Khopotso Bodibe : 14 July 2011
Improved and sustained efforts to diagnose and treat TB need to be made to address tuberculosis infection among children.
This is according to the National Institute for Communicable Diseases (NICD), after results of a clinical study it conducted showed that prophylaxis with Isoniazid does not prevent TB in children.
Working from the premise that when taken daily, Isoniazid or INH prevents the development of tuberculosis in adults who have HIV, the study recruited over 500 HIV-positive children and about 850 HIV-uninfected children that were born to HIV-positive mothers in high-risk TB areas of Johannesburg, Cape Town and KwaZulu-Natal. The study sought to investigate whether the use of Isoniazid at a very early age - three to four months - can protect children from developing TB as most infection occurs in children under two years of age. It was a randomised study where one group of children received the actual Isoniazid pill and the other a placebo. The intervention proved to be ineffective. Shabir Madhi is the Director of the National Institute for Communicable Diseases (NICD).
"Unfortunately, what the study showed is that, firstly, even when HIV-infected children are receiving antiretroviral treatment, as much as 20% of them will actually develop tuberculosis in the first two years of life. So, it tells us that even with antiretroviral treatment HIV-infected children remain highly susceptible to developing tuberculosis", says Professor Madhi, Director of the National Institute for Communicable Diseases (NICD).
"The results of the study, unfortunately, showed as well that the use of Isoniazid prophylaxis aimed at preventing TB, unfortunately did not work in reducing the risk of developing TB infection in the HIV-uninfected children that were born to HIV-infected mothers", Professor. Madhi continues.
In HIV-negative children, it was found that about 4 - 5% get infected with TB annually in the first two years of their lives. Professor Madhi says to participate in the study the young ones had to come from a household with no prior history of TB infection. Yet, some of the children did develop TB.
"What we found, subsequently, is that of all of the children that developed tuberculosis in this particular study, only one-third of them actually developed tuberculosis in the presence of another member in that household having TB, which tells us that the majority of children that develop tuberculosis, the exposure to the infectious case is actually unknown. And the frightening part of that is that it goes against the dogma that children usually develop TB mainly because of household contact", he says.
"What that tells us is that children mainly become infected with tuberculosis because of the adults that are surrounding them. And what it tells us is that we need to basically improve our targeting of the management of tuberculosis in adults to prevent the child from becoming infected because all of this infection and all of this disease that's happening in children is almost a measure it's a marker of how well we're doing in terms of controlling tuberculosis in adults because if we're able to control tuberculosis in adults these children won't become infected. The adults are really the sources of infection of tuberculosis for these young children", adds Professor Madhi.
This means more needs to be done to identify TB cases in communities.
"That has got extremely important implications in terms of how we need to go about looking out for TB in children, but more importantly, how much more important it is that we actually intervene at the community level amongst adults in preventing TB because unless we're able to reduce that overall community exposure of TB which children are exposed to, we're not going to reduce the burden of TB in children purely by targeting the prophylaxis of children that have a known household exposure".
Prof. Madhi says there was a fair amount of confidence that Isoniazid would work as an intervention to protect children against TB when the research was initiated. Now researchers have learned that Isoniazid prophylaxis in children is a quick-fix where long-term solutions are needed. Madhi says he hopes that the Gene-Xpert PCR test which is able to make a TB diagnosis almost immediately instead of in weeks, will be widely used as it will have positive spin-offs.
"Now what that strategy will allow us to do is that it will allow us to basically make sure that we're treating the infectious cases that are coming to our health facilities immediately and, hopefully, reduce the number of people that end up not being treated. But, more importantly, is active surveillance for TB going down to the community level knocking on doors finding anyone that has got a cough, as an example getting them to agree to send a sample for testing and then identifying these TB cases at a very, very early stage before they start spreading the bug throughout the community. And that's the only way we're going to win this game. We're not going to win the game in South Africa in protecting against TB by trying to prevent it with Isoniazid prophylaxis. There's just too much TB circulating for short-cut interventions", he says
http://allafrica.com/stories/201107140012.html
Showing posts with label tuberculosis statistics(South Africa). Show all posts
Showing posts with label tuberculosis statistics(South Africa). Show all posts
Sunday, 17 July 2011
Monday, 28 March 2011
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
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: South Africa has high TB prevalence
Mar 25, 2011 : NIVASHNI NAIR Anyone who believes the Department of Health is exaggerating the problem of Aids and tuberculosis is living in a "fool's paradise", Health Minister Aaron Motsoaledi said yesterday.
COUGHING UP: KwaZulu-Natal health MEC Sibongiseni Dhlomo and Minister of Health Aaron Motsoaledi launch the GeneXpert TB detection machine at Prince Mshiyeni Hospital in Umlazi yesterday Picture: TEBOGO LETSIE
South Africa ranks highest on the list of 22 high-burden TB countries, Motsoaledi said in Durban, on World TB Day.
"If TB and Aids are a snake, then the head is in South Africa while the tail is quickly moving to other African countries. And if the head of the snake is in South Africa, then the teeth are in Durban," he said.
One in 100 South Africans has TB.
"South Africa has a large TB challenge. There are [proportionately] more people with TB in our country than in the most populous countries, such as China and India," said Motsoaledi.
"We know that the TB epidemic is being fuelled by the HIV epidemic - these epidemics are two sides of the same coin."
He chose Durban for the launch of the government's latest salvo against TB because eThekwini has the highest number of TB cases in the country: 45000.
As part of the government's response to the TB pandemic, the municipality in February launched door-to-door visits to screen and counsel residents.
Since the beginning of March, 67 teams have visited 18000 families in KwaZulu-Natal and 60000 people have been screened for TB.
"There are about 407000 people in South Africa with TB," said Motsoaledi.
"I stand here today saying that, on World TB Day 2012, at least half of them will have been visited.
"The battlefield is out there, so I would rather have empty hospitals with nurses doing their job out there. This is what primary healthcare is about."
He said Africa's first new technologically advanced tuberculosis diagnosis machine, GeneXpert, which he inaugurated yesterday, would complement the door-to-door visits.
The machine is able to diagnose TB in 120 minutes and multidrug-resistant TB in six to eight weeks. In the past, patients had to wait for up to five months for their results.
"At present we do 4.6million smears and 950000 cultures annually. This is possibly the largest number of smears and cultures for TB of country," said Motsoaledi.
"[The use of the machines] means that we will increase the diagnosis of TB and therefore find more people with TB.
"It means that [patients] do not have to return to a clinic for the result and, if positive for TB, they can be started on treatment immediately."
The machines, which cost the department R53-million, will be introduced across the country over the next 18 months. - nairn@thetimes.co.za
http://www.timeslive.co.za/specialreports/hivaids/article986588.ece/SA-has-high-TB-prevalence
COUGHING UP: KwaZulu-Natal health MEC Sibongiseni Dhlomo and Minister of Health Aaron Motsoaledi launch the GeneXpert TB detection machine at Prince Mshiyeni Hospital in Umlazi yesterday Picture: TEBOGO LETSIE South Africa ranks highest on the list of 22 high-burden TB countries, Motsoaledi said in Durban, on World TB Day.
"If TB and Aids are a snake, then the head is in South Africa while the tail is quickly moving to other African countries. And if the head of the snake is in South Africa, then the teeth are in Durban," he said.
One in 100 South Africans has TB.
"South Africa has a large TB challenge. There are [proportionately] more people with TB in our country than in the most populous countries, such as China and India," said Motsoaledi.
"We know that the TB epidemic is being fuelled by the HIV epidemic - these epidemics are two sides of the same coin."
He chose Durban for the launch of the government's latest salvo against TB because eThekwini has the highest number of TB cases in the country: 45000.
As part of the government's response to the TB pandemic, the municipality in February launched door-to-door visits to screen and counsel residents.
Since the beginning of March, 67 teams have visited 18000 families in KwaZulu-Natal and 60000 people have been screened for TB.
"There are about 407000 people in South Africa with TB," said Motsoaledi.
"I stand here today saying that, on World TB Day 2012, at least half of them will have been visited.
"The battlefield is out there, so I would rather have empty hospitals with nurses doing their job out there. This is what primary healthcare is about."
He said Africa's first new technologically advanced tuberculosis diagnosis machine, GeneXpert, which he inaugurated yesterday, would complement the door-to-door visits.
The machine is able to diagnose TB in 120 minutes and multidrug-resistant TB in six to eight weeks. In the past, patients had to wait for up to five months for their results.
"At present we do 4.6million smears and 950000 cultures annually. This is possibly the largest number of smears and cultures for TB of country," said Motsoaledi.
"[The use of the machines] means that we will increase the diagnosis of TB and therefore find more people with TB.
"It means that [patients] do not have to return to a clinic for the result and, if positive for TB, they can be started on treatment immediately."
The machines, which cost the department R53-million, will be introduced across the country over the next 18 months. - nairn@thetimes.co.za
http://www.timeslive.co.za/specialreports/hivaids/article986588.ece/SA-has-high-TB-prevalence
Sunday, 6 February 2011
TUBERCULOSIS: High prevalence of multi-drug resistant tuberculosis in Johannesburg, South Africa:
Lee Fairlie , Natalie C Beylis , Gary Reubenson , David P Moore and Shabir A Madhi :
BMC Infectious Diseases 2011, 11:28doi:10.1186/1471-2334-11-28
Published: 26 January 2011
Background
There are limited data on the prevalence of multi-drug resistant tuberculosis (MDR-TB), estimated at 0.6-6.7 %, in African children with tuberculosis. We undertook a retrospective analysis of the prevalence of MDR-TB in children with Mycobacterium tuberculosis (MTB) at two hospitals in Johannesburg, South Africa.
Methods
Culture-confirmed cases of MTB in children under 14 years, attending two academic hospitals in Johannesburg, South Africa during 2008 were identified and hospital records of children diagnosed with drug-resistant TB were reviewed, including clinical and radiological outcomes at 6 and 12 months post-diagnosis. Culture of Mycobacterium tuberculosis complex (MTB) was performed using the automated liquid broth MGITTM 960 method. Drug susceptibility testing (DST) was performed using the MGITTM 960 method for both first and second-line anti-TB drugs.
Results
1317 children were treated for tuberculosis in 2008 between the two hospitals where the study was conducted. Drug susceptibility testing was undertaken in 148 (72.5%) of the 204 children who had culture-confirmed tuberculosis. The prevalence of isoniazid-resistance was 14.2% (n=21) (95%CI, 9.0-20.9%) and the prevalence of MDR-TB 8.8% (n=13) (95%CI, 4.8-14.6%).The prevalence of HIV co-infection was 52.1 % in children with drug susceptible-TB and 53.9 % in children with MDR-TB. Ten (76.9%) of the 13 children with MDR-TB received appropriate treatment and four (30.8%) died at a median of 2.8 months (range 0.1-4.0 months) after the date of tuberculosis investigation.
Conclusions
There is a high prevalence of drug-resistant tuberculosis in children in Johannesburg in a setting with a high prevalence of HIV co-infection, although no association between HIV infection and MDR-TB was found in this study. Routine HIV and drug-susceptibility testing is warranted to optimize the management of childhood tuberculosis in settings such as ours.
http://www.biomedcentral.com/1471-2334/11/28
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