POVERTY: INDONESIA: Facing the stigma of leprosy

JAKARTA, 22 March 2012 (IRIN)


 Photo: Mark Wilson/IRIN
Leprosy patients, shunned in the community, retreat to a compound village

In Indonesia, a diagnosis of leprosy can cut patients off from family, employment, public services, even marriage and places of worship, say health officials.
According to a 2011 World Health Organization (WHO) report, Indonesia ranked third globally in 2010 with 19,785 registered leprosy patients, behind Brazil with 29,761 and India with 83,041. By the end of 2011 there were 22,726 recorded cases in Indonesia, with approximately 1,900 under the age of 15.

More than a health risk
Leprosy is caused by a bacillus transmitted by air through droplets from the nose and mouth during frequent contact with untreated persons. Without treatment, the disease can lead to permanent nerve damage and muscle paralysis, according to the WHO.
People with leprosy often face social ostracism, especially when they lose limbs, which can be eaten away by infections that go unnoticed or treated due to lack of sensation in the fingers and toes, and also by facial deformities caused by damaged nerve tissue.
H M Subuh, a senior Health Ministry official for infectious diseases, told IRIN that there is widespread stigma associated with the disease and the people who suffer from it.
"They are rejected by public services, experience difficulties in finding new spouses after divorce from their previous partners due to their diagnosis, and they have also been rejected in religious places.”
According to Intan Setiadi, coordinator of a leprosy patient group in the city of Tangerang in West Java Province, even children are not spared. “If children have been disabled by the disease, if they have lost fingers or toes, then they too can become stigmatized.”

“Leprophobia”
Sitanala Hospital in West Java is one of three state hospitals in Indonesia with a unit specifically for leprosy patients (the others are in the provinces of South Sumatra and South Sulawesi).
The local government covers the cost of care, along with the WHO, which provides medication.
Once patients have been treated for the disease there is no risk of passing it on to others, but some 60 post-treatment patients are still quarantined in West Java’s Sitanala District Hospital.
“Other patients would not want to come to this hospital if they thought that leprosy patients were mixed in with other patients,” said Ruli, a doctor working at the hospital. “Due to the stigma, and to ensure that we can attract other patients, we must have a separate leprosy facility.”
Ruli says that what she calls “leprophobia” is common. “The disease can be considered a curse. People are scared when they hear the name but they don’t really understand the disease.”
“We all have something in common here”
Like many Indonesians, Marcus goes by one name. He used to work for a logging company in Kalimantan, an Indonesian island some 1,000 km northeast of the capital, Jakarta. In the 1980s he contracted leprosy and lost toes and fingers. Eventually he came to Sitanala District for medical help.
“Once my family knew what I had, they were scared of what the rest of the community would think,” said the 72-year-old. “I didn’t want my family to be shunned by the community, so I left and came to a place where I would be more accepted.”
He never returned to work after contracting the disease, opting instead to live in a village in the hospital compound with hundreds of others who have had leprosy. The hospital provides older leprosy patients in the village with free accommodation and three meals daily.
“I have many friends here,” Marcus said. “We all have something in common because we’re all leprosy sufferers.”
His contact with the world is limited to attending the local church. His fellow residents, Enny, 40, and Yuniati, 38, both admitted their embarrassment about venturing outside the compound because they have lost legs to the disease.

 Photo: Mark Wilson/IRIN
“They are all scared of me, and if I go back to my home in Bandung [capital of West Java], they won’t accept me because they know I’ve had leprosy. I’ve forgotten my address, it’s been that long.”

Sumiyati, 70, a neighbour, says she has had leprosy since 1985. Unlike Marcus, she was diagnosed early and has only a slight deformity to her nose. She has three children and seven grandchildren, but has not seen any member of her family since the week after she was admitted to the hospital in 1985.
“They are all scared of me, and if I go back to my home in Bandung [capital of West Java], they won’t accept me because they know I’ve had leprosy. I’ve forgotten my address, it’s been that long.” Sumiyati has helped at the district hospital since she was cured.
Unable to return home and resume their previous jobs - and lives - some patients garden or clean nearby, while others can be seen begging, selling food or operating rickshaws.
Despite the hospital’s efforts to get patients into the community through paid work, nearby residents keep their distance.
Nurhadi, 43, a local taxi driver, says he never eats from street vendors in the vicinity of the village because he worries that they may have leprosy.
“I feel pity for them because of their suffering,” he says. “But at the same time I prefer to keep my distance from them because I don’t want to catch anything. A lot of people here think that way.”
http://www.irinnews.org/Report/95129/INDONESIA-Facing-the-stigma-of-leprosy

POVERTY: COTE D'IVOIRE: Leprosy fight still flagging

DIMBOKRO/TOUMODI, 8 February 2012 (IRIN) -

 Photo: Olivier Monnier/IRIN
Samuel, who lives with leprosy, is learning how to become a shoemaker

Côte d’Ivoire’s leprosy programme was consistently under-funded during the civil war (2002-2007) and last year’s political turmoil, say health practitioners, leading to a loss of expertise in terms of detecting or treating the disease.
Not considered a public health priority, the government and donors de-prioritized the leprosy fight over the past decade, with funding dropping to 30 percent of the original total, according to Alain de Kersabiec, Côte d’Ivoire and Benin representative for French NGO the Follereau Foundation (FRF), which helps treat existing and new leprosy patients around the country.
The World Health Organization (WHO) considers a disease to be a public health emergency if the prevalence is greater than one case per 10,000 inhabitants (a 0.01 prevalence rate). In 2009, the leprosy prevalence rate was 0.36 in Côte d’Ivoire.
While there is enough medicine available to treat leprosy - WHO provides it all - detecting and monitoring new cases in remote areas is difficult given the lack of qualified nurses and means of transport such as motorcycles to reach villages, said Joachim Akochi, one of 70 state nurses trained to detect and treat leprosy countrywide.
FRF has in many cases been stepping in to fill the gaps: It provides nurses with petrol coupons to help reach leprosy patients for instance - but now it is trying to ease off, said Kersabiec, hoping state institutions will step in to take responsibility, he told IRIN.
There is good news: The caseload is going down. In 2011 some 770 new cases were detected versus 887 cases in 2009, according to the Côte d’Ivoire Health Ministry, though Kersabiec notes the number of cases being detected is “stagnating”, so it is it is difficult to give accurate figures.
Over the past few years the health system’s understanding of leprosy has gradually been eroded, said Kersabiec. “A nurse at a health centre may never have encountered a case of leprosy - they are not accustomed to treating it,” he said.
 Photo: Olivier Monnier/IRIN 
Bernadette an ex-leprosy patient in Dimbokro

Too many cases are left to develop into advanced stages, said Kersabiec, who describes the disease as “insidious and silent”: A painless incubation period can last for years, while the first symptoms can take up to 20 years to appear. “The symptoms appear very late. Thus, when a new case is detected, it is very difficult to know where and when the person was infected,” he told IRIN.
Another problem is that many people live up to 20km from their nearest health clinic, making it difficult for them to visit.
Leprosy can be treated in 6-12 months, at which point the patient will no longer be contagious, but once symptoms such as loss of limbs or blindness have set in, they cannot be reversed.
Treatment is particularly patchy in the north, which was ruled by the ex-rebel Forces Nouvelles for a decade, during which time much of the state infrastructure was neglected. Many nurses left northern Côte d’Ivoire to work in the south, according to health practitioners.
Many leprosy patients are reluctant to come forward as some associate the disease with having been cursed, said Akochi, who works in the southern central department of Tomoudi. "Once they [patients] start to lose their limbs, many patients become ashamed and hide,” he said.
Traditional healers often play into this dynamic, having little medical knowledge of leprosy and giving patients inappropriate treatment, said Akochi.

Shame, poverty
Part of the shame may also be linked to poverty: Leprosy mainly affects poor and remote parts of the country, partly because unhygienic living conditions help the bacteria carrying leprosy to spread (it is spread via droplets in the mouth or nose).
"Leprosy is a disease of poverty: it is caused by poverty and throws sufferers into even greater poverty once they contract it,” says Kersabiec.
A nun, Sister Pauline, runs a health clinic in Dimbokro, south-central Côte d’Ivoire, and looks after people living with leprosy in the village of Chrétienko 5km away, trying to build their confidence and help them lead productive lives.
"They are encouraged to get to work, not to pity themselves or their situation,” Sister Pauline told IRIN.
"We try to help patients but not so much that they become overly-dependent,” said Sister Pauline. "To be mutilated will always be painful, but people must leave the house, do what they can to survive. They must live,” she said.
Former leprosy patient Samuel, lives in Chrétienko, where he is undergoing training to become a shoemaker, making special shoes for people living with leprosy. "I am very proud because it allows me to show the world that despite the handicap, we can do things," he told IRIN.
Views on leprosy are changing slowly, said Sister Pauline. "Things are moving in a positive direction, and there is less [societal] rejection than before," she said.
After just eight months in power, it is too early to tell if President Alassane Ouattara’s government will reinvigorate the leprosy fight, said Kersabiec. But, having met the health minister on 2 February, he has hope: “I wait to see if the engagement is real, the resources put in place, and promises kept.”
http://www.irinnews.org/report.aspx?reportID=94814

MALARIA: One in 100 people 'can naturally resist HIV, malaria, leprosy and hepatitis'

 Daily Mail Reporter : 6th February 2012
 Bio-hazard: Scientists found three out of 234 people were virtually insensitive to the anthrax toxin. They said this could have implications for other pathogens like HIV

One per cent of the population have a natural genetic resistance to deadly disease such as HIV, malaria, leprosy and hepatitis, scientists have revealed.
The findings came after research into anthrax found susceptibility to the acute disease caused by the bacterium Bacillus anthracis varied from person to person.
Most forms of the disease are lethal and it affects both humans and other animals.
There are effective vaccines against anthrax and some forms of the disease respond well to antibiotic treatment.
However, researchers have discovered that susceptibility to anthrax toxin is a heritable genetic trait.
Among 234 people studied by researchers at the Stanford University School of Medicine in the United States, the cells of three people were virtually insensitive to the toxin, while the cells of some people were hundreds of times more sensitive than those of others.
The findings may have important implications for national security, as people known to be more resistant to anthrax exposure could be effective first-line responders in times of crises.
The research also highlights the fact that many lethal pathogens - including HIV, malaria, leprosy and hepatitis - rely on interactions with host genes to infect and replicate within human cells.
Inherited differences in the level of expression of these genes can lead to large variations in the relative susceptibility of different individuals to the pathogen.
The senior author of the report, funded by the Defence Threat Reduction Agency of the U.S. Department of Defence, is Professor of genetics Stanley Cohen.
'Every pathogen has its own virulence strategy,' said Stanford professor of microbiology and immunology David Relman, who was not involved in the research.
'We already knew that infection by the same organisms in different people can have different outcomes.
'But until now it’s been very difficult to determine whether this variability was due to genetic or environmental factors.
'This is one of the few studies that has successfully identified a host-genetics-based molecular cause of this variability.'
In the new study, Prof Cohen and his colleagues found that variation in the level of expression of a gene that produces a cell-surface protein called CMG2 affects the success of the anthrax toxin in gaining entry into human cells.
The research suggests that analogous effects may occur in people exposed to anthrax bacteria.
Anthrax disease is caused by infection with the anthrax bacteria. Spores of the bacteria exist naturally in the environment.
When inhaled by humans or animals, the spores are transported by immune cells to lymph nodes, where the bacteria begin to multiply and are secreted into the bloodstream.
Once in the bloodstream, the bacteria begin to produce the anthrax toxin that infiltrates and kills host cells.

 Many lethal pathogens - including HIV (pictured) malaria, leprosy and hepatitis - rely on interactions with host genes to infect and replicate within human cells

Untreated, anthrax infection can cause widespread tissue damage, bleeding and death.
The researchers studied immune cells called lymphocytes collected from 234 people of varying ethnic and geographic backgrounds: 84 Nigerians, 63 Americans whose ancestors came from northern and western Europe, 44 Japanese and 43 Han Chinese.
They found that, of the 234 samples, lymphocytes from three individuals of European ancestry were thousands of times more resistant to killing by an engineered hybrid toxin brought into the cells by protective antigen.
The extent of variation in sensitivity was surprising to the scientists.
Even excluding the virtually resistant cells, they sometimes had to apply as much as 250 times more toxin to kill a similar number of cells in one sample as in another.
In addition, they observed that cells isolated from parents and their children responded similarly, indicating that toxin sensitivity is an inherited trait.
Prof Relman said: 'This research offers an important proof of principle.
'They’ve showed that genetically-determined variations in the level of expression of a human protein can influence the susceptibility of host cells to anthrax toxin.
'The findings also provide a possible means for predicting who is likely to become seriously ill after exposure, which could be extremely useful when faced with a large number of exposed people, such as was the case during the 2001 anthrax attacks.
'Finally, they could lead to the development of novel treatment strategies, perhaps by blocking the interaction between the toxin and the receptor, or by down-regulating its expression.'
The authors note in the study that the research has implications beyond anthrax exposure.
Prof Cohen added: 'Our findings, which reveal the previously unsuspected magnitude of genetically determined differences in toxin sensitivity among cells from different individuals, suggest a broadly applicable approach for investigating pathogen susceptibility in diverse human populations.'
The research was published online in the Proceedings of the National Academy of Sciences.
 http://www.dailymail.co.uk/health/article-2097313/One-100-people-naturally-resist-HIV-malaria-leprosy-hepatitis.html#ixzz1lhecgLJb

POVERTY: Experts pledge to eradicate "neglected" diseases

LONDON, 3 February 2012 (IRIN)


 Photo: Anthony Morland/IRIN
A patient gets his eyes checked for trachoma, one of the 'neglected' diseases, at a clinic in Ethiopia

Ten little-known but debilitating diseases will be high on the agenda of the world's pharmaceutical chiefs, health ministers and donor governments after they pledged their support for a World Health Organization (WHO) initiative to wipe out guinea worm, river blindness, trachoma, leprosy, bilharzia and intestinal worms, among other "neglected" diseases.
Caroline Anstey, a managing director of the World Bank, told the delegates at the meeting in London: “We are not really talking about neglected diseases; we are talking about neglected people. I think that is very key, and it is all about how and if and whether we value them.”
The participants on 30 January pledged to support the WHO programme for controlling or eliminating these diseases by 2020, promising more research and an increased supply of free drugs.
In turn, donor governments and private philanthropists, including Bill Gates, promised to support the delivery of the drugs and strengthen the health systems of the affected countries to run control and eradication programmes. Health ministers from Mozambique, Bangladesh and Brazil attended the meeting.
Working on these diseases has been frustrating because they are not incurable. Drugs to treat them exist. But these drugs have been too expensive or in short supply, or only available in a form that is difficult to use. The key to this initiative is that the organizers, especially Gates, have brought the drug companies on board.
“The drug suppliers are willing to be generous,” he said, “But they need to know there is a road map which comes from the WHO; they need to know that there is delivery funding which comes from people like DFID [UK Department for International Development] and USAID; and they need to know that the countries involved are going to orchestrate their health systems to make sure that all the drugs really get to the people in need.” The Bill and Melinda Gates Foundation pledged US$340 million over the next five years, partly to fund research into better treatment and partly to support delivery programmes.
Gates managed to persuade the companies to do things they would never normally consider, like giving away their products for nothing. Haruo Naito, president and CEO of the Japanese company Esai, which produces drugs for Lymphatic Filariasis, commonly known as Elephantiasis, set out the problem: “Our company is going to spend something like $35 million for this project. How can we persuade our shareholders? Well, we tell them it is a long-term investment for the people, for societies and for the economies of developing countries, to lift them up to become middle-income countries in the future.”
The issue of collaborative research was even trickier. Christopher Viebacher, head of Sanofi, which is researching improved drugs for sleeping sickness, said: “We are competitors. It's not that easy for us to work together commercially. And now you are talking about research and development, which is really where the core secrets of companies are. Sharing our libraries of compounds is extraordinarily difficult and it is only because of the great need that we have been able to get together, and this is where Bill Gates has played such a critical role in catalyzing it.”

Voices of dissent
However, there were warnings that even an unlimited supply of free and suitable drugs would not in themselves be enough. Daniel Berman of Médecins sans Frontières said that while his organization was delighted these neglected diseases were finally getting more attention, “We are concerned that the challenges for some of these diseases are being glossed over.” MSF cited the example of sleeping sickness, which was virtually eliminated in the early 1960s but returned with a vengeance in the 1990s as elimination efforts were not sustained. It wants to see more emphasis on programme support and surveillance capacity in affected countries.
And in a letter to the London-based medical magazine, The Lancet, two academics, Tim Allen of the London School of Economics, and Melissa Parker of Brunel University, raised another issue – the practical problems associated with mass medication. The control or eradication of many of these diseases would entail treating whole villages, even those not infected, sometimes many times over, to wipe out the pool of infection. They found people in Tanzania, where this kind of programme was introduced, were suspicious and often hostile.
“After multiple rounds of mass drug administration for Lymphatic Filariasis, the vast majority of the people interviewed... were unaware of the link between the disease and mosquitoes, and at best had a very limited understanding of the rationale for mass treatment. They asked why people with no visible symptoms should take tablets... It is hardly surprising that rumours circulate about the real purpose of the drugs.” Some of those involved in administering the programme were chased and beaten and had to be rescued by police.
“The provision of free and subsidized drugs,” they conclude, “creates a window of opportunity to make a massive difference. But the availability of tablets is not enough.”
http://www.irinnews.org/report.aspx?reportid=94788

BIOTERRORISM: Leprosy, Plague and Other Visitors to New York

ANEMONA HARTOCOLLIS : Published: February 10, 2011

When New York City’s health department revealed last weekend that three people had contracted cholera, it was a reminder that the city is not just a world capital of arts, business and the like — but also of exotic diseases.




Multimedia Graphic

Rare, but Not GoneIf a disease has cropped up in the world, there is a good chance it will eventually find its way to New York City through the diverse travelers who cross the city’s borders. For instance, several people every year are found to have a biblical disease, leprosy, though health officials say no one has to fear catching it in the subway. In 2002, bubonic plague, more commonly associated with the 14th century, found its way to New York City through two travelers who came from a ranch in New Mexico, where the disease is endemic in flea-bitten wild animals like prairie dogs.
Since the anthrax scares after the terrorist attacks of 2001, the city has sharpened its surveillance systems to pick up evidence of biological warfare. Its so-called syndromic surveillance system, which was used during the swine flu pandemic in 2009, looks for unusual patterns of disease in hospital emergency rooms. As part of a federal program to guard against bioterrorism, biosensor detectors in various large cities use a device to draw in air and analyze it for telltale pathogens.
“We definitely are a world capital,” said Dr. Don Weiss, the director of surveillance for the health department’s Bureau of Communicable Diseases. “We have a lot of tourism. We have people who live here whose birth countries are just about every country in the world. We do get some exotic diseases, but not to a point where every day my phone is ringing off the hook.”
For hypochondriacs, New York City offers EpiQuery, an interactive database of communicable diseases from amebiasis to yersiniosis on the health department’s Web site. (EpiQuery lists only diseases that are caught by New York City residents and are reportable by law.)
The city’s database memorializes seven 2001 cases of anthrax and one more, the only case since then — in 2006, Vado Diomande, a maker of African drums, got inhalation anthrax from animal skins contaminated with the anthrax spores.
Malaria is a steady presence in New York City, with about 200 cases a year — a far greater incidence than that of another mosquito-borne disease, West Nile, which infected 42 New Yorkers last year. “The mosquito that transmitted it doesn’t live in this part of the world,” Dr. Weiss said. “People going home to Africa pick it up and bring it here.”
Leprosy, he said, has a long incubation period and was believed to have been brought from other countries, not transmitted within the United States. “We don’t know a lot about how it’s transmitted,” Dr. Weiss said. “It’s not clear whether it takes skin-to-skin contact or can be transmitted through respiratory secretions.”
But he said health officials were not worried about leprosy being passed on in the subway, frightening as that might sound. “Some things can be scary until you have sort of a long period of observation,” Dr. Weiss said. “Three Mile Island, when that happened, everybody was scared out of their wits. But after three weeks, it didn’t blow up, and people said, ‘Oh, it’s probably not going to blow up.’ ”
Centuries of experience have shown that when it comes to epidemics, leprosy “is not as great a concern as tuberculosis, which has been a huge killer worldwide,” Dr. Weiss said.
More prosaically, Lyme disease is on the rise, with more than 500 cases reported in 2008, the last year for which statistics were available, up from 215 in 2000. But here, Dr. Weiss hypothesizes, the higher numbers could reflect increased testing.
Although the city has counted more than 100 rabid raccoons in the past year, there has not been a reported human case of rabies infection in New York City since 1944, according to the health department. “Raccoons are pretty smart and people are pretty smart, and they stay out of each other’s way,” Dr. Weiss said.
Salmonella, he believes, is underreported, because most people with salmonella recover without ever going to the doctor.
And then there are the natural fluctuations. By the second year of West Nile, many of the birds that carried it had acquired immunity, so the incidence fell.
As for cholera, New York City receives reports of about one case a year, almost always found in someone who has traveled abroad, so the three cases of last weekend represent a bit of an increase. All three people attended the same wedding in the Dominican Republic, where health officials said they contracted the disease, which is spread by ingesting bacteria-contaminated food or water. None were hospitalized, and they have recovered, the health department said.
“That to me is what the fascinating thing about it is,” Dr. Weiss said. “All these individual factors that have to do with ecology, population, animals, different people traveling from all over the world. There’s that perfect storm that has to happen, and then you might have something interesting.”
http://www.nytimes.com/2011/02/11/nyregion/11diseases.html?partner=rss&emc=rss

TUBERCULOSIS: When It Comes to Fighting Tuberculosis, Genetic Balance May Be the Key

Why do some people exposed to the bacteria that causes tuberculosis (TB) get sick, while others completely resist the disease? Research published this year in the journal Cell suggests that it all comes down to balance.
Scientists from the University of Washington used a combination of zebrafish experiments and human genetics to identify how a precisely tuned level of inflammation allows the body to fight off Mycobacterium tuberculosis, the causative agent of TB, but not go overboard. These findings not only help explain why some people are hypersensitive to TB, but may also have important implications for prevention and cure of this disease caused by a bacterium that can be found in one third of the world’s population.
The researchers began by creating random mutations in zebrafish and then exposing the animals to Mycobacterium marinum, a close genetic relative of the human TB bacterium and a natural pathogen for the fish. The reactions of these genetically altered fish varied from completely resistant to extremely susceptible. Further analysis showed that much of this variability was due to the LTA4H gene, which regulates the balance between pro- and anti-inflammatory factors.
Armed with findings from their zebrafish experiments, the researchers then turned to humans. They examined whether variations in the human version of LTA4H, known from previous research to affect inflammation, also affected susceptibility to TB. They analyzed DNA from 692 Vietnamese people with TB and 759 healthy controls. They found that heterozygosity – having one pro-inflammatory version of the LTA4H gene and one anti-inflammatory version – was the best position to be in. For example, having one copy of an A and one copy of a G at rs1978331 was associated with with about 30% lower odds of having TB compared to people with either two As or two Gs. The people with AG at this SNP who did develop TB were less likely to die if their disease reached a severe state.
Brinkmann/Schaible, MPI for Infection Biology
A study of a group of people in Nepal who had been exposed to leprosy, another disease caused by a mycobacterium, showed the same protective effect of having one copy of an A and one copy of a G at rs1978331. There was no effect on actually contracting leprosy, but people with AG at this SNP were less likely to develop a severe case.
X
Having two different versions of certain LTA4H variations seems to keep pro- and anti-inflammatory response mechanisms balanced. The authors suggest that when inflammation is inadequate (as may be the case when a person has two Gs at rs1978331), the risk of infection with TB or leprosy is high, as are the chances of severe disease and possibly death. On the other hand, when inflammation is excessive (as might happen with two As at rs1978331), tissue damage can occur, which can also lead to severe disease and death. The sweet spot in the middle, when there is neither too little nor too much inflammation, allows the body to adequately control and eventually clear an infection, without destroying itself in the process.
If the researchers’ hypothesis is true, if a balanced immune response to TB is best, this could explain why people with TB often improve when given anti-inflammatory immunosuppressive drugs alongside the standard antibiotic treatments.
The identification of the LTA4H variants opens the possibility for the development of new treatments for TB. In a press release, the senior author of the paper notes that because the same variations they identified in LTA4H have also been associated with heart disease, it’s possible that drugs that target this pathway in heart disease might be useful for treating TB too. Many strains of Mycobacterium tuberculosis have become resistant to standard treatments, so finding new ways to fight the disease is a priority. The new genetic findings may help researchers develop treatments that focus on helping a person’s immune system fight the infection, instead of attacking the pathogen directly.
About TuberculosisTB is a highly contagious disease that is spread through airborne droplets containing the bacterium. While the highest incidence rates occur in South-East Asia and Sub-Saharan Africa, about one third of the world is thought to be infected with the bacterium that causes TB, with a new infection occurring every second. However, not all infected people have active TB, which is characterized by a chronic cough with blood-tinged sputum, a fever, night-sweats, and weight loss. People with latent TB do not experience any symptoms and are not contagious. They simply respond positively to a TB skin test and have a 5-10% chance of developing active TB. HIV infection is the strongest risk factor for the development of active TB because it compromises the immune system.
Current methods of prevention and treatment for TB are complicated, at best. A vaccine against TB does exist – the BCG vaccine – however efficacy varies based on age, geography, TB type, and duration. Treatment for TB depends on resistance. Directly observed therapy (DOT) entails taking a strict regimen of drugs for about six months under supervision. Multidrug resistant strains of TB (MDR-TB) have developed in response to mismanaged treatment and require a different drug regimen. Extensively drug resistant TB (XDR-TB) is virtually untreatable.
http://spittoon.23andme.com/