TUBERCULOSIS: Tuberculosis Control in the Western Pacific Region - 2010 Report

The status of the tuberculosis (TB) epidemic and progress in control of the disease has been assessed annually since 1997. This report presents an overview of progress in reducing the burden of TB in the Western Pacific Region (the Region) using data on disease burden and case notification in 2008 and treatment outcomes for patients registered in 2007. The data were collected from 36 countries and areas in the Region using the WHO standard form for reporting surveillance data. The report contains data trends on estimated TB prevalence and mortality, TB notifications by age group and sex, TB/HIV co-infection and other indicators of progress, including treatment outcomes and laboratory capacity and quality. This report presents data on multidrug resistant-TB from various drug resistance surveys from the countries and areas in the Region. The specific country profiles of countries with a high burden of TB provide country-specific information on progress of TB control. TB data and trends in the Pacific island countries and areas are also included in the report. A directory of partners in the countries with a high burden of TB in the Region is appended.
WHO Regional Office for the Western Pacific: 2011, 110 pages : ISBN 9789290615224 : Price: $10.00
Price for developing countries: 7.00 US$
http://www.wpro.who.int/publications/PUB_9789290615224.htm

TUBERCULOSIS: 9 Steps for a Tuberculosis Infection-Control Program (CDC)

Rob Kurtz : March 23, 2011 According to the Centers for Disease Control and Prevention, a tuberculosis infection-control program should consist of administrative controls, environmental controls and a respiratory-protection program. Every setting in which services are provided to persons who have suspected or confirmed infectious TB disease, including laboratories and nontraditional facility-based settings, should have a TB infection-control plan.
The CDC recommends following these nine steps to establish a TB infection-control program in these settings.

1. Assign supervisory responsibility for the TB infection-control program to a designated person or group with expertise in LTBI and TB disease, infection control, occupational health, environmental controls and respiratory protection. Give the supervisor or supervisory body the support and authority to conduct a TB risk assessment, implement and enforce TB infection-control policies, and ensure recommended training and education of healthcare workers.
—Train the persons responsible for implementing and enforcing the TB infection-control program.
—Designate one person with a back-up as the TB resource person to whom questions and problems should be addressed, if supervisory responsibility is assigned to a committee.

2. Develop a written TB infection-control plan that outlines a protocol for the prompt recognition and initiation of airborne precautions of persons with suspected or confirmed TB disease, and update it annually.

3. Conduct a problem evaluation if a case of suspected or confirmed TB disease is not promptly recognized and appropriate airborne precautions not initiated, or if administrative, environmental or respiratory-protection controls fail.

4. Perform a contact investigation in collaboration with the local or state health department if healthcare-associated transmission of M. tuberculosis is suspected. Implement and monitor corrective action.

5. Collaborate with the local or state health department to develop administrative controls consisting of the risk assessment, the written TB infection-control plan, management of patients with suspected or confirmed TB disease, training and education of healthcare workers, screening and evaluation of healthcare workers, problem evaluation and coordination.

6. Implement and maintain environmental controls, including all room(s).

7. Implement a respiratory-protection program.

8. Perform ongoing training and education of healthcare workers.

9. Create a plan for accepting patients who have suspected or confirmed TB disease if they are transferred from another setting.

Source: CDC
http://www.beckersasc.com/asc-quality-infection-control/9-steps-for-a-tuberculosis-infection-control-program.html

TUBERCULOSIS: KENYA: Activists appeal for release of TB prisoners

15 September 2010 (PLUSNEWS) -
Kenyan human rights activists have filed an appeal for the release of two men imprisoned [ http://www.plusnews.org/Report.aspx?ReportId=90270 ] for defaulting on their tuberculosis (TB) treatment, and are warning that the arrests could discourage other patients from seeking treatment. The appeal has been filed at Kapsabet court in Rift Valley Province. Arrested in August, the two men have been held in police remand in Kapsabet for "posing a risk to the health of the wider community". Under the Public Health Act, they can be held until the district medical officer who ordered their arrest decides they are no longer a public health threat. "I have actually gone there - the two have not been isolated, yet this was the reason for the arrest," said Nelson Otwoma, national coordinator of the Network of People Living with HIV/AIDS in Kenya. He warned that the arrests could act as a deterrent to patients needing treatment. "When I visited the family of one the [imprisoned] patients, his wife is afraid to take a sick child who is coughing for treatment for fear of arrest," Otwoma said. "This is a negative consequence of the government action... Now everybody with TB might see themselves as criminals." "Counselling of those on treatment will have better outcomes," he added. Ideally, the two men, both suffering from multi-drug resistant tuberculosis (MDR-TB), would undergo treatment in the isolation wing of a health facility, but most Kenyan health facilities are not equipped with isolation wards. MDR-TB often develops as a result of patients on first-line TB drugs not completing their six-month course of treatment. Each MDR-TB case costs the Kenyan government an estimated US$21,000, compared with $80 for patients with non-resistant TB; fewer than half of the estimated 500 Kenyan MDR-TB patients are currently on treatment. Joseph Sitienei, head of the National Leprosy and TB Control Programme, defended the men's arrest: "This action was taken in good faith; while they have their rights, the other members of the public also have [the] right to be protected from an infectious disease. It is a delicate balancing act of the two sets of rights."
Http://www.plusnews.org/report.aspx?ReportID=90481

TUBERCULOSIS: New Yor City, Board of Health rules

The city’s Board of Health passed a regulation Tuesday strengthening the city’s control over the treatment and monitoring of tuberculosis patients.
The regulation requires hospitals and other health care centers to consult with the Department of Health and Mental Hygiene at least 72 hours before discharging tuberculosis patients, and to wait for the department to determine that the patient is not a danger to public health before letting the patient out of the hospital.
It also requires doctors to submit treatment plans for new patients within one month of beginning treatment.
The new regulations are intended to help the city make sure that patients take their required course of medication, usually for six months, even after they are feeling better, said Dr. Chrispin Kambili, assistant city health commissioner in charge of tuberculosis control.
When patients fail to finish the course of medication, Dr. Kambili said, the disease can become drug resistant and much more difficult and expensive to cure.
“When patients who have unstable situations get discharged, they can get lost,” he added. “Patients in homeless situations, patients living with friends — no one really knows where they went. When they reappear, they may have infected more people because they weren’t on treatment.”
He said the city provides free medication as part of its monitoring program.
Although there is a global tuberculosis epidemic, Dr. Kambili said, New York City’s tuberculosis cases are at their lowest — 760 in 2009 — since the city began counting them in the 1800s. The number has declined by a third since 2003, when the city had 1,140 newly reported cases.
But Dr. Kamibili said that those who do have TB, primarily immigrants who bring it from other countries, are going to private doctors rather than to hospitals and clinics — perhaps, he theorized, because of some cultural mistrust of authority and institutions.
This makes new TB cases much harder to track, he said, and also means that the doctors treating those patients may not have the experience they need to give them the most effective treatment.
“Now a lot of tuberculosis care is being provided by private physicians in the neighborhoods where people live,” he said,”and some providers may not actually have the experience that we would like people to have.”
http://cityroom.blogs.nytimes.com/