosis, XDR-TB, has emerged as a top priority - in Sub-Saharan Africa it is said to be threatening to undermine the progress in the fight against HIV/AIDS. The WHO, the Bill Gates Foundation and the European Union have launched programmes to tackle the problem.

Poorer countries are not the only ones to be hit by TB. London for example is called "the TB capital of Europe", and most large cities in Europe and North American have seen sharp rises in the disease.

But the problem is bigger in Africa and Asia because of the higher prevalence of HIV/AIDS and reduced healthcare capability, particularly shortages of TB drugs and ensuring patients finish the treatment programme which can take up to 18 months. This is how resistant strains emerge.

Other groups have also launched campaigns. In the US, philanthropist and political activist George Soros, chair of the Open Society Institute announced earlier this week a coalition with Partners in Health, Brigham and Women's Hospital, and the RESULTS Educational Fund. They have set up a fund to develop new treatments for patients with drug-resistant TB and HIV/AIDS in developing countries.

The coalition have called on governments in the wealthier nations to support initiatives to stop the global epidemic that hits poorer nations with under-resourced healthcare systems much harder. Basic control of TB is the key, they say.

Many health experts are saying that the way to stop the dual epidemic is to fight it on two fronts. Strengthen basic control of TB, and develop new treatments for the drug-resistant strains.

A potential new treatment was highlighted earlier this month when UK scientists announced that a drug used to treat common fungal infections could hold the key to treating drug-resistant TB.

Biologists at The University of Manchester showed that compounds known as azoles - the active agent in many antifungal drugs - kill the TB bacteria, and could also be effective against emerging drug-resistant strains.

Professor Andrew Munro, who led the research in Manchester's Faculty of Life Sciences, said "TB is back with a vengeance with a third of the world's population currently infected".

Professor Munro explained the resurgence of TB and the drug-resistant strains: "The bacterium survives the initial attack by the body's immune system and then lies dormant, usually in the lungs, waiting for any sign of weakness, such as a secondary infection. Its resurgence over the last 20 years has been closely associated with the AIDS epidemic, which destroys the human immune system and has allowed TB to get a grip once again."

"People in places like India or Africa would be given antibiotics but often not in sufficient quantities to kill the bug completely; this is how resistant strains develop and these regions have become huge breeding grounds for these 'super strains'," said Professor Munro.

In researching the DNA of the TB bacterium, the Manchester scientists found it had a large number of enzymes called P450s, which is unusual for a small organism like a bacteria. They discovered that existing anti-fungal treatments based on azoles already target P450s, for instance in the treatment for Candida albicans (the causative agent of thrush).

They found that azoles were good at killing TB bacterium as well, by blocking the action of its P450s that are essential for maintaining cell structure. They also bind tightly to some of the TB P450 enzymes and inactivate them.

The research is published in the Journal of Biological Chemistry.

Meanwhile the WHO has announced that 650 million dollars will be needed every year to treat over 1.5 million patients with drug-resistant TB by 2015.

Dr Paul Nunn of the WHO's Stop TB Department announced the figure to delegates at the opening session of the 14th Conference on Retroviruses and Opportunistic Infections (RCOI) in Los Angeles at the end of last month. He called drug-resistant TB "one of the most urgent issues in the developing world".

XDR-TB stands for extremely drug-resistant TB, which according to the WHO is MDR-TB (multi drug-resistant TB) plus additional resistance to certain second line drugs. More specifically, XDR-TB is resistant to the fluoroquinolones and resistant to at least one of the injectable drugs,amikacin, kanamycin and capreomycin.

The problem of XDR-TB was first defined in March 2006 by the US Centers for Disease Control and the WHO. 18,000 TB isolates were shown to contain 20 per cent of MDR-TB. These were tested for 2nd line drug resistance. Ten per cent of the MDR isolates were found to be resistant to 3 or more of the 6 second-line drugs.

In order to fight XDR-TB, developing countries need more advanced facilities, particularly on the laboratory side. Dr Nunn said, for example, there is an acute shortage of laboratories with capability to perform drug susceptibility tests (DST), particularly for second line drugs, which is technically more demanding. "South Africa, alone, has more DST capable laboratories than the rest of sub-Saharan Africa put together," he said.

According to Dr Paul Farmer, co-founder of Partners In Health and based at Harvard University and Brigham and Women's Hospital in Boston, the growth of "XDR-TB highlights a global failure to prevent and treat basic TB". He said TB can be treated with simple and inexpensive drug treatment programme, but when we don't handle that very well, TB becomes drug resistant.

According to the WHO, the best way to prevent strains of XDR-TB from developing, is to strenghten the control of basic TB. To do this it estimates 5 billion dollars will be needed in 2007 to treat more than 9 million new cases worldwide.

Saturday 24th March is World TB Day.

Source: http://www.medicalnewstoday.com/healthnews.php?newsid=65508&nfid=rssfeeds

$3m pledge to battle XDR-TB in Africa

2007-03-19T15:33:00.000+07:00
By, Global Africa Network, March 15, 2007

MASERU, Billionaire George Soros pledged $3-million on Wednesday to fight a deadly strain of tuberculosis in Africa.

Since an outbreak of extensively drug-resistant tuberculosis (XDR-TB) was identified in South Africa last year, health experts have repeatedly issued dire warnings about the disease's spread across the continent, fuelled by the Aids pandemic. But aside from a series of worldwide meetings, little concrete action has been taken.

Soros's Open Society Institute announced a $3-million grant to the non-profit organisation Partners in Health and Brigham and Women's Hospital in Boston, Massachusetts. The donation will be used to design a model project of community-based XDR-TB treatment in Lesotho.

Once treatment guidelines are developed, experts hope the programme might be adopted in other poor countries.

Partners in Health has previously implemented community-based programmes for drug-resistant TB in countries including Peru and Rwanda. "It is possible to treat highly resistant tuberculosis," said Dr Paul Farmer, co-founder of Partners in Health, who disputed characterisations of the disease as "virtually untreatable".

Farmer emphasised the need for HIV and TB treatment to be integrated.

"It's great that Soros has stepped forward, but what we really need is massive investments from governments," said Mark Harrington, executive director of the Treatment Action Group, a United States-based health advocacy group.

"Governments have been embarrassed about the outbreak and terrified of not knowing what to do about it," he said, calling the XDR-TB problem "out of control".

Last September, the World Health Organisation (WHO) confirmed 53 XDR-TB cases in South Africa, of which 52 were fatal. Most of the patients were also HIV-positive. To date, more than 300 cases have been identified, and at least 30 more are picked up each month.

In a few weeks, WHO experts will finally begin helping South African authorities investigate the origins and spread of last year's outbreak. The WHO estimates $650-million is needed to combat the XDR-TB problem annually.

XDR-TB exists worldwide, but it is of particular concern in Africa, where patients are often co-infected with HIV/Aids, which essentially translates into a death sentence. XDR-TB is a variant of TB, an easily transmissible disease that is resistant to two of the second-line TB drugs, used as a last line of defence.

No XDR-TB cases have been found in neighbouring countries such as Lesotho, Malawi or Zimbabwe, but experts suspect weak surveillance systems there are simply not picking them up. The disease has been identified in 28 countries worldwide, including all Group of Eight countries.

The delayed response to XDR-TB, Harrington said, does not match the severity of the outbreak. "People think of TB as an old disease, and it's largely been ignored," he said. "But if they really understood how serious XDR-TB was, they would be scared out of their wits." - AP

Source: http://news.africast.com/africastv/article.php?newsID=61487

XDR-TB is 'an absolute emergency'

2007-03-13T10:32:00.000+07:00
By, Mail & Guardian online, March 12, 2007

South Africa is struggling to contain an outbreak of extensively drug-resistant tuberculosis (XDR-TB) and the World Health Organisation (WHO) is sending a permanent staff member to help, reported the Lancet.

The medical journal said the WHO TB expert would advise the Health Department on how to deal with the outbreak of the often-fatal XDR-TB, which has spread to all nine provinces. The department has confirmed 269 cases of XDR-TB.

The director of Stop TB at WHO, Mario Raviglione, said the local, national and international response to the spread of XDR-TB was too little too late.

"This is an absolute emergency," he told the Lancet.

"It is the most urgent thing I have seen in my 15 years of working in tuberculosis: a highly resistant strain that is now killing HIV-positive people and is spreading very rapidly.

"Nobody is moving fast enough."

An appeal for $95-million made last October in Paris had met little response, he said.

The WHO is also discussing the possibility of stationing WHO staff members in each province.

Raviglione said the immediate focus should be to investigate the outbreak at the Church of Scotland Hospital at Tugela Ferry in KwaZulu-Natal.

A study published online by the Lancet last August showed that 53 patients contracted XDR-TB and 52 died at the hospital. KwaZulu-Natal authorities launched their own investigations, but these have yet to be completed.

A total of 205 XDR-TB cases have been confirmed in KwaZulu-Natal, the province with the highest HIV prevalence.

XDR-TB cases are those resistant to three or more of the six second-line TB drugs. -- Sapa

Source: http://www.mg.co.za/articlePage.aspx?articleid=301718&area=/breaking_news/breaking_news__national/

Antifungal drug kills tuberculosis bug

2007-03-13T10:04:00.000+07:00
By, News-Medical.net, March 12, 2007

Scientists hoping to find new treatments for one of the world's most deadly infectious diseases say drugs used to treat common fungal infections may provide the answer.
Tuberculosis, or TB, is a highly contagious disease of the lungs that was thought to have been virtually eliminated by the 1960s, but is now resurgent and kills nearly two million people worldwide every year. New infections are occurring at a rate of one per second.

Of equal concern is the dramatic rise in the incidence of new strains of TB that are resistant to traditional antibiotics. As a result, the World Health Organisation, the Bill Gates Foundation and the European Union have all launched initiatives to tackle the problem.

Now, biologists at The University of Manchester have shown that chemicals called azoles - the active agent in many antifungal drugs - kill the TB bacteria, and could be effective in tackling the emerging drug-resistant strains.

"TB is back with a vengeance with a third of the world's population currently infected," said Professor Andrew Munro, who led the research in Manchester's Faculty of Life Sciences.

"The bacterium survives the initial attack by the body's immune system and then lies dormant, usually in the lungs, waiting for any sign of weakness, such as a secondary infection. Its resurgence over the last 20 years has been closely associated with the AIDS epidemic, which destroys the human immune system and has allowed TB to get a grip once again."

London is the TB capital of Europe, although most large cities here and in North America have seen rapid increases in the number of TB infections. However, the problem is most acute in Africa and Asia where HIV/AIDS is also most prolific and a shortage of traditional TB medicines and problems with patient compliance has led to the emergence of drug-resistant strains of the disease.

"There were only ever a limited number of drugs that were effective against TB anyway," said Professor Munro, who is based in the University's £38 million Manchester Interdisciplinary Biocentre.

"People in places like India or Africa would be given antibiotics but often not in sufficient quantities to kill the bug completely; this is how resistant strains develop and these regions have become huge breeding grounds for these 'super strains'."

Funded by the EU's NM4TB (new medicines for tuberculosis) project, the Manchester team set about trying to find alternative drugs that could be used to treat these multi-drug resistant varieties of TB, known as MDR-TB.

"We knew that the TB bacterium was a clever organism, able to evade the human immune system and to survive long-term, sometimes unnoticed, in the body. We also realised that these peculiar features of the TB bacterium must mean that there are 'unusual' aspects of its composition and biochemistry that set it apart from most other bacteria and that could provide new targets for antibiotic drugs.

"When we began looking at the bug and its DNA content in more detail, we noticed it had some unusual characteristics. In particular, we noted the presence of a very large number of enzymes called P450s, which are usually associated with more complex organisms.

"In humans, P450s oxygenate molecules in the body and are essential for steroid metabolism; they are also prevalent in the liver where they help us detoxify and dispose of countless chemicals and toxins that enter our system. Most bacteria have few, if any, P450s but we discovered that the TB bacterium has 20 different types."

Even more exciting for the team was the knowledge that existing anti-fungal drugs already target P450s as a way to treat, for example, systemic and more superficial infections caused by fungi such as Candida albicans (the causative agent of thrush).

"The class of drugs called azoles are able to kill off fungal infections by blocking the actions of one of its P450s that is essential for maintaining the cell structure," said Professor Munro. "We were able to show in laboratory experiments that various types of these azole drugs were also very good at killing the TB bacterium, and also that they bind very tightly to a number of the TB P450 enzymes that we have isolated - inactivating their function."

The research - published in the Journal of Biological Chemistry - offers the potential of a whole new approach to fighting the TB bug and has already attracted interest from one major pharmaceutical company.

http://www.manchester.ac.uk

Source: http://www.news-medical.net/?id=22548

TB the silent killer

2007-03-12T14:13:00.000+07:00
By, Ishrat Firdousi,The Financial Express, March 10, 2007

In developed countries, many people think tuberculosis (TB) is a disease of the past. TB, however, is still a leading killer of young adults worldwide. Some 2 billion people-one-third of the world's population-are thought to be infected with TB bacteria, Mycobacterium tuberculosis.

TB is a chronic bacterial infection. It is spread through the air and usually infects the lungs, although other organs and parts of the body can be involved as well. Most people who are infected with M. tuberculosis harbor the bacterium without symptoms (have latent TB), but some will develop active TB disease. According to World Health Organization (WHO) estimates, each year, 8 million people worldwide develop active TB and nearly 2 million die.

One in 10 people who are infected with M. tuberculosis may develop active TB at some time in their lives. The risk of developing active disease is greatest in the first year after infection, but active disease often does not occur until many years later.

TB is primarily an airborne disease. The bacteria are spread from person to person in tiny microscopic droplets when a TB sufferer coughs, sneezes, speaks, sings, or laughs. Only people with active TB can spread the disease to others. People with TB who have been treated with the correct drugs for at least 2 weeks, however, are no longer contagious and do not spread the bacteria to others.

To identify those who may have been exposed to M. tuberculosis, health care providers typically inject a substance called tuberculin under the skin of the forearm. If a red welt forms around the injection site within 72 hours, the person may have been infected. This doesn't necessarily mean he or she has active disease.

If people have an obvious reaction to the skin test, other tests can help to show if they have active TB. In making a diagnosis, doctors rely on symptoms and other physical signs, the person's history of exposure to TB, and X-rays that may show evidence of M. tuberculosis infection.

The health care provider also will take sputum and other samples to see if the TB bacteria will grow in the lab. If bacteria are growing, this positive culture confirms the diagnosis of TB. Because M. tuberculosis grows very slowly, it can take 4 weeks to confirm the diagnosis. An additional 2 to 3 weeks usually are needed to determine which antibiotics to use to treat the disease.

Between 2 to 8 weeks after being infected with M. tuberculosis, a person's immune system responds to the TB germ by walling off infected cells. From then on the body maintains a standoff with the infection, sometimes for years. Most people undergo complete healing of their initial infection, and the bacteria eventually die off. A positive TB skin test, and old scars on a chest X-ray, may provide the only evidence of the infection.

If, however, the body's resistance is low because of aging, infections such as HIV, malnutrition, or other reasons, the bacteria may break out of hiding and cause active TB.

Early symptoms of active TB can include weight loss, fever, night sweats, and loss of appetite. Symptoms may be vague, however, and go unnoticed by the affected person. For some, the disease either goes into remission (halts) or becomes chronic and more debilitating with cough, chest pain, and bloody sputum.

Symptoms of TB involving areas other than the lungs vary, depending upon the organ or area affected. With appropriate antibiotic treatment, TB can be cured in most people. Successful treatment of TB depends on close cooperation between patient and health care provider. Treatment usually combines several different antibiotic drugs that are given for at least 6 months, sometimes for as long as 12 months.

Some people with TB do not get better with treatment because their disease is caused by a TB strain that is resistant to one or more of the standard TB drugs. If that happens, their health care providers will prescribe different drugs and increase the length of treatment.

People who do not take all the required medications can become sick again and spread TB to others. Additionally, when people do not take all the prescribed medicines or skip times when they are supposed to take them, the TB bacteria evolve to outwit the TB antibiotics. Soon those medicines no longer work against the disease. If this happens, the person now has drug-resistant TB.

Some people have disease that is resistant to two or more drugs. This is called multidrug-resistant TB or MDR-TB. This form of TB is much more difficult to cure.
Treatment for MDR-TB often requires the use of special TB drugs, all of which can produce serious side effects. People with MDR-TB may have to take several antibiotics, at least three to which the bacteria still respond, every day for up to 2 years. Even with this treatment, however, between four and six out of 10 patients with MDR-TB will die, which is the same rate seen with TB patients who are not treated.

TB is largely a preventable disease, and adequate ventilation is the most important measure to prevent its transmission in the community.

Health care providers try to identify people infected with M. tuberculosis as early as possible, before they have developed active TB. They will give infected people a medicine called isoniazid (INH) to prevent active disease. This medicine is given every day for 6 to 12 months. INH can cause hepatitis (inflammation of the liver) in a small percentage of people, especially those older than 35 years.

Hospitals and clinics take precautions to prevent the spread of TB, which include using ultraviolet light to sterilize the air, special filters, and special respirators and masks. In hospitals, people with TB are isolated in special rooms with controlled ventilation and airflow until they can no longer spread TB bacteria.

In those parts of the world where the disease is common, WHO recommends that infants receive a vaccine called BCG (Bacille Calmette Guerin) made from a live weakened bacterium related to M. tuberculosis. BCG vaccine prevents M. tuberculosis from spreading within the body, thus preventing TB from developing.

BCG has its drawbacks, however. It does not protect adults very well against TB. In addition, BCG may interfere with the TB skin test, showing a positive skin test reaction in people who have received the vaccine. In countries where BCG vaccine is used, the ability of the skin test to identify people infected with M. tuberculosis is limited. Because of these limitations, U.S. health experts do not recommend BCG for general use in this country.

WHO estimates 11.4 million people worldwide are infected with both M. tuberculosis and HIV (human immunodeficiency virus, which causes AIDS [acquired immunodeficiency disease]). The primary cause of death in those infected with body microbes is from TB, not AIDS.

One of the first signs that a person is infected with HIV may be that he or she suddenly develops TB. This form of TB often occurs in areas outside the lungs, particularly when the person is in the later stages of AIDS.

It is much more likely for people infected with M. tuberculosis and HIV to develop active TB than it is for someone that is only infected with M. tuberculosis. Fortunately, TB disease can be prevented and cured, even in people with HIV infection.

People infected with both MDR-TB and HIV appear to have a more rapid and deadly disease course than do those with MDR-TB only. If no medicines are available, as many as eight out of ten people with both infections may die, often within months of diagnosis.

Diagnosing TB in people with HIV infection is often difficult. They frequently have disease symptoms similar to those of TB and may not react to the standard TB skin test because their immune system does not work properly. X-rays, sputum tests, and physical exams may also fail to show evidence of M. tuberculosis infection with in people infected with HIV.

Source: http://www.financialexpress-bd.com/index3.asp?cnd=3/10/2007§ion_id=10&newsid=54960&spcl=no

WHO calls for greater efforts to fight TB

2007-03-12T13:54:00.000+07:00
By, earthtimes.org, March 12, 2007

The World Health Organization (WHO) on Monday hailed the progress of governments of Western Pacific countries in fighting tuberculosis (TB), but warned that the region needed greater effort to effectively control the disease. The region has successfully met the WHO's 2005 target of detecting at least 70 per cent of TB cases and curing at least 85 per cent of infections, said Pieter van Maaren, regional adviser for the health body's TB programme.

He was speaking at a three-day WHO meeting on TB held in Malaysia's eastern city of Kuching on Borneo island.

TB control efforts in the region were intensified following the declaration of a TB crisis in 1999, and funding to affected countries was increased.

However, despite the positive trend in eradicating TB, van Maaren warned that the region was still far from achieving its 2010 goal of reducing TB deaths by half, compared to the 2000 levels.

In recent years, over 3.5 million TB cases and nearly 300,000 deaths have been recorded in the region, he was quoted as saying in a WHO statement.

"We clearly still have a lot of work to do before we can meet the goal we have set for ourselves," he said.

He cited problems such as limited access to and quality of health services, the emergence of multidrug-resistant TB, HIV-associated TB epidemics, inadequate engagement of all care providers and lack of adequate human resources as some of the problems that needed to be overcome.

Han Tieru, WHO representative in Malaysia, Brunei and Singapore, added that a rise in TB cases was due to lack of activities to address the link between the spreading of the disease and HIV.

"In settings such as in Singapore and Malaysia where TB and HIV share common risk factors, TB-HIV co-infection is of increasing concern," he said.

"We cannot control one without controlling the other. So, we must rapidly scale up TB-HIV collaborative activities through formally established mechanisms and plans."

Health representatives from eight countries, as well as TB are present for the conference, which ends Wednesday.

Source: http://www.earthtimes.org/articles/show/39091.html

Warning Over TB 'Epidemic'

2007-03-12T13:45:00.000+07:00
By, Patrick Sawer, Evening Standard, March 10, 2007

TUBERCULOSIS cases in London increased by 11.2 per cent last year.

Figures published today show that the number of people suffering from the lung disease has risen by 31.7 per cent since 2000.

The worst-affected boroughs were Brent, with 285 cases, followed by Newham with 259, Ealing with 240 and Hounslow with 167.

Liberal Democrat MP Lynne Featherstone, who released the figures, is demanding the Government investigates and puts together a plan to combat the disease.

Ms Featherstone, the Lib-Dem spokeswoman on international development, said: "I raised this issue last year and clearly nothing has been done. How long will it take for the Government to wake up? TB is a curable disease.

This rise is, therefore, unacceptable and the apparent lack of action from the Government is unforgivable.

"It urgently needs to find out why TB cases in London are increasing and make clear how it plans to deal with this epidemic."

TB had been in steady decline in the UK until an increase in travel to and from developing countries led to a resurgence. Around 40 per cent of all UK cases are in London. TB most frequently attacks the lungs and, if left untreated, can be fatal.

Microscopic droplets of the bacteria are spread from carriers in coughs and sneezes.

Dr John Hayward of charity TB Alert said: "Increased global travel is one of the biggest factors. People are travelling to their home areas, namely Africa, India, Pakistan, Bangladesh and South America.

"Any place that has high rates of HIV will also have high rates of TB because of lowered immunity."

In Britain, poorer inner-city areas provide a breeding ground, with bad diet and health leaving many people with less resistance. But Hayward, a former director of public health for Newham, warned: "You don't have to be HIV positive, born in Somalia and live in a squat to catch TB.

"You can also be a white middleclass lawyer and catch the disease."

The most common symptom coughing formore than three weeks.

Only last week, 14 hospital patients who came into contact with a new infected employee hospital in West Sussex were warned to contact doctors.

Worthing and Southlands Hospitals NHS Trust said there was risk to the public.

(c) 2007 Evening Standard; London (UK). Provided by ProQuest Information and Learning. All rights Reserved.

Source: http://www.redorbit.com/news/health/865562/warning_over_tb_epidemic/index.html?source=r_health

Commentary: Africa TB alarm after years of neglect

2007-03-09T09:47:00.000+07:00
By, Masimba Biriwasha, March 7, 2007

HARARE -- The recent emergence of extensively drug-resistant tuberculosis (XDR-TB) in South Africa is not only the result of poor treatment adherence by TB patients; it stems from years of neglect endured by TB programs throughout sub-Saharan Africa.

The current scale of the region's drug resistance challenge is poorly understood, and African TB programs are so dilapidated, many are at a loss as to how to respond.

"We don't understand the extent of it, and whether it's more widespread than anyone thinks," admits the head of the World Health Organization's (WHO) TB department, Dr. Mario Raviglione. "And if we don't know what has caused it, then we don't know how to stop it," he told the New York Times last week.

It has been widely acknowledged that the new deadly TB strain may have developed because of insufficient medication, or because patients missed some of their treatments. This ignores the many factors known to have major impact on treatment adherence. These include social and economic factors, as well as weaknesses in the healthcare system itself - all widespread in sub-Saharan Africa. This means that even "compliant" patients are at a high risk of TB recurrence, as well as developing and transmitting drug-resistant strains.

The tendency of recent reports to focus on patient-related factors as the "cause" of drug resistant TB conveniently overlooks the pervasive systemic factors driving TB and drug resistance in Africa.

HIV infection increases the likelihood of active TB more than 50-fold, for example, an estimated one-third of the 24.5 million people living with HIV (PLHIV) in sub-Saharan Africa, also have TB. To make matters worse, current diagnostic tests for TB often fail to detect the disease among PLHIV.

As a result of the high rate of HIV infection in the region - and an almost complete lack of TB infection control measures in health centers - the threat of the new deadly TB strain spreading is high. There are fears that should XDR-TB spread among the HIV-positive population, it could wreak havoc among millions of people throughout sub-Saharan Africa, reversing gains made in TB control and antiretroviral programs.

The capacity for TB drug resistance testing is, ironically, better in South Africa than anywhere else in the region. If XDR-TB had emerged in Zambia, or Lesotho, or Zimbabwe, for example, we might never have known. And if it has already emerged elsewhere, we still might not know, even today, because of the relative inability to detect TB drug resistance.

More than anything else, what makes the reported South African cases so alarming is that it could indicate that TB drug-resistance underlies the HIV epidemic throughout the region. The factors behind the emergence of drug-resistant TB are by no means unique to South Africa, but are also prevalent throughout neighboring countries.

Eleven of the 15 countries with the highest TB incidence globally are in the sub-Saharan Africa region. Nevertheless, TB is regarded as far less of a health priority than HIV. In recent years, annual spending on HIV programs in the region has skyrocketed, while, in the same period, anti-TB efforts have received paltry increases in resources.

Responding to the challenge of drug resistance - and TB in general - will require re-building the basics of African TB programs in a number of ways: training and retaining health workers in sufficient numbers; strengthening diagnostic and laboratory facilities; maintaining continuous drug supplies (including second-line drugs for treating drug-resistant forms of TB); introducing infection control measures to stop the spread of TB; raising awareness among affected people and communities.

As a first step to rolling back the years of neglect, understanding the extent of the drug resistance problem and its interaction with HIV is paramount. Detailed population-based studies of TB drug resistance in Africa are urgently required.

Secondly, difficult questions must also be asked about whether current TB control strategies are sufficient to address TB drug resistance and TB/HIV co-epidemics in the context of Africa.

Not until these two question marks have been lifted will investment by the international community ensure an appropriate response.

Source: http://www.metimes.com/storyview.php?StoryID=20070307-010714-9806r

Masimba Biriwasha is a member of The Key Correspondent Team, coordinated by the Health and Development Networks (HDN). The HDN's Web site is: www.TheCorrespondent.org and its email is: Correspondents@hdnet.org. This commentary was submitted to the Middle East Times.

XDR-TB may get out of control: experts

2007-03-09T09:23:00.000+07:00
By, SABC News, March 8, 2007

Leading health experts say the extreme drug resistant tuberculosis (XDR-TB) virus affecting certain parts of KwaZulu-Natal and the Eastern Cape can get out of control if it is not immediately treated. XDR-TB has already killed more than 50 people in KwaZulu-Natal.

The deadly XDR-TB is reported to be spreading rapidly across the country. US public health experts say most South Africans who are infected with HIV are actually being killed by TB. Richard Chaisson, of the Consortium to Respond Effectively to the Aids/TB epidemic, otherwise known as CREATE, says TB has become more dangerous.

SA has some tools to fight TB
Chaisson says funding for research, and development of new tools to effectively fight this latest scourge, remains the problem. However he says South Africa has other resources to deal with it.

Archbishop Tutu is already sounding the alarm. Last week he wrote an open letter to the US congress, asking for $300 million to fight TB in Africa. The XDR-TB virus has already been detected in 28 other countries.

George Soros, a US billionaire, and other activists have started a campaign to urge governments to take necessary steps to stop this latest scourge before it gets out of control.

Source: http://www.sabcnews.com/south_africa/health/0,2172,145039,00.html

TB strain threatens "uncontrollable" epidemic

2007-03-08T10:34:00.000+07:00
By, Laura MacInnis, Reuters, March 6, 2007

Extremely drug-resistant strains of tuberculosis could spark a "practically uncontrollable" epidemic among HIV/AIDS sufferers in areas like Africa, a World Health Organization (WHO) official said on Tuesday.

Mario Raviglione, director of the United Nations agency's Stop TB Department, said health experts needed to ensure a recently discovered strain - known as XDR-TB - did not trigger a wave of infections among those with weak immune systems.

He said better diagnostic tools and improved health care procedures - including isolation rooms for those afflicted with the highly contagious bug - were vital to stop its spread.

"If all the elements of good TB control are put in place, we have a chance of taking care of this disease," the Italian doctor said in an interview at the WHO's headquarters.

"If we let the situation ... with XDR go out of control, as it might well do, then we are in trouble. All of our gains over the last 10 years in controlling TB would be lost."

Tuberculosis, an airborne disease spread like the common cold, afflicts about 9 million people each year and kills 1.6 million. It is normally treatable with antibiotics but drug-resistant strains have emerged in past years, complicating a U.N.-backed drive to stop the spread of the disease by 2015.

More than 400,000 people were found in 2004 to have developed "multi-drug resistant" strains that could not be treated with at least two key first-line tuberculosis drugs, with most cases in China, India and Russia.

XDR-TB, a "super bug" which resists three or more classes of second-line tuberculosis drugs, has been identified in 28 countries worldwide, with cases concentrated in the United States, Latvia and South Korea.

In South Africa, the XDR strain has killed nearly 200 people since September, mainly HIV patients unable to fend it off.

Raviglione said the strain could cause widespread deaths among those with HIV/AIDS, given their susceptibility to tuberculosis and the difficulty in treating it.

"Either we intervene rapidly to stop the spread of this strain, or you could foresee in the future that this strain would replace the other one," he said. "That would make it practically uncontrollable."

New antibiotics and drugs to fight XDR-TB could take more than five years to reach the market, Raviglione said, so countries needed to boost their laboratory capacities to quickly identify which patients have drug-resistant TB strains.

"In South Africa they are capable, that is why they discovered it. But we don't know what's happening in Mozambique, in Lesotho, in Swaziland, in Zimbabwe," he said, noting it was possible the strain was more widespread in the region.

Africa accounted for most of the world's tuberculosis deaths in 2004, followed by southeast Asia, according to WHO data.

http://www.kare11.com/news/health/health_article.aspx?storyid=246323

2007-03-07T11:39:00.000+07:00
By, Anita Manning, USA TODAY, March 6, 2007

A dangerous form of tuberculosis that resists treatment with both first-line and second-line drugs is spreading around the world, spurring an urgent search for new ways to stop the ancient scourge.

Extensively drug-resistant TB (XDR-TB) has been found in 28 countries, including, rarely, the USA, the World Health Organization says.

Multi-drug-resistant TB (MDR-TB), which is immune to the two most powerful anti-TB drugs, has been reported for years and is now in 90 countries. But it was not until March 2006 that WHO and the Centers for Disease Control and Prevention recognized XDR-TB, a form of the disease that has developed further immunity, which makes some of the second-tier drugs ineffective. It is still sometimes curable, but only with expensive drugs and intensive treatment.

Last August, an outbreak in South Africa was reported in which 52 of 53 patients with XDR-TB died. Most also had HIV. Now, XDR-TB is in every province of South Africa. At last week's Conference on Retroviruses and Opportunistic Infections in Los Angeles, Karin Weyer of the South Africa Medical Research Council estimated 600 XDR-TB cases in the country with a fatality rate of 84%. More than 80% of those infected are HIV patients.

WHO says $650 million is needed each year to control drug-resistant TB.

"We were fairly complacent with the sense that we had drugs that work, and we do," says Maria Freire, CEO of The Global Alliance for TB Drug Development, a non-profit devoted to finding new TB drugs.

But when those drugs are given inappropriately or stopped too soon, drug resistance emerges, requiring more expensive and toxic alternatives. Regular TB can be cured with a combination of drugs taken for six months. MDR-TB requires a different combination, taken for 18 months to two years. If that regimen isn't followed carefully, XDR-TB can emerge.

"It doesn't mean you're totally untreatable, it means . they're giving you everything they have," Freire says. And in some cases, "we've simply run out of ammunition. We no longer have the drugs we need to fight this."

The TB Alliance is working with pharmaceutical companies, academic researchers and institutes to find new drugs, Freire says, and there are promising candidates in the pipeline. She says the goal is to develop drug combinations that attack different parts of TB bacteria to reduce resistance; that can be taken along with the anti-retroviral therapy needed by HIV/AIDS patients; and that are effective when taken for two months or less.

"That's a huge leap," she says, "but not an impossible goal." Ultimately, she says, the hope is to be able to "treat TB as you would any normal infection, with a 10-day treatment," but that may require a decade or more of biological research.

Source: http://www.kare11.com/news/health/health_article.aspx?storyid=246323

Drugs are not enough for extreme TB - doctors

2007-03-07T11:25:00.000+07:00
By, iol.co.za, March 6, 2007

Multi-drug-resistant tuberculosis (MDR-TB) needs a proactive networked response, particularly when it appears together with HIV infection, an international discussion on MDR-TB heard in Johannesburg on Monday.

"It is one disease where there are more questions than answers," said Dr Norbert Ndjeka from Limpopo - part of a group of South African doctors who travelled to Latvia for training in MDR-TB management.

MDR-TB is TB which does not respond to standard TB treatment, and extreme drug resistant TB (XDR-TB) is even more resistant to treatment. The combination of XDR-TB and HIV infection in South Africa has been proving deadly.

The Johannesburg meeting, organised by the international Lilly MDR-TB Partnership brought South Africans together with Lilly affiliates from Europe.

'It is one disease where there are more questions than answers'This partnership is underwritten by international pharmaceutical company Lilly to the tune of $70-million and brings together public and private partners, health professionals, business and communities to address MDR-TB around the world. It was the partnership's first global study tour.

"Drugs are not enough," said partnership project head, Dr Patrizia Carlevaro.

The partnership aims to combat the growing MDR-TB pandemic and support the World Health Organisation's goal of treating 800 000 patients by 2015.

Ndjeka said 13 medical professionals from eight provinces - excluding the Eastern Cape - attended the Latvia training, which included monitoring and management, MDR-TB and HIV co-infection, infection control and drug management.Ndjeka told the Johannesburg meeting that the training they received was "superb" and said South Africa could learn a lot from Latvia's management of MDR-TB.

'Drugs are not enough'"Their cure rate is above 66 percent... Ours is below 50 percent."

Ndjeka said Latvia had good methods of networking on patient difficulties."We do not have all the information around resistance patterns in the South African population."

He said South Africa also did not have all the drugs - XDR-TB treatment required six or seven drugs.Latvia has policies on infection control in place, runs effective isolation of XDR-TB patients, has masks and special lights to kill TB germs through radiation, and screens health care workers annually for infection.

The South African team trained in Latvia recommended to the health department that the national MDR-TB protocol be updated and encouraged research and networking on the MDR-TB problem, including HIV and TB collaboration."

As government alone we cannot make it."Involvement of all stakeholders is essential to achieve better outcomes for our national TB control programme," said Ndjeka."

The growing incidence of extreme drug resistant TB in South Africa is highlighting the urgent need for more effective measures for preventing, detecting, diagnosing and managing TB," said Dr Kgosi Letlape, chairman of the South African Medical Association (Sama).

Letlape said South Africa ranked seventh in the world in reported TB cases and was among the 22 high-burden countries targeted as part of the WHO's Stop TB campaign.

He said Sama aimed to help develop the capacity of health professionals to deal with TB. He said TB and HIV care should be integrated and commented that HIV-positive patients were generally better informed than those with TB, which impacted on their treatment.

"You have got much higher compliance among HIV patients than among TB patients."Sama is developing an online training course for physicians on MDR-TB which will include the WHO guidelines on combating the disease.

The course aims to provide doctors with the skills to diagnose, prevent, detect and manage TB, including promoting education and self-care, promoting therapy compliance and controlling associated disorders.

Letlape said 2554 health professionals had been trained in TB management since 2003, and Sama hoped to increase this to 5000 in 2007.General secretary for the Democratic Nurses' Association of South Africa (Denosa), Thembeka Gwagwa, said Denosa aimed to empower nurses to deal with TB.

As part of this, Denosa trained a core group of 20 nurses from seven provinces in TB management, who in turn trained another 500 nationally.

Northern Cape nurses reported that during the last quarter of 2006, after their 186 nurses were trained, the TB cure rate increased from 18.7 percent to 20.1 percent, while the treatment interruption rate dropped from 21.3 percent to 14.8 percent.Eastern Cape trained 60 nurses, and reported that the TB treatment compliance improved by 30 percent.

Mpumalanga and KwaZulu-Natal nurses reported a "sharp decrease" in the treatment interruption rate after training.

Gwagwa pointed out that some provinces had no budget for training, which "doesn't augur well".

She said poverty was a huge challenge in battling MDR-TB, as it stopped patients from getting to clinics and meant they took medication on empty stomachs."

MDR-TB is a man-made problem," said nurse and educator Kathy Dennill, who heads the nursing leadership programme at the Foundation for Professional Development (FPD)."

It stems from bad management. And we need to look at that management."Dennill's foundation runs training for nurses.FPD's Dr Anton Stoltz said the links between HIV and TB were crucial."It is very important that we know how people with TB present with HIV."

In support of the battle against MDR-TB, Lilly has passed on the skills and technology needed to manufacture TB drugs."We have given away our trademark," said Carlevaro.

"Twenty years ago people were saying MDR-TB is a lost cause. Now we say it's cost-effective to treat."

In South Africa, Lilly has passed on technology, skills and capital funding to pharmaceutical company Aspen Pharmacare, to enable it to produce low-cost drugs to fight MDR-TB, including XDR-TB.

Aspen currently manufactures the oral TB drug cycloserine and within about 15 months will be able to manufacture capreomycin, thanks to Lilly's assistance, said Aspen executive director Stavros Nicolaou.

He said Aspen was developing the capacity to manufacture a dried injectable powder in a vial which required only water to be added to it, a method which kept the medicine stable.

This would be used for capreomycin.He urged support for the battle against both TB and HIV - "a potentially devastating cocktail".Nicolaou said that thanks to Lilly's help, Aspen could sell the MDR-TB drugs "largely on a cost-recovery basis" instead of a profit-making basis. - Sapa

Source: http://www.int.iol.co.za/index.php?from=rss_News&set_id=1&click_id=79&art_id=nw20070305225920738C736233

HIV/AIDS, tuberculosis and malaria in Kenya could destabilize the country

2007-03-06T10:42:00.000+07:00
By, news-medical.net, March 4, 2007

The prevalence of HIV/AIDS, tuberculosis and malaria in Kenya could destabilize the country's social and economic sectors, according to the recently released Kenya National Human Development Report 2006, Kenya's Nation reports.

"The limited amount of resources spent on HIV/AIDS, malaria and TB intervention programs constrain the quality and range of social services -- including education, health care, law and order, water and sanitation -- which are often seen as basic rights and essentials for human development," the report says.

It adds that the three diseases "erode society's capabilities to realizing anticipated development since these diseases divert resources towards emergency health care provision, away from training and growth opportunities."

According to the report, as more children contract the diseases or lose their parents to them, there will be fewer students to enroll in schools.

The report also says that HIV prevalence is higher in more impoverished regions of the country, highlighting the "likely effect of HIV/AIDS on human capabilities and human development in the most affected regions."

According to the report, 75% of all police deaths in 1999 were because of AIDS-related complications, which increases the potential for crime as police capacity to address crime is reduced.

Malaria, which accounts for roughly 5% of deaths nationwide and 30% of outpatient hospital visits, also has a "sporadic and yet devastating" effect on Kenya's highland areas, the report says.

In addition, there were roughly 200,000 cases of active TB in Kenya in 2005, but only 50% of cases were covered by the TB control program, raising concern that the number of TB cases could be higher, according to the report (Mwaniki, Nation, 2/28).

Source: http://www.news-medical.net/?id=22366

Drug-resistant TB spreading around the world

2007-03-06T10:35:00.000+07:00
By, Anita Manning, USA TODAY, March 5, 2007

A dangerous form of tuberculosis that resists treatment with both first-line and second-line drugs is spreading around the world, spurring an urgent search for new ways to stop the ancient scourge.

Extensively drug-resistant TB (XDR-TB) has been found in 28 countries, including, rarely, the USA, the World Health Organization says.

Multi-drug-resistant TB (MDR-TB), which is immune to the two most powerful anti-TB drugs, has been reported for years and is now in 90 countries. But it was not until March 2006 that WHO and the Centers for Disease Control and Prevention recognized XDR-TB, a form of the disease that has developed further immunity, which makes some of the second-tier drugs ineffective. It is still sometimes curable, but only with expensive drugs and intensive treatment.

Last August, an outbreak in South Africa was reported in which 52 of 53 patients with XDR-TB died. Most also had HIV. Now, XDR-TB is in every province of South Africa. At last week's Conference on Retroviruses and Opportunistic Infections in Los Angeles, Karin Weyer of the South Africa Medical Research Council estimated 600 XDR-TB cases in the country with a fatality rate of 84%. More than 80% of those infected are HIV patients.

WHO says $650 million is needed each year to control drug-resistant TB.

"We were fairly complacent with the sense that we had drugs that work, and we do," says Maria Freire, CEO of The Global Alliance for TB Drug Development, a non-profit devoted to finding new TB drugs.

But when those drugs are given inappropriately or stopped too soon, drug resistance emerges, requiring more expensive and toxic alternatives. Regular TB can be cured with a combination of drugs taken for six months. MDR-TB requires a different combination, taken for 18 months to two years. If that regimen isn't followed carefully, XDR-TB can emerge.

"It doesn't mean you're totally untreatable, it means … they're giving you everything they have," Freire says. And in some cases, "we've simply run out of ammunition. We no longer have the drugs we need to fight this."

The TB Alliance is working with pharmaceutical companies, academic researchers and institutes to find new drugs, Freire says, and there are promising candidates in the pipeline. She says the goal is to develop drug combinations that attack different parts of TB bacteria to reduce resistance; that can be taken along with the anti-retroviral therapy needed by HIV/AIDS patients; and that are effective when taken for two months or less.

"That's a huge leap," she says, "but not an impossible goal." Ultimately, she says, the hope is to be able to "treat TB as you would any normal infection, with a 10-day treatment," but that may require a decade or more of biological research.

Source: http://www.usatoday.com/news/health/2007-03-04-tb-strain_N.htm?csp=34