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

POVERTY: The silence on EU subsidies is a gift to Eurosceptics

Julian Glover guardian.co.uk, Sunday 26 December 2010

By not fighting to reform the common agricultural policy pro-Europeans are helping their opponents, as Cameron well knows
Here's a jolly game for a bank holiday walk. It's called guess the farming subsidy. Anyone can play, and the genius is that you don't even have to be in the countryside to take part.
Strolling past the Guardian's offices in Islington? Locals received €291,071 in payments from the common agricultural policy over the last decade, in part thanks to the borough's ability to export isoglucose from the previously unknown sugar beet fields of Clerkenwell and Barnsbury.
If you are somewhere where you can see real sheep, cows and crops, the game becomes even more fun. Perhaps the Queen has asked you to stay for Christmas. If so, you'll want to know that Sandringham Farms received €3,309,318, including supplementary aid for growing durum wheat (but then Prince Charles does have his quirks).
Do have a go while you can, though. The game may not be so easy to play next year. Not because the CAP's abuses are waning, but through the simpler expedient of covering things up. Programmers and researchers at the farmsubsidy.org website, who have processed the data, are being foiled by a European court of justice ruling, which recently decided that the names of subsidy recipients should be private. Most governments have already removed from their websites information that allows campaigners to name names.
The detailed truth is particularly embarrassing: but with the CAP even the broad totals are startling enough. A subsidy bill of around €55bn a year. A distorted system that means Greek farmers get paid €560 a hectare, but Latvians only €90. A rigged market which means the biggest agribusinesses get the most money and small farmers, who mostly do less harm to the environment, a smaller share of the cash.
The disaster is overfamiliar, so it is ignored. Only pro- and anti-European zealots and environmentalists really care either way. A few years ago, a minister resigned from the UK government, promising to devote himself to the campaign for CAP reform – and of course nothing more was ever heard of him.
There have been bursts of change – decoupling, in Eurospeak – which tied money to land, not production, and removed the worst excesses. Nitrogen fertiliser use has fallen by a third since 1998; some unsustainable crops have gone; and some landowners – charities in Britain included – do use their payments to improve the environment. But not the majority. Rising payments in eastern Europe have lured US grain barons, who are rewarded with EU taxpayers' cash; Poland has been paid to ship pork scraps to Africa.
2011 was supposed to be the year for CAP reform: officials in Brussels slipped out a sensible policy paper last month. But even this contains options for the status quo to continue, or for there to be no policy on agriculture at all. The authors know Europe too well to expect better when governments work out a deal in the coming year.
So, I think, does David Cameron, which is why he is conniving at an arrangement that will keep the CAP in its present form. One of the apparent puzzles of his government is why such an unshakable Eurosceptic is doing so little to cause trouble in Brussels. Liberal Democrats like to think that they have toned down his outrage, and perhaps they have.
But there is another reason too. Like Karl Marx, Cameron has come to understand the revolutionary power of internal dialectical contradiction. Or, in the more traditional phraseology a Tory might choose, "give a man enough rope and he'll hang himself". It suits the Tories to give the Europeans rope.
Cameron dislikes the European Union more than most people realise. But it does not follow that on matters European he feels he must behave in a crassly Eurosceptic manner. If you think that the federalist dream is dead and the institution itself is heading for some form of collapse (as any open-eyed observer might do), then the logical thing is to just wait.
So it was no surprise when just before Christmas it was reported that Britain had done a dirty deal with Germany and France to save the CAP. This country will agree to leave agricultural subsidies essentially unchanged in return for the continued toleration of the British budget rebate. The losers will be eastern European states (the Poles have already denounced "British perfidy, the British lie") and, in the end, the EU itself.
A deal to save the rebate will buy Cameron some peace among his backbenchers at home. Farming friends will be happy too. As beneficiaries of sterling's fall against the euro (the currency in which subsidies are set), they are alone in the UK at not suffering from spending cuts. But a Eurosceptic who truly thought that Europe was a growing force would not be content, as Cameron is, to let the CAP rot continue. Apathy will carry the day: the EU is losing what remains of its momentum and courage.
In 2011 it is pro-Europeans who need to act. They ought to be fighting for CAP and budget reform (as, to be fair, Tony Blair tried to do in the last round of budget negotiations). But for the most part all we get is a lethal silence. The apparent solidity of the Brussels institutions hides shaky foundations.
For some, Europe will always be an affair of the heart. They know what they feel regardless of the facts. But for most, the case for the EU rests on practicalities. It needs to do things well, or at least more effectively than when they are done apart.
Can Europe still claim this to be the case? Perhaps with the bailouts – but then they are driven by the need to save the euro, a currency without a cause. Certainly not with the CAP, which makes up almost half the EU's budget. If, over the next year, the British government ducks a fight over the EU budget, some will take it as a sign that the fire has gone out of the Eurosceptic fight. The truth is the opposite: Cameron has recognised what it means for the sceptics to have won.
http://www.guardian.co.uk/commentisfree/2010/dec/26/eurosceptics-subsidies-cap-cameron

TUBERCULOSIS: Test offers hope of tuberculosis breakthrough

A blood test that can tell doctors whether someone is likely to develop the active and dangerous form of tuberculosis has become a realistic possibility.
Scientists believe they have finally found a way that could distinguish the 10 per cent of people infected with TB who will go on to develop the full-blown disease from the 90 per cent of healthy carriers who have the latent form of the lung infection.
It would mean that doctors could concentrate on treating the one in 10 infected people who are at high risk of becoming seriously ill, rather than attempting to give potent anti-TB drugs to everyone who is shown to be infected with the TB bacterium.
About two million people worldwide die each year from TB, mostly in the developing world, but the disease has also made a come-back in developed countries. In Britain 9,153 cases were recorded in 2009, the largest annual increase (5.5 per cent) since 2005, with nine out of 10 cases occurring in ethnic minorities.
The researchers, led by Anne O'Garra of the Medical Research Council's National Institute for Medical Research in London, found a "genetic signature" in the blood of people with active TB which could be used as the basis of a diagnostic test.
The study in the journal Nature also found the same genetic signature – evidence of certain infection-related genes being activated – in 10 per cent of people with the latent form of the disease. However, further work needs to be done to assess whether this 10 per cent will be the same 10 per cent of latent patients who go on to develop active TB, Dr O'Garra said.
"As an immunologist, what most intrigued me was that approximately a third of the world has been exposed or infected with the TB bacterium but only 10 per cent of these people get sick and the question is why – what determines when people get active tuberculosis?" Dr O'Garra said.
"What we've described is a distinct blood gene signature in active TB patients, and intriguingly this is absent in other infectious diseases and also in healthy individuals. But it is present in latent TB individuals, but only in 10 per cent of these individuals," she said.
The study involved a wide range of ethnic groups in London, where 3,500 cases of TB were diagnosed last year, about 40 per cent of all UK cases. More than 400 participants took part in the study, which also involved analysing the blood of TB patients in Cape Town in South Africa.
"By doing the study in London we were able to involve individuals with a really wide range of backgrounds and diverse ethnicity and thus make our findings more widely available to this global disease," said Matthew Berry, a consultant in respiratory medicine.
The blood signature found in active TB patients is independent of ethnicity, age and sex, and appears to reflect the severity and extent of the disease. The signature also disappears after successful treatment, Dr Berry said.
"What such a test would enable is very targeted treatment. Instead of trying to treat everyone with latent TB you could focus all of your efforts on that 10 per cent who would develop the disease," he said.
The genetic signature shows that certain genes in specialised blood cells called neutrophils have been turned on by the action of a molecule in the immune system known as type-1 interferon, which can aggravate bacterial infections, Dr O'Garra said. "Finding these molecules expressed in TB suggests that they may be contributing to make the disease worse," she said.
Robert Wilkinson of the University of Cape Town said that the existing diagnostic test for TB has not changed for 125 years. "We're excited by the study because it gives us greater insight into how tissue damage might occur in tuberculosis. It also raises the prospect of developing a diagnostic test or a way of learning who is most at risk of TB," he said.
http://www.independent.co.uk/news/science/test-offers-hope-of-tuberculosis-breakthrough-2056374.html