TUBERCULOSIS: .World Health Organization calls for TB blood test ban

Matt McGrath : 21 July 2011 BBC World Service Science reporter

 TB can lie dormant for years

Blood tests designed to detect active TB are inaccurate and should be banned, the World Health Organization has said.
More than two million such tests are carried out annually, but the WHO says they are unethical and lead to misdiagnosis and the mistreatment of patients.
The organisation's review of these tuberculosis test kits says they give wrong results in around 50% of cases.
The kits are mainly sold in the developing world.
However, most of the 18 kits on the market are produced in Europe and North America.
According to Dr Mario Raviglone, the director of the WHO Stop TB Department, the tests must be banned.
He said: "A blood test for diagnosing active TB disease is bad practice. Tests are inconsistent, imprecise and put patients' lives in danger."
The tests work by detecting antibodies or antigens in the blood that are produced in response to the bacterium.
But some of these commercial tests have what's called "low sensitivity" which leads to large numbers of patients being told they do not have TB when they do.

'Unethical'
Dr Karen Weyer, who is also from the WHO Stop TB department, added: "The evidence we reviewed over the past couple of months shows that one in two patients will be wrongly diagnosed, either [as] false negative or false positive.

"If it's a false negative patients get the all clear when they in fact have TB, the disease continues to spread, and the patients may die. "If, on the other hand, it's false positive, patients are put on treatments unnecessarily while the true cause of their disease remains undiagnosed." "We would describe this as unethical - and we are making a very strong urge to governments to consider that TB is a threat and the use of these ineffective tests is also a threat."

The WHO says that the tests which are manufactured in Europe and North America are prevented from going on sale where they are made due to regulations that call for extensive evidence of accuracy.
But this is not the case in the developing world - including in India and China.
Dr Weyer added: "One of the major problems is that these developing countries often have little or very weak regulatory mechanisms to make sure that tests are registered before they are used at country level.
"Another problem is that these tests are often used in the private sector, which is a difficult sector to regulate and as a result there is a wide misuse, I would say, of these inaccurate tests in the private sector in at least 17 countries that we are aware of."
She said there was a need for a TB test that could be used "at the bedside". But she added: "We don't have a blood test for TB that can be used at the point of care level."
The WHO says this call for a ban is a highly unusual move - It's the first time the organisation has issued an explicitly negative policy recommendation against a practice that is widely used in tuberculosis care.
TB kills 1.7m people every year, and is the biggest cause of death of people living with HIV.

http://www.bbc.co.uk/news/health-14234575

TUBERCULOSIS: Seminar in "The Lancet"

The Lancet, Volume 378, Issue 9785, Pages 57 - 72, 2 July 2011
Stephen D Lawn MRCP, Prof Alimuddin I Zumla FRCP
Summary
Tuberculosis results in an estimated 1·7 million deaths each year and the worldwide number of new cases (more than 9 million) is higher than at any other time in history. 22 low-income and middle-income countries account for more than 80% of the active cases in the world. Due to the devastating effect of HIV on susceptibility to tuberculosis, sub-Saharan Africa has been disproportionately affected and accounts for four of every five cases of HIV-associated tuberculosis. In many regions highly endemic for tuberculosis, diagnosis continues to rely on century-old sputum microscopy; there is no vaccine with adequate effectiveness and tuberculosis treatment regimens are protracted and have a risk of toxic effects. Increasing rates of drug-resistant tuberculosis in eastern Europe, Asia, and sub-Saharan Africa now threaten to undermine the gains made by worldwide tuberculosis control programmes. Moreover, our fundamental understanding of the pathogenesis of this disease is inadequate. However, increased investment has allowed basic science and translational and applied research to produce new data, leading to promising progress in the development of improved tuberculosis diagnostics, biomarkers of disease activity, drugs, and vaccines. The growing scientific momentum must be accompanied by much greater investment and political commitment to meet this huge persisting challenge to public health. Our Seminar presents current perspectives on the scale of the epidemic, the pathogen and the host response, present and emerging methods for disease control (including diagnostics, drugs, biomarkers, and vaccines), and the ongoing challenge of tuberculosis control in adults in the 21st century.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62173-3/fulltext

TUBERCULOSIS: Simplifying treatment for TB without symptoms

May 16 2011
The findings of a large government trial show a treatment regimen that differs from the standard therapy may be effective in treating the latent form of tuberculosis.
About 11 million people in the U.S. are infected with latent tuberculosis, which is symptom-free and is not contagious. Of those, 5 to 10 percent will go on to develop active TB, which can be spread to others and can be fatal if not properly treated.
Researchers looked at 8,000 people with latent TB, mostly in the United States or Canada. They were randomly given one of two treatments- the standard course of therapy, which takes nine months of daily treatment, or a once-weekly treatment for three months. The standard treatment is isoniazid. The experimental regimen combined isoniazid with rifapentine.
"The treatment of latent TB can be shortened from 270 doses to 12 doses, and be just as effective- that's pretty impressive," said Dr. Dean Schraufnagel, president of the American Thoracic Society and a TB expert.
Those on the once-weekly treatment were more likely to complete it- 82% versus the current rate of 69%.
"This new treatment for TB may have great, extraordinary consequences," Schraufnagel said. "I believe this will be a major strategy to control TB, both in the U.S. and worldwide."
Statistics from the CDC show the case count is on the decline, but in 2007, 544 deaths occurred from TB. In 2009, the case numbers were at an all-time low. Asians, African Americans and Native Hawaiians, along with foreign-born individuals, are disproportionately affected more than whites.
“Achieving CDC's goal of TB elimination in the United States means not only treating those individuals who already have TB disease, but also treating those with latent TB infection who are at high risk of developing TB disease and potentially transmitting it to others,” said Dr. Kevin Fenton, Director of CDC’s National Center for HIV-AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP).
“While the number of reported cases of TB disease is currently low, in today's highly interconnected world, we need to guard against a resurgence of TB both at home and abroad,” he added.
Symptoms of TB can include chest pain, a bad cough (possibly with blood), weakness and a fever. While TB usually impacts the lungs, the kidneys, brain and spine may also be affected.
Schraufnagel said people with latent TB who go on to develop active TB won't know it at first.
"They'll develop a little cough- the cough persists," he said. "They think it might be a cold, sometimes they might have a little fever. This cough doesn't go away and after a month or two months, or three months, they may contact a doctor. And even then, they're often treated for a cold or some other thing. Then they would get an X-ray or examine the sputum and make the diagnosis of TB. By that time, those people have infected 10, 20, 30, 40, a lot of new people."

The CDC offers these guidelines as to who should get tested for TB:
- If you've been around someone with active TB disease
- If you have HIV or another condition that makes the immune system weaker
- If you live in a homeless shelter or some nursing homes
- If you are from a country where TB is very common
- If you inject illegal drugs

One-third of the world's total population are infected with TB bacteria, according to the World Health Organization.
It says each person who becomes sick with active TB, if not treated, can infect on average 10 to 15 other people a year.
"It's important to note that the study was conducted in countries which carry a low to medium incidence of tuberculosis,” said Dr. Kenneth Castro, Director, Division of Tuberculosis Elimination, NCHHSTP. "That is primarily in the United States and Canada, and the results can therefore only be applied to these settings. The trial did not include countries with high tuberculosis incidence where the increased risk of re-infection could affect the effectiveness of this regimen."
http://thechart.blogs.cnn.com/2011/05/16/simplifying-treatment-for-tb-without-symptoms/

TUBERCULOSIS: A Neglected Pandemic

4/13/11: German Center for Research and Innovation (GCRI), New York

With 2 billion cases of tuberculosis infection worldwide and 2 million deaths from the disease each year, Prof. Stefan H. E. Kaufmann (Max Planck Institute for Infection Biology) and Dr. Carl Nathan (Weill Cornell Medical College) discussed the challenges for current tuberculosis research, along with drastically needed changes in both infectious disease research and research funding.
One week after World Tuberculosis Day, on March 31, 2011, the German Center for Research and Innovation (GCRI), in cooperation with the Max Planck Florida Institute, hosted a discussion on the treatments and challenges of Tuberculosis (TB) featuring highly cited immunologist Prof. Stefan H.E. Kaufmann.
Prof. Kaufmann, who is the founding and current director of the Department of Immunobiology of the Max Planck Institute for Infection Biology in Berlin and president of the International Union of Immunological Societies (IUIS), was joined by Robert Koch Award recipient Dr. Carl Nathan, the R.A. Rees Pritchett Professor and chair of the Department of Microbiology and Immunology at Weill Cornell Medical College in New York. Dr. Ann Ginsberg, Chief Medical Officer of the Global Alliance for TB Drug Development (TB Alliance), a not-for-profit product development partnership focused on the discovery and development of improved and affordable treatments for TB, moderated.
According to both speakers, part of the problem with infectious disease research is the way in which researchers approach disease. There is an insistence on a one-drug cure, a narrow focus on synthetic over natural antibiotics, and a limited view of how to target the disease-causing pathogen. Traditional drugs attack only a pathogen’s ability to replicate.
Prof. Kaufmann illustrated clinical trials as time-consuming and expensive. Even if a new vaccine existed, it would take ten to twenty years for the drug to exit the testing phase and become available to those who need it. As the principle investigator (PI) of the Grand Challenge 6 “Tuberculosis in the Context of HIV/AIDS in Africa,” Prof. Kaufmann’s work had the unique benefit of starting research with patients before going into the lab. He used the natural human immune response to TB as a guide to develop a new vaccine. The first of the 11 vaccines his lab produced has had very promising results. “Optimistically speaking the current drugs in development could reduce TB by 60-70% by 2015,” Prof. Kaufmann said. However, this would not meet the World Health Organization’s set goal for the eradication of TB worldwide by 2015.
To treat all TB cases with drugs worldwide, two billion dollars are needed, said Prof. Kaufmann, a mere one-tenth of the USD 20 billion in financial losses that result from the disease. The amount of funding currently available for TB is USD 500 million.
Dr. Nathan, whose talk was titled “Taming Tuberculosis: A Challenge for Science and Society,” spoke about the highly competitive nature of funding processes. Topics that are more attractive within the public’s imagination have received more funding than those that are not, he said. Competition between researchers leads to a high amount of unshared or destroyed data. If shared, this data could not only save time and money, but also speed up the development of new treatments. No matter the disease, research is expensive – and most people infected with TB are too poor to pay for most medicine. In the words of the health activist and a Congressional Gold Medal recipient Mary Lasker: “If you think research is expensive, try disease.”
The German Center for Research and Innovation, www.GermanInnovation.org, provides information and support for the realization of cooperative and collaborative projects between North America and Germany. With the goal of enhancing communication on the critical challenges of the 21st century, the GCRI hosts a wide range of events from lectures and exhibitions to workshops and science dinners. Opened in February 2010, the GCRI was created as a cornerstone of the German government’s initiative to internationalize science and research and is one of five centers worldwide.
http://www.research-in-germany.de/63700/2011-04-13-tubercolosis-a-neglected-pandemic.html

TUBERCULOSIS: Australian Agency for International Development (AusAID) statement

23 Mar 2011
World Tuberculosis Day (24 March) gives us an opportunity to take stock of our progress in tackling a disease that kills nearly two million people each year, mostly in developing countries.
In Australia, we don't often think of tuberculosis as a major disease. However, in 2009 it killed 1.7 million people around the world.
It is also a major health issue in our region – in 2009, 55 per cent of all new tuberculosis cases were in Asia and the Pacific.
To tackle this problem, AusAID is supporting tuberculosis control programs and surveillance efforts in Kiribati, Indonesia and Papua New Guinea. These programs are showing good results.
In Kiribati, Australian support has contributed to a major decrease in tuberculosis cases from 745 in 2007 to 294 in 2010.
Australia is working with the Government of Papua New Guinea to minimise cross-border tuberculosis transmission between northern Queensland and Papua New Guinea's Western province, through support for laboratories, surveillance and training.
Australia is cancelling up to $75 million in debt owed by Indonesia over six years so they can invest $37.5 million in tuberculosis programs approved by the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Australia has also pledged $210 million over the next three years (2011-13) to the Global Fund to Fight AIDS, Tuberculosis and Malaria. To date, programs supported by the Global Fund have provided tuberculosis treatment for 7.7 million people worldwide, including 2,200 people in the Pacific.
Globally, we are making progress, with mortality and infection rates declining - but the disease continues to be a serious health issue.
People living with HIV are particularly susceptible to contracting tuberculosis and emerging multi-drug resistant tuberculosis poses a major threat to efforts to halt the disease. AusAID supports the World Health Organisation, which is leading efforts to address these problems.
We know there is a big task ahead but tuberculosis is preventable and it is curable.
http://www.reliefweb.int/rw/rwb.nsf/db900SID/JARD-8F87HA?OpenDocument

TUBERCULOSIS: WHO warns of multi-drug resistant tuberculosis

April 2, 2011

The World Health Organization (WHO) warned that over 2 million people will become infected with multidrug-resistant tuberculosis (MDR TB) until 2015, exactly on the day that the World TB Day is celebrated on, March 24, recalling that, despite milestones achieved, further efforts are needed for all those affected by this disease so they can have access to treatment.
According to the director general of WHO, Dr. Margaret Chan, ""many countries have made progress"" in this field, but ""despite the recent growth efforts, the world needs to do much more for all MDR TB patients accessing the treatment they need.""
""We cannot allow drug-resistant tuberculosis to spread unchecked,"" she says. To live with untreated MDR-TB increases the risk of spreading TB strains resistant to drugs in the world.
Programs funded by the Global Foundation and subsequent WHO standard treatments are expected to diagnose and treat about 200,000 people of MDR-TB by 2015, a figure that is four times that of patients receiving treatment at present, only about 50,000 .
The Global Foundation will provide 84 percent of international funding for TB control in 2011. However, according to WHO, both international countries and organizations should increase their efforts against TB and progress in the fight against tuberculosis.
According to Professor Michel Kazatchkine, executive director of the Global Foundation, ""MDR-TB is a challenge for all countries because it is difficult and expensive to treat.""
""Unless there is not a special effort made to address this problem, our ability to finance and ensure progress against tuberculosis in general might be threatened,"" he warns.
For the special envoy for 'Stop TB' of the UN, Jorge Sampaio, ""it is time that countries with rapidly growing economies and a high burden of multidrug-resistant tuberculosis increase their commitment and funding for their programs against this disease.""
Since 2009, the 23 countries most affected by MDR-TB have almost doubled their burden of this disease. From 2002 to 2010, the Global Foundation has funded programs throughout the world that have provided treatment to about 7.7 million people, saving the lives of 4.1 million patients.
In 2009, WHO reported that 9.4 million people became infected with tuberculosis and 1.7 million died from this cause, among which 380,000 people with HIV-associated tuberculosis are included. In 2008 there were about 440,000 cases of MDR-TB and 150,000 deaths.
(Source: Latin Daily Financial News)
http://www.tehrantimes.com/index_View.asp?code=237853

TUBERCULOSIS: Australia: drug-resistant tuberculosis making comeback

 March 24, 2011
Tuberculosis looks intent to make a comeback following a big increase in cases of multi-drug resistant tuberculosis (MDR-TB) in Australia over the past few years, an Australian health care expert warned .
"The trend has been an increase in multi-drug resistant TB in Australia over the last 10 years, which is worrying," Dr Bernadette Saunders, from Sydney's Centenary Institute, said to mark World TB Day on Thursday.
Saunders has worked in the field of mycobacterial research for over 10 years. She has extensive experience investigating the immunology, pathology and genetics of tuberculosis disease.
"Many people thought tuberculosis would just disappear over time but, really, TB levels have been rising since the 1990s,"she said.
"It's a disease that we need to be aware of, certainly in terms of MDR-TB and, in the last few years, there has been what we call 'XDRs' which are extreme-drug resistant strains," she added.
There was a 30 percent rise in Australian cases of multi-drug resistant tuberculosis (MDR-TB) from 2007 to 2009, while in 2010 the nation recorded another rare case of even harder to kill XDR- TB.
About 1,200 TB cases diagnosed in Australia each year, and the proportion of MDR-TB infections seen in Australia has risen steadily - up from just eight cases in 2000 to 24 in 2007, and 31 in 2009.
About a quarter of all people infected with MDR-TB globally die from it - more than double the mortality rate of non-resistant TB.
Around the world, about eight to nine million new cases of TB infection are reported each year, with about 1.7 million deaths.
"It is a major, major health issue, across the globe," Saunders said.
"In some parts of the world levels of multi-drug resistance is very high and if we're not vigilant, and continue to work very hard, to keep drug resistance low and treat people who are multi- drug resistant, there is a strong potential for it to spread," she said.

Source: Xinhua
http://english.people.com.cn/90001/90782/90880/7330447.html

TUBERCULOSIS: South African babies hold TB vaccine hopes

Justine Gerardy (AFP)
WORCESTER, South Africa — The baby wiggles without care on his mother's lap as the world's most promising hope for the first new tuberculosis vaccine in 90 years is injected into his arm.

The infant is one of 2,784 pint-sized volunteers in a two-year-trial in South Africa's winelands that scientists hope will lead to a more effective inoculation against the lung disease, which kills one person every 20 seconds worldwide.
"There are 12 different vaccines in clinical trials, but this is the most advanced," said Michele Tameris who manages the trial at the South African Tuberculosis Vaccine Initiative (SATVI) site.
"This is the first time you're actually testing to see if a vaccine is effective in real life. Now we've got to show that it's actually protecting against TB in the humans."
And South Africa is a prolific testing ground, with the world's second heaviest rate of TB after Swaziland, according to SATVI.
The disease preys on weakened immune systems so it saw a surge here thanks to one of the world's highest HIV levels, which affects 5.7 million of the country's 48 million population.
In the Western Cape region, the airborne bacterial infection is rife at 900 per 100,000 people, as compared to 15 people per 100,000 in the United States.
And in the Worcester area, a mountainous grape-growing centre 120 kilometres (75 miles) northeast of the provincial capital Cape Town, one in 100 people develop TB every year.
Mothers readily brought their babies to the testing site at a local hospital for the one-off inoculation of either the vaccine or a placebo, with the final shots to be administered in late April.
Typical was Marlene Abrahams holding her tiny son Malico in the waiting area. "I want to know if he's healthy," she said.
The vaccine tested in Worcester, developed at Oxford University and known as MVA85A, is hailed as the most exciting advance since a 1921 shot created by two French doctors which is the sole TB vaccine in use today.
That vaccine, the BCG, is not necessarily effective against all strains of TB, for all age groups or for people with HIV.
"We do absolutely need a preventative vaccine if we want to get rid of tuberculosis," said Uli Fruth, a World Health Organisation scientist scientist working on TB inoculations. He gave a ball mark cost for developing a new vaccine at 150 to 250 million dollars.
"This is the most advanced of all the new TB vaccine candidates by far," he said of the trials at Worcester. "There's a lot of hope about it."
Globally, the disease stabilised in 2009, with 9.4 million new infections and around 1.7 million deaths. The World Health Organisation wants to halve deaths by 2015.
A new vaccine is seen as a key defence against what is mostly a developing world problem -- 85 percent of cases are in Asia and Africa.
But TB has also been on the march in wealthier countries. In London, cases have risen nearly 50 percent since 1999, according to British medical journal Lancet which dubbed the city western Europe's TB capital.
For Fruth, South Africa "is the best place in the world to test such a new vaccine," given what he called the country's huge tuberculosis burden and good research infrastructure.
"I guess that if we ever get a new TB vaccine we cannot do it without South Africa," he said.
The tiny Worcester volunteers will be followed up for two years to check if they develop the disease and the first results will only be known by mid-2012.
If it proves successful, the vaccine will go to Phase III clinical trials involving around 20,000 people to test its efficacy as a booster to the existing shot, the final step before drugs go to market.
Even in the best case, scientists doubt a new vaccine could be ready before 2016 to 2020.
"We say around 2018 if everything goes well," said Fruth.
http://www.google.com/hostednews/afp/article/ALeqM5i0LNk-Tc6akZLmBNCyzg8VWqvobg?docId=CNG.de0b8ea9bea371e7cf772979c14c8895.491

TUBERCULOSIS: In Children: Call for Action

CALL TO ACTION for CHILDHOOD TB

We, participants gathered at the ‘International Childhood Tuberculosis Meeting’ held March 17-18, 2011 in Stockholm, Sweden recognize that:
o Worldwide, about 1 million TB cases occur each year in children under 15 years of age.
o The true burden of TB in children is unknown because of the lack of child-friendly diagnostic tools and inadequate surveillance and reporting of childhood TB cases.
o Children with TB infection today represent the reservoir of TB disease tomorrow.
o Children are more likely to develop more serious forms of TB such as miliary TB and TB meningitis resulting in high morbidity and mortality.
o Despite policy guidelines, the implementation of contact tracing and delivery of isoniazid preventive therapy (IPT) to young and HIV-infected children is often neglected by public health programmes.
o Most public health programs have limited capacity to meet the demand for care and high-quality services for childhood TB.
o TB care for children is not consistently integrated into HIV and care and maternal and child health programs.
o BCG, the only licenced TB vaccine, has limited efficacy against the most common forms of childhood TB and its effect is of limited duration.
o Due to inadequate case detection it is estimated that a large number of children suffering from TB are not appropriately treated. This is further compounded by drug stock outs and the lack of child-friendly formulations of drugs for TB treatment and prevention.
o Children are rarely included in clinical trials to evaluate new TB drugs, diagnostics or preventive strategies.

To address this current situation, we, the undersigned, call for:
o National TB programmes to include and prioritize childhood TB in their national strategic plans in order to address millennium development goals for children and pregnant women.
o All health care providers to integrate childhood TB into their services.
o The scientific community to include children—of all ages—in clinical and operational studies.
o TB drug and diagnostic product developers to specifically include children in development plans and implementation of research at an early stage.
o Donors to encourage collaboration with researchers, local communities, TB control programmes and other stakeholders to address the growing problem of childhood TB concentrating on:
o Innovative research to develop child-friendly TB diagnostics, drugs, biomarkers and vaccines
o The strengthening of public health facilities and services so that mothers and children with and without HIV can receive appropriate TB care
o Providers of technical assistance to invest in building local technical and programmatic capacity to prevent, diagnose and treat TB in children in all age groups.
o The WHO to accelerate in-country adoption and use of childhood TB guidelines.
o Policy makers to adopt the existing and new WHO recommendations for childhood TB, evaluate implementation, scale-up and assess the impact of implementation strategies.
o Civil society to demand equitable prevention, diagnostics, treatment and care services for childhood TB and to monitor the scale- up of these services.

To ensure that all children exposed to TB or suffering from TB are correctly managed and receive the appropriate treatment, the individuals and institutions signing on to this call to action, pledge to advocate for universal access to prevention, diagnosis and treatment of TB for people of all ages.

We furthermore call on the international community to endorse this call for action to ensure that there is capacity to address the needs of children with TB.
http://www.stoptb.org/

TUBERCULOSIS: Prevention on the Navajo Reservation, USA

March 17, 2011 
Tuberculosis infects about one third of the world’s population, according to the World Health Organization, and American Indians are six times more likely to die from tuberculosis, reported The Circle.
The contagious disease generally attacks the lungs, although it can affect other organs, and is best known by a blood-tinged cough, reported the World Health Organization.
In 1955, the Navajo Nation hit a high of 200 cases of tuberculosis. Just last year, the nation counted 26 Diné people contaminated with the occasionally fatal disease, up from 17 cases in 2009, stated Sarah Yazzie, TB coordinator at the Gallup Indian Medical Center, to the Navajo Times. So for World TB Day, observed on March 24, Navajo Nation and New Mexico public health officials will join forces to raise awareness about the disease, which can be cured if caught early, reported the Times. “The key is to make sure someone is diagnosed soon enough to be treated,” said Diana Fortune, acting TB manager for the state of New Mexico, to the Times. “You can die from it if you’re not treated.”
The communicable disease caused by bacteria spreads through the air, generally through excessive exposure through coughing or sneezing. Symptoms include coughing up blood, fever, chest pain, feeling tired or weak, night sweats, weight loss and lumps in the neck, according to the World Health Organization. Anyone who experiences these symptoms should have a mantoux tuberculin skin test, Yazzie told the Times. If the skin test returns positive, the person has been infected with the tuberculosis bacteria, and more tests, often chest X-rays, must be performed to determine if they have TB disease, Yazzie said.
The TB advocacy work on the Navajo Nation follows in the footsteps of Annie Wauneka, the first woman elected to the Navajo Tribal Council, serving from 1951 until 1978, according to the Arizona Womens Heritage Trail. She made eradicating tuberculosis among Navajos a top priority. Wauneka traveled the reservation, personally visiting the ill and encouraging those with tuberculosis to seek treatment. “We’re like Annie Wauneka educating Navajo people about tuberculosis,” said TB technician Zena Arviso, who travels about 3,000 miles per month to assist and monitor patients taking their medication in their homes to help prevent the spread of the disease, reported the Times.
http://indiancountrytodaymedianetwork.com/2011/03/promoting-tuberculosis-prevention-on-the-navajo-reservation/

TUBERCULOSIS: Hong King: TB is still a threat

Hong Kong (HKSAR) - The Acting Director of Health, Dr Thomas Tsang, today (March 19) urged members of the public to stay vigilant against tuberculosis (TB), which remains a major infectious disease across the world.

Speaking at a ceremony to mark 2011 World TB Day, Dr Tsang said TB is still a threat to the health of Hong Kong people despite improvements to the living environment and healthcare quality and that continued caution is advisable.
According to the World Health Organisation (WHO), there were more than nine million new TB cases in 2009, claiming some 1.7 million lives worldwide.
In Hong Kong, there were around 5,000 cases in 2010, with a rate of some 70 cases per 100,000 population, a historical low compared with previous years.
However, Dr Tsang expressed concern over the emergence of drug-resistant TB, which had become a global challenge to healthcare workers in recent years.
"The emergence of drug-resistant TB is largely related to the improper use of drugs by patients who may not take all their medicines regularly for the required period. To effectively prevent TB, the Hong Kong Government has adopted the 'Directly Observed Treatment' (DOT) method recommended by the WHO since the 1970s," Dr Tsang noted.
Under DOT, TB patients take medication regularly and complete the course of drug therapy under the direct observation of healthcare staff to minimise the possibility of drug-resistance.
"The Department of Health (DH) also keeps watch on the latest trend of TB through its TB surveillance system and takes precautions in a timely manner," he added.
Dr Tsang called for support and co-operation from the community in the battle against TB.
The theme of the 2011 World TB Day campaign kicked off by today's ceremony is "On the move against tuberculosis: Transforming the fight towards elimination", which stresses timely diagnosis and effective treatment to stop TB.
The ceremony was jointly organised by the Hong Kong Tuberculosis, Chest and Heart Diseases Association, the Department of Health and the Hospital Authority. A two-day exhibition and educational activities will be held to disseminate the anti-TB message.
The Chairman of the Hong Kong Tuberculosis, Chest and Heart Diseases Association, Mr Edwin C C Leung, and the Chairman of the Hospital Authority, Mr Anthony Wu, were among the officiating guests.
The public can call the DH's TB hotline 2572 6024 for more TB-related information, or visit the website (www.info.gov.hk/tb_chest) jointly developed by the Department of Health and the Hospital Authority, or the WHO website (www.who.int/gtb).
http://7thspace.com/headlines/376187/vigilance_against_tuberculosis_urged.html

TUBERCULOSIS: World: Drug resistance hampers fight against tuberculosis

 Mar 17 2011: Kate Kelland : (Editing by Douglas Hamilton)
LONDON (Reuters) - Rising rates of multi-drug resistant tuberculosis (TB) are hampering world health programs aimed at tackling TB and threaten to wipe out progress made against the disease, scientists said on Friday.
Experts from the World Health Organization and the European Center for Disease Prevention and Control (ECDC) said they were concerned about spreading multidrug-resistant TB, known as MDR TB, in Europe, and the persistence of TB among children.
A second report, in The Lancet medical journal, said sub-Saharan Africa was disproportionately affected and accounted for four of every five cases of tuberculosis linked to HIV, the human immunodeficiency virus that causes AIDS.
"Increasing rates of drug-resistant TB in eastern Europe, Asia, and sub-Saharan Africa now threaten to undermine the gains made by worldwide tuberculosis control programs," said researchers in The Lancet.
TB kills an estimated 1.7 million people each year and the worldwide number of new cases -- more than 9 million -- is higher than at any other time in history, they said.
According to data from the WHO's European office, reported rates of TB have been falling in Europe since 2005 with a regional average of 36.8 notifications per 100,000 population in 2009. But notification rates of newly detected and relapsed TB cases in 18 high-priority countries remain almost eight times higher than in the rest of the region, the WHO data show.
"Vulnerable populations, including children, still do not have ready access to quality and timely diagnosis and treatment," the WHO-ECDC report said. "This remains a matter of urgency given the high prevalence of multi- and extensively drug-resistant TB in the region.
Up to a third of people worldwide are infected with the bacterium that causes TB, but only a small percentage ever develop the disease. Studies show that people with substance abuse problems, those who are poor and those who live in hard-to-reach communities are more prone to the disease.
The AIDS epidemic drove up the number of TB cases across the world in the late 1980s and 1990s because the immune suppression caused by HIV can make a person far more susceptible to TB.
People can get drug-resistant forms of TB either as a result of catching such a strain from another person or because of inappropriate or incomplete treatment.
In The Lancet report, Alimuddin Zumla of University College London Medical School and Stephen Lawn of the University of Cape Town said rising global rates of diabetes and high rates of smoking in low and middle-income countries were now increasingly important drivers of the TB epidemic.
Diabetes raises the risk of developing TB three-fold and smoking increases it two-fold, they said.
The experts concluded that progress toward controlling TB worldwide was being hampered by an absence of a quick and cheap diagnostic test, the long duration of treatment, the lack of an effective vaccine, rising rates of drug-resistant TB and weak health systems in developing countries.
http://uk.reuters.com/article/2011/03/18/health-us-tuberculosis-resistance-idUKTRE72H31B20110318

TUBERCULOSIS: International meeting on eliminating childhood tuberculosis

11-03-2011
Children suffer severe tuberculosis (TB) related illness that contributes to the overall burden of TB and potentially to overall child mortality. Worldwide, about 1 million TB cases occur each year in children (under 15 years of age) (1).
The latest data from the entire WHO European Region shows that more than 12.6 thousand (8 per 100 000 population) new TB cases occur annually among children. More than 85 % of them were reported by the 18 high priority countries to Stop TB in the Region (3). Rates in those countries were more than six times higher than in the rest of the Region, 14.25 and 2.32 per 100 000 population respectively. However, it is considered that TB in children is underdetected because of the difficulty in diagnosing the disease and/or possible underreporting.
In spite of the overall decline of TB notification rates in the last decade, three thousand children developed TB in the countries of the European Union and European Economic Area in 2010, which remains a marker of transmission in the community, with paediatric cases increasing in the low-burden countries over the past 10 years.
Treatment of TB in children is challenging due to lack of readily available paediatric and child-friendly formulations of anti-TB drugs and difficulty in treating severe forms of TB such as TB meningitis and disseminated TB, as well as multidrug resistant TB and TB and HIV co-infection in children.
While the Bacillus Calmette-Guérin (BCG) vaccination is widely recognized as protecting against severe forms of TB in infants and children, there is less evidence that this protection can be extended to adults. Countries in Europe have large variations in their BCG policies, which are not clearly linked to national TB prevalence. Policies range from no use of BCG at all to vaccination of all children at birth, in infancy, at school entry and in later school years.
To date, considerable efforts on TB have been undertaken in the framework of Millennium Development Goal 6. However, improving children's health is also the prime focus of Millennium Development Goal 4. By acknowledging the fact that TB and other respiratory tract infections seriously impact on the health of children, it is important to work towards the elimination of TB in this vulnerable group to improve childhood health. In collaboration with the Childhood TB Subgroup (DOTS Expansion Working Group (DEWG)-STOP TB Partnership), ECDC is hosting an international meeting on childhood tuberculosis in Stockholm 17 and 18 March 2011 to highlight the challenges and to move the agenda forward in order to achieve a concerted advocacy approach and to hear the voice of children.WHO/Europe is participating in the event as a member of the steering group.
The Regional Director will deliver a video message to the international audience, highlighting children’s health as one of our corporate priorities.

(1) Guidance for national tuberculosis programmes on the management of tuberculosis in children. Geneva, World Health Organization, 2006 (WHO/HTM/TB/2006.371; WHO/FC H/CAH/2006.7).
(2) The 18 high priority countries are: Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Republic of Moldova, Romania, Russian Federation, Tajikistan, Turkey, Turkmenistan, Ukraine and Uzbekistan. WHO Regional Office for Europe. Plan to stop TB in 18 high-priority countries in the European Region, 2007–2015. Copenhagen: 2007
http://www.euro.who.int/en/what-we-do/health-topics/diseases-and-conditions/tuberculosis/news2/news/2011/03/international-meeting-on-eliminating-childhood-tuberculosis