Tuberculosis updates

waltky · Oct 18, 2012

WHO targets reducing tuberculosis (TB) deaths by 50 percent from the 1990 rate...

Program to Eradicate Tuberculosis On Track, WHO Says
October 17, 2012 - The World Health Organization says it is on track to reach its goal of reducing tuberculosis (TB) deaths by 50 percent from the 1990 rate, but global progress has been uneven.

In its annual assessment of TB, the WHO says new cases of the disease fell at a rate of more than two percent from 2010 to 2011. However, WHO TB department director Mario Raviglione says millions of people are still affected by the disease. "The global burden of TB remains enormous with an estimated, in the latest estimate of this report, 8.7 million new cases of which 13 percent, or over a million, are co-infected with HIV," Raviglione said.

At a Wednesday news conference, Raviglione said 40 percent of TB cases are in India and China while the African region has about 24 percent of the world's cases.

He said an estimated $8 billion a year will be needed to fight TB globally between 2013 and 2015 but there are "critical gaps" in funding. "We know that there is a gap of some $3 billion U.S. dollars already in 2013 out of the $8 billion needed," Raviglione said. Tuberculosis is caused by bacteria, which usually attack the lungs but can attack any part of the body. It is spread through the air from person to person.

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waltky · Oct 19, 2012

TB cases retreating, but still a problem...

Tuberculosis Cases Down, Disease Still A Major Killer
October 18, 2012 - The World Health Organization reports that the number of people who caught tuberculosis (TB) fell last year, but it also said the number of deaths from TB remained the same and that TB is still a major killer.

The news from the World Health Organization is mixed: some 20 million people are alive today as a result of international efforts to control tuberculosis and care for those who have it. As a result, the death rate has dropped by 40 percent since 1990, but lately, it has remained stubbornly level. And progress has been painfully slow in reducing the overall number of TB cases, and in containing the spread of multi-drug resistant strains of the infection.

Dr. Mario Raviglione, with the WHO, discussed the agency's 2012 report at a Washington news conference. Dr. Raviglione said a shortage of money threatens to halt progress in containing the spread of TB, and he warns of serious consequences if this funding gap is not filled. "We will have to accept that millions more people will be dying of tuberculosis on an annual basis. We'll have to accept that the incidents of TB, instead of going towards elimination-- which is what we hope for --is going to stagnate and increase again, and we'll have to accept that multi-drug resistant TB will be created and further spread," he said.

Tuberculosis is a bacterial infection that primarily affects the lungs, although it can be found in other organs. It's highly contagious, and it's transmitted by breathing in droplets of air from the cough or sneeze of a TB-infected person. The WHO report shows more than half the number of TB cases are in Asia. Forty percent are in India and China. But the problem in sub-Saharan Africa is also severe because many of those who have TB also have HIV/AIDS. Eighty percent of those infected with both TB and HIV live in this region.

But doctors now have rapid TB tests that can show if a person has the infection in about an hour and a half. And new drugs to fight TB will soon be available. "We expect two, if not three, entirely new compounds that kill the TB bacillus very effectively to be available in the next few months," Dr. Raviglione stated. A vaccine to prevent TB is what scientists hope for. But until one can be developed, the World Heath Organization is calling for countries to commit to TB control programs and increased testing and for international donors to continue large-scale funding of these efforts.

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waltky · Oct 23, 2012

AIDS complicates TB treatment...

Tough TB Responds to Drug Treatment
October 22, 2012 - An antibiotic used to treat severe infections shows promise against a very resistant and deadly form of tuberculosis. XDR-TB is resistant to at least four of the drugs used most often against the disease.

Extensively drug resistant tuberculosis or XDR-TB is still considered rare, although cases have been reported in nearly 80 countries. Health officials believe the number of XDR-TB cases is underreported because theres no specific test for it. It can be cured, but the odds against that happening are often quite high. It can kill quickly, especially if a person is co-infected with HIV, the virus that causes AIDS.

Dr. Ray Chen, a staff clinician at the National Institute of Allergy and Infectious Diseases, says XDR-TB is the next step after MDR-TB, or multi-drug resistant tuberculosis, which is a lot more common. Thats been a known problem for many years, primarily as a result of people who dont take their drugs well. And then the tuberculosis bug slowly develops resistance to the drugs that are used, he said.

MDR-TB is resistant to two of the top line drugs used for standard tuberculosis therapy. When the disease becomes resistant to two additional first-line drugs, its upgraded to XDR-TB. It came to world attention in 2006 in a study in South Africa where a number of patients were found to have this extensive resistance to tuberculosis drugs, and they had a very high mortality rate. And so it became recognized as a major problem for tuberculosis, he said.

More http://www.voanews.com/content/xdrtb-drg-22oct12/1530836.html
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Richard Powell · Nov 12, 2012

The information provided in thsi post must be updated on regular time interval as some readers are present on this platform in order to get about medical science

waltky · Feb 4, 2013

TB vaccine doesn't pass muster...

Tuberculosis vaccine hopes dashed
4 February 2013 - Prof Helen McShane, from the University of Oxford, who developed the vaccine, said that the trial provided valuable information despite the setback.

A major trial of a new booster vaccine has ended in failure, marking a major setback in the fight against tuberculosis (TB). It was the first big study in infants since the Bacillus Calmette-Guerin (BCG) vaccine was introduced in 1921. BCG is only partially effective against the bacterium that causes TB, which is why several international teams are working on new vaccines. The latest, known as MVA85A, failed to protect babies who had already had BCG. The trial, in South Africa, involved 2,794 healthy children aged four to six months, half of whom received MVA85A and the rest a placebo. They were followed up for an average of two years. The researchers, reporting in the Lancet medical journal, found 32 cases of TB in those who had received the vaccine compared with 39 in the placebo group. This gave an effectiveness of 17%, which is so low as to be statistically non-significant.

'Disappointing'

Designed to boost the immune responses that have been primed by the BCG vaccine, MVA85A has been undergoing human trials for more than a decade, showing it to be safe and to stimulate a high level of immune response in adults. Prof Helen McShane, from the University of Oxford, who developed the vaccine, said: "[It] induced modest immune responses against TB in the infants, but these were much lower than those previously seen in adults, and were insufficient to protect against the disease. "This is the first efficacy trial of a new TB vaccine since Bacille Calmette-Guérin, a significant step in itself, and there is much that we and others can learn from the study and the data it has produced." In an accompanying editorial Christopher Dye, of the World Health Organization (WHO), and Paul Fine, from the London School of Hygiene and Tropical Medicine, said although the results were disappointing they were "not a terminal prognosis for MVA85A, or for any of the other tuberculosis vaccines in development".

They added: "Now is a key moment in tuberculosis vaccine research. "If the history of tuberculosis vaccine research teaches us anything, it is to expect surprises. We need to go on playing the high-stakes game." The MVA85A study was funded by AERAS, the Wellcome Trust and Oxford-Emergent Tuberculosis Consortium. AERAS, a not-for-profit organisation, was set up to develop new TB vaccines. MVA85A was the most advanced of six vaccine candidates it is helping develop. Dr Tom Evans, interim CEO of AERAS said: "Because of the urgency to control the global TB epidemic, and despite these trial results, we remain steadfast in our belief that an improved TB vaccine will be developed and represents the best hope for eliminating the disease." TB is a major global health problem with an estimated 8.7 million cases and 1.4 million deaths a year, according to the WHO. The disease is the leading cause of death among people with HIV in South Africa.

Historic

Dr Richard White, an epidemiologist at the London School of Hygiene & Tropical Medicine and Director of the TB Modelling and Analysis Consortium, said: "This is a very disappointing result, but this was just the first of around 12 new tuberculosis vaccines currently being tested in humans and around 50 vaccine candidates currently being tested in the lab. It was a historic trial, the first of a new TB vaccine for nearly a century. It will lead to much valuable knowledge to help us design effective vaccines in the future. "

http://www.bbc.co.uk/news/health-21302518
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waltky · Mar 1, 2013

Viruses can make people more susceptible to bacterial infections...

'Wrong' immune response aids TB
28 February 2013 - Some bacteria, including tuberculosis, are able to invade because the body launches the 'wrong' immune response, say researchers.

Instead of fighting off tuberculosis, people with a severe infection produce a protein which attacks viruses, the journal Science reports. About 8.7 million people are infected with tuberculosis every year. The findings may explain why viruses can make people more susceptible to bacterial infections. A spring peak in tuberculosis infections may be linked to the effects of viruses circulating in winter, experts suggested. US researchers first identified the phenomenon using leprosy - which is caused by a similar bacterium to tuberculosis.

Looking at skin lesions in leprosy patients, the team found that two different immune proteins were present. In those with a milder form of the disease, they found a protein associated with a bacterial immune response - interferon-gamma. Whereas in patients with a more serious form of leprosy, a protein associated with a viral response - interferon-beta - was prominent. Further work showed the genes for interferon-beta - the virus-fighting protein - were more frequently expressed in the blood of tuberculosis patients with more severe disease.

Tuberculosis attacks the lungs

In disguise

The researchers said in those with severe disease, the body was responding as if it was attacking a virus, enabling the bacteria to remain hidden and replicate unchallenged within cells. Not only is interferon-beta an ineffective weapon against bacteria, it can block the action of interferon gamma - which is when bacteria can gain a foothold, the researchers said. In the face of a real viral infection it may mean that the attention of the immune system is diverted letting a bacterial infection in. Prof Robert Modlin, a dermatology and microbiology expert at the University of California, Los Angeles, said the study raises the possibility that a decrease or increase of one of these two proteins could shift the balance from mild to more serious disease. "We may find that therapeutic interventions to block or enhance specific interferon responses may be an effective strategy to alter the balance in favour of protection against bacterial diseases."

The results may also help to explain why outbreaks of tuberculosis in winter such as one currently spreading among homeless groups in Los Angeles are quick to take hold. A potent combination of people sleeping in close quarters in shelters, flu outbreaks diverting the body's immune response to the viral setting and a lack of vitamin D from sunlight, which also impacts the immune response, may be to blame, they suggested. "With TB on the rise, this scenario could play out not only in cities in the United States but all over the world," Prof Modlin said. Prof Ajit Lalvani, director of the Tuberculosis Research Unit at Imperial College London said there is a spring peak in rates of tuberculosis which have been attributed to low levels of vitamin D. "But this shows there could be at least one other reason - that other viral infections are leading some months down the line to progression from latent to active TB disease. "The timing fits, but that remains to be proven."

http://www.bbc.co.uk/news/health-21619594
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waltky · Mar 2, 2013

TB hidden in bone marrow may recur after clear lung X-ray...

Tuberculosis Evades Detection by Hiding in Bone Marrow
March 01, 2013 - It's been a long-standing medical mystery: how tuberculosis (TB), a potentially fatal respiratory infection, can spring to life in a patient after lying dormant for many years. Scientists have discovered that the bacterium which causes TB hides in cells in the bone marrow, making it hard to treat with antibiotics.

Unlike other bacterial infections, tuberculosis is notoriously difficult to treat. Despite the availability of antibiotics for 50 years, treatment for TB involves a rigorous multi-drug regimen of up to six months' duration. Thats led researchers to conclude that Mycobacterium tuberculosis, the pathogen that causes the deadly lung ailment, is lurking in tissue, where neither antibiotics nor the bodys protective immune system can kill it. One potential hiding place is bone marrow, a spongy tissue inside bones containing stem cells responsible for manufacturing a variety of blood cells. Marrow has mechanisms for keeping out foreign substances, including antibiotics.

Researcher Antonio Campos-Neto, director of the Forsyth Center for Global Infectious Diseases in Cambridge, Massachusetts, and his colleagues at Stanford University School of Medicine in California conducted test tube, or in vitro, experiments to see what happened when bone marrow cells and the TB bacterium were mixed together. And sure enough, you know, in vitro experiments show the microorganism could be internalized very easily inside the stem cells, said Campos-Neto. That finding, according to Campos-Neto, may explain why the lung disease exists in two forms -- a latent phase in which individuals can be infected for decades without symptoms, and an active phase, characterized by extreme illness and, without treatment, death.

And it may have implications for the treatment of TB, explaining why antibiotics do not always rid patients of the disease. Many, many [TB] patients who have been successfully treated, later on in their life they can come back with tuberculosis again. And nobody ever understood why this was so difficult, and now we start to have this firsthand [knowledge] that its because the TB is hiding itself in some protective niche that drugs cannot reach, explained Campos-Neto.

An estimated 2.2 billion people around the world live symptom-free with latent tuberculosis. Once active, the illness kills upwards of 1.7 million people every year. Campos-Neto says researchers need to learn more about this complex disease so new diagnostic tests and effective treatments can be developed. An article by Antonio Campos-Neto and colleagues on latent tuberculosis is published in the journal Science Translational Medicine.

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waltky · Mar 18, 2013

Africa, Europe to be impacted by funding shortfall...

Major Funding Gap Exists in Battle Against TB
March 18, 2013 Strains of tuberculosis that are resistant to multiple drugs present a major threat and could spread widely, the World Health Organization and the Global Fund to Fight AIDS, TB and Malaria said Monday. The organizations are campaigning for funds to tackle the world's second deadliest infectious disease.

Tackling the TB epidemic is one of the eight Millennium Development Goals that U.N. member states agreed to achieve by 2015. Annually, the number of new TB cases has declined since 2006 and the number of TB-related deaths is on track to reach a 50-percent reduction by 2015. But in 2011, according to the World Health Organization, there were still 8.7 million new cases and 1.4 million people died from TB.

Drug-resistant TB on rise

Additionally, multidrug-resistant TB is posing an increasing threat. Mario Raviglione, director of the World Health Organization's Stop TB Department, said there has been a two-percent yearly decline in people falling ill from TB. It's good that the numbers are going down, he said, but the progress is too slow. "We are not seeing a dent in making the numbers of cases of TB reduced year by year in an accelerated way," said Raviglione. Two regions, Europe and Africa, are not on track to halve the TB death rate by 2015, which is the goal laid out by the U.N.

Africa, Europe in spotlight

Raviglione said that in Western Europe and North America there are, on average, about five or six TB cases per 100,000 people. The numbers in Africa, which has the greatest per capita TB death rate, are much higher. "In Africa you find peaks, especially in southern Africa, like South Africa, Swaziland, Lesotho, etcetera, of 1,000 cases per 100,000 - so, many times higher than what you find in rich countries," he said. The two Geneva-based organizations held a press conference Monday highlighting the urgent need for funds to combat the TB crisis.

They say an extra $1.6 billion in international funding is needed annually for the treatment and prevention of the disease. By filling the gap, it says treatment could be provided to 17 million TB and multidrug-resistant TB patients, and save 6 million lives between 2014-2016. Raviglione said about 60 percent of the $1.6 billion would be for WHOs Africa region.

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waltky · Mar 23, 2013

DR-TB on the rise in Europe...

Drug-Resistant TB Threatens Europe
March 22, 2013 In wealthy regions of the world like Western Europe, the infectious disease tuberculosis often has been seen as a health problem of the past - a deadly bacterial illness, but one that can be cured with antibiotic treatment. Now health experts say drug-resistant tuberculosis is on the rise: the numbers in Britain increased by 25 percent last year, and in Eastern Europe about one-third of all new TB cases are resistant to the key front-line drugs.

The Olallo Project in Central London was set up to help homeless people from Central and Eastern Europe get back on their feet by helping them find a place to live and get a job. The charity has evolved, though, to serve another pressing need - tackling tuberculosis among Britains migrant community.

A man (L) is x-rayed to detect tuberculosis during a medical examination, organized by the Belarusian Red Cross society, in Minsk, Jan. 29, 2013.

Tough medicine

Rimgaudas Planecinas from Lithuania has just finished an extended 18-month treatment to fight multi-drug-resistant TB, or MDR-TB. He found it difficult to describe the experience. Planecinas said the treatment made him unwell and affected his vision. He said he still suffers, even now that the treatment has ended. He said he has trouble with breathing and weakness. He still feels weak, he said. In 2011, more than 400 cases of drug-resistant TB were reported in Britain. Compared to other parts of the world, it may not sound like a lot, but it was a 26 percent rise from the previous year.

David Barratt, manager of the Olallo Project, said TB seems to become tougher to beat every year. For the last few years the prevalence of multi-drug-resistance cases has been growing. We opened up the service just over a year ago now, initially expecting it to be for clients with normal TB looking for six months treatment," said Barratt. "And out of 14 referrals, 13 of them have had multi-drug-resistant TB.

Person-to-person transmission
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waltky · Mar 23, 2013

Many first-choice antibiotics no longer work against some strains of the tuberculosis bacterium...

'Visionary' leadership needed on TB
23 March 2013 - Plans to tackle tuberculosis are failing and a new visionary approach is needed, according to an international group of doctors and scientists.

There is mounting concern that a rise in "virtually untreatable" tuberculosis poses a threat to countries around the world. Writing in the Lancet medical journal, the group said governments were "complacent" and "neglectful". It called for countries to do more to tackle the problem. The World Health Organization says nearly nine million people become sick and 1.4 million die from tuberculosis each year.

Resistance

Some countries are facing problems with drug resistance, with many first-choice antibiotics no longer working against some strains of the tuberculosis bacterium. It is particularly acute in some parts of eastern Europe and central Asia, where up to a third of cases can be multi-drug resistant, known as MDR-TB. The number of laboratory-confirmed cases of MDR-TB around the world has gone from 12,000 in 2005 to 62,000 in 2011. However, the real figure is thought to be closer to 300,000.

An even more stubborn version, resistant to more antibiotics, is called extensively drug-resistant tuberculosis and has been detected in 84 countries. "With ease of international travel, and increased rates of MDR tuberculosis in eastern Europe, central Asia, and elsewhere, the threat and range of the spread of untreatable tuberculosis is very real," the report said.

It argued that countries had spent decades being complacent in their response to the infection and that a "major conceptual change and visionary global leadership" were needed. "To prevent further cases of multi-drug-resistant and extensively drug-resistant tuberculosis, a radical change in political and scientific thinking, and the implementation of specific measures worldwide, are needed. "The global economic crisis and reduced investments in health services threaten national tuberculosis programmes and the gains made in global tuberculosis control."

Tackling poverty
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waltky · Mar 30, 2014

Cats Spread TB To 4 People...

First cases alert: Cats spread TB to four people
Friday 28 March 2014 ~ Two people have developed tuberculosis (TB) after coming into contact with a domestic cat, in the first ever recorded cases of cat-to-human transmission, Public Health England (PHE) has said.

The cat was infected with the Mycobacterium bovis (M.bovis) bacteria, which causes bovine TB in cattle and other animals. Nine cases of M. bovis infection in domestic cats in Berkshire and Hampshire were investigated by the Animal Health and Veterinary Laboratories Agency (AHVLA) and PHE last year. PHE said there have been no further cases of TB in cats reported in the two areas since March 2013, and said it believed the risk of transmission from cats to humans was very low. The organisation said it had offered TB screening to 39 people identified as having had contact with the nine infected cats, with 24 people accepting. Two were found to have active TB in their systems, and are responding to treatment. There were two additional cases of latent TB, meaning the people had been exposed to TB at some point but did not have an active infection.

Analysis of the samples of active TB from the humans and the infected cats by the AHVLA showed the M. bovis was indistinguishable. This indicates transmission of the bacterium from an infected cat, PHE said. In the cases of latent TB infection, it was not possible to confirm if they were caused by M. bovis. According to PHE, transmission of the bacteria from infected animals to humans can occur by inhaling or ingesting bacteria shed by the animal or through contamination of unprotected cuts in the skin while handling infected animals or their carcasses.

Dr Dilys Morgan, head of gastrointestinal, emerging and zoonotic diseases department at PHE, said: It's important to remember that this was a very unusual cluster of TB in domestic cats. M. bovis is still uncommon in cats - it mainly affects livestock animals. "These are the first documented cases of cat-to-human transmission and so, although PHE has assessed the risk of people catching this infection from infected cats as being very low, we are recommending that household and close contacts of cats with confirmed M. bovis infection should be assessed and receive public health advice." TB is a serious condition but can be cured with proper treatment, namely antibiotics taken for at least six months. The disease mainly affects the lungs but can affect any part of the body, including the bones and nervous system. Typical symptoms include having a persistent cough for more than three weeks that brings up phlegm (which may be bloody), weight loss and night sweats.

People can also experience a fever, tiredness and fatigue and a loss of appetite. Usually, TB only spreads after prolonged exposure to someone with the illness, such as living in the same house. In 2012, 8,751 cases of TB were reported in the UK. Mike Mandelbaum, chief executive of the charity TB Alert, said: In the UK we are a nation of cat lovers, so this may prove quite shocking for people who may now look at their pets in a different light. "Although I would stress that the risk of catching TB from a cat is likely to remain very low, this is a stark reminder that TB is still a problem in the UK today, with almost 9,000 people developing it last year. "As TB is airborne, the best way to control the spread of all forms of this curable illness, including those transmitted by animals, is for it to be diagnosed and treated as early as possible."

http://www.independent.co.uk/news/u...et-cats-spread-tb-to-four-people-9220060.html
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waltky · Nov 3, 2015

'Double whammy' of diabetes and TB...

Call for action against 'twin scourge' of diabetes and TB
3 November 2015 - More needs to be done to tackle a dual threat of patients having both tuberculosis (TB) and diabetes, global health experts say.

A declaration made at a summit in Indonesia warns that the convergence of the two illnesses represents a "looming co-epidemic". The statement calls for greater co-ordination in testing and treating diabetes and TB. Experts say progress in this area has not been fast enough. Six countries projected to have significant numbers of diabetes patients - China, India, Brazil, Indonesia, Pakistan and Russia - are also classed as having a high burden of TB. Diabetes weakens the immune system and triples the risk of people developing TB. Patients also respond less well to TB treatment and are more likely to have the infection recur.

Gangrene

Prof Anthony Harries, from the International Union Against TB and Lung Disease (The Union), said: "There's evidence that if we treat diabetes and TB, we reduce the risk of these poor outcomes. "In India, for example, there's a national policy for TB patients to be screened for diabetes. "But it's only been implemented in a couple of southern states. "The TB world tends to have good monitoring systems - and they are already used to giving people blood tests for HIV. "Many people with diabetes don't know they have it, so this is one small way of identifying some of them. "We have more work to do to persuade diabetes doctors to screen for TB. "They don't always perceive it as a huge issue, because they are more worried about eye problems and gangrene. "The general situation is better than five years ago, when nothing was being done. "But we still need more action. I'm confident and optimistic this will happen."

Dual threat

A document launched in 2011 by The Union and the World Health Organization says TB patients should be screened for diabetes. It also calls for diabetics to be screened if they live in countries which have a high burden of TB. This is defined as more than 100 cases of TB per 100,000 of the population - which is the case in some London boroughs. Anders Dejgaard, who runs the World Diabetes Foundation which also signed the declaration, said: "Healthcare systems must prepare to deal with this challenge. "It is most severe in low and middle-income countries. "We need to ensure that healthcare professionals are equipped to diagnose and take care of these two diseases as they increasingly appear together in the same patients." The declaration was made at a meeting in Bali which aims to highlight the dual threat, ahead of a conference about TB in Cape Town next month. Data from an Indian initiative was presented, showing that out of 52,000 people screened in the past year, a quarter who had TB also tested positive for diabetes.

http://www.bbc.com/news/health-34702351
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waltky · Dec 3, 2015

TB treatment focuses on children...

New Tuberculosis Treatment Aimed at Children
December 02, 2015 Researchers at the annual Union World Conference on Lung Health on Wednesday announced the debut of a child-friendly tuberculosis treatment a move they hope will strike a serious blow in the fight against this often-deadly disease. It sickens at least 1 million children a year, according to the World Health Organization.

Dr. Mel Spigelman, president and CEO of the TB Alliance, an international nonprofit organization, told VOA the treatment is a major advance. "For the first time, we have appropriate treatment for the million children who have tuberculosis, with a formulation of drug that is easy for kids to take, that tastes good and that will hopefully make the disease much easier to treat," Spigelman said at the conference in Cape Town. Until now, children have been given cut-up adult pills, which they often reject because of the bad taste, the doctor said. The new medicine is dissolvable in water and comes in flavors like strawberry and raspberry in precise doses.

Anwar, 4, gets treated for tuberculosis at the Kashi Vidyapith block hospital near Varanasi, India, Feb. 1, 2014. The country has the worlds highest incidence of TB. Researchers have unveiled an affordable, child-friendly medicine to combat the disease.

The treatment was developed with the help of international aid groups including the World Health Organization and the U.S. Agency for International Development. Spigelman said thats because major pharmaceutical companies have little financial incentive to develop medicine for TB, which is largely a disease of the poor. "TB is a disease that is intimately linked with socioeconomic status," he said. "Its intimately linked with poverty, with crowding, with poor nutrition." The airborne respiratory illness remains one of the worlds biggest killers, despite the fact that nearly all cases can be cured, the WHO says. It reported 1.5 million TB deaths in 2014; of those, 140,000 were child victims.

Evidence of failures

Speigelman noted that TB also lacks high-profile champions. To illustrate his point, Speigelman referred to perhaps the most famous TB patient, Fantine, the fictional peasant-turned-prostitute in French author Victor Hugos 19th century novel, Les Miserables. But Dr. Lucica Ditiu, executive director of the Stop TB Partnership in Geneva, said TB is a very modern threat. She said the disease is on the rise, with the emergence of multiple drug-resistant strains.

Researchers are lauding a new tuberculosis treatment aimed at children. The medicine is affordable, flavorful and easy to swallow.

"TB is coming back. And TB's coming up is a sign of global failure, because TB is a sign of poverty, and misery and lack of nutrition and lack of basic things and people living in bad conditions and being so desperate or unwell that health remains as the last of their priorities," she said. She urged international donors and leaders to do more and invest more to fight the disease.

http://www.voanews.com/content/new-tuberculosis-treatment-aimed-at-children/3084468.html
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waltky · Dec 22, 2015

MR-TB on Obama's agenda...

White House releases plan to combat multidrug-resistant TB
Dec. 22, 2015 - The plan includes increased investment into research and development for treatment.

The Obama administration announced a plan to help combat multidrug-resistant tuberculosis in the United States and around the world, which it calls an advancement of previous plans to work with the World Health Organization to reduce overall cases and deaths caused by TB. While about 100 cases of MDR-TB are found in the United States each year, it affects nearly half a million people around the world annually. More than 9.5 million people develop active tuberculosis infections every year, according to the WHO, which recently reported TB passed AIDS as the leading global cause of death. "The National Action Plan is an effort to articulate a comprehensive strategy, and to mobilize political will and additional financial and in-kind commitments from bilateral and multilateral donor partners, private-sector partners, and governments of all affected countries," according to a White House press release.

Tuberculosis is a lung disease spread through the air from person to person. While there are less than 100 reported cases of multi-drug resistant TB in the United States, cases are increasing other places and the disease is leading global cause of death overall.

Obama's National Action Plan is built on three goals: strengthening domestic capacity to combat MDR-TB; improving work with other countries to better combat MDR-TB; and accelerating research publicly and privately in the United States to better fight MDR-TB. Just under 10,000 cases of tuberculosis were reported in the United States in 2014, according to the Centers for Disease Control and Prevention, which represented a decrease from 2013, but was the smallest year-to-year decrease in a decade. Overall, TB has been declining in the United States for 20 years, and fell below 10,000 for the first time in 2012.

The 3- to 5-year plan is in line with the WHO's global strategy to reduce tuberculosis around the world, and comes weeks after the global organization announced the most recent statistics on the infectious lung disease. "The [WHO] report shows that TB control has had a tremendous impact in terms of lives saved and patients cured," WHO Director-General Margaret Chan said at the time. "These advances are heartening, but if the world is to end this epidemic, it needs to scale up services and, critically, invest in research."

http://www.upi.com/Health_News/2015...drug-resistant-TB/3881450806680/?spt=slh&or=3
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waltky · Dec 31, 2015

Drug combo to fight MDR-TB...

Drug Combo Could Advance Fight Against Multi-Drug-Resistant TB
December 30, 2015 - The U.S. Centers for Disease Control and Prevention, or CDC, estimates 10 million people became sick and 1.5 million died in 2014 as a result of multi-drug-resistant tuberculosis. Without an effective and aggressive treatment strategy, the number of cases could rise to 75 million worldwide by 2050.

A new study concludes that a combination of at least six drugs may be needed to combat the growing health menace.
Multi-drug-resistant tuberculosis bacteria. (Credit: U.S. Centers for Disease Control and Prevention)Multi-drug-resistant tuberculosis bacteria. (Credit: U.S. Centers for Disease Control and Prevention) "If we don't act promptly, if we don't act now, then the problem of drug-resistant TB will just get worse," said Peter Cegielski, team leader for Drug-Resistant TB and Infection Control in the global TB branch at the CDC.

A doctor examines chest X-rays at a tuberculosis clinic in Cape Town, South Africa

Cegielski says that when a person is infected with multi-drug-resistant or MDR TB, the bacterium that causes the disease does not respond to two gold-standard drugs for treating the illness: isoniazid and rifampicin. So doctors turn to a cocktail of many more-expensive but less-effective drugs. How many drugs should be in that cocktail was the focus of a study led by Cegielski.

Multi-drug-resistant tuberculosis bacteria

Six over five

Currently, the World Health Organization recommends that five drugs be administered simultaneously. But the study, conducted at 26 sites in nine countries, found that using six drugs could provide a necessary boost in efforts to defeat MDR-TB. Participating countries included Russia, South Africa, Taiwan and Estonia. Among the 1,100 adult patients in the study with MDR-TB, those who received six potentially effective drugs saw a 36 percent greater likelihood of responding to treatment compared with those who received five or fewer drugs. The findings were published in the journal PLoS Medicine.

An inmate sits in the multi-drug-resistant tuberculosis ward in a prison hospital in Russia.

Conducting pre-treatment testing also helped to determine which drugs were most likely to be effective against resistant TB infections, according to Cegielski. "So, it was clear from this work that more testing for drug resistance, and especially testing for the full range of drug resistance, would be important so that physicians can choose the most effective drugs based on those laboratory results," he said. The WHO is now encouraging doctors around the world to do drug-sensitivity testing prior to treating their MDR-TB patients, Cegielski said. Meanwhile, the Obama administration unveiled an action plan to bring resources to bear in the prompt identification and treatment of patients infected with multi-drug-resistant tuberculosis.

http://www.voanews.com/content/drug...against-multi-drug-resistance-tb/3125069.html
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waltky · May 13, 2016

Shorter treatment 'will help tackle' TB...

Shorter treatment 'will help tackle' drug-resistant TB
Thu, 12 May 2016 - New guidelines from the World Health Organization aim to speed up the treatment of multi-drug resistant tuberculosis (MDR-TB).

The advice from the World Health Organization (WHO) should reduce treatment to around nine months. Currently, it can take as long as two years - and many patients fail to complete what can be a burdensome course. Doctors urged countries to implement the guidelines quickly. Conventional treatment can involve thousands of pills and daily injections. Deafness is one of the main side-effects. Cure rates are as low as 50% because patients abandon treatment, leading to further problems with resistance. The WHO is also recommending a faster test for MDR-TB, which gives results within two days - compared with the current three months.

Tuberculosis lungs x-ray

It hailed the guidelines as a "critical step forward". Around 5% of TB cases are thought to have resistance to the two most effective drugs. This translates into 480,000 cases worldwide - and 190,000 deaths from this form of TB every year. Many patients are not being identified. The shorter treatment plan costs less than $1,000 per patient - compared with conventional treatment which costs $2,400 for the medicines alone. The International Union against TB and Lung Disease and Medecins Sans Frontieres have been involved in trials of the new treatment method in Bangladesh and nine African countries, which have influenced the WHO's decision. The Union hailed today's advice as "an historic moment".

Cases 'driven underground'

Its senior vice president, Dr I D Rusen, told me: "When we first saw evidence about the shorter regimen, back in 2007, it was almost too good to be true. "Then further results which were consistent were presented at our conference late last year. Next year we'll have more evidence from a head-to-head trial comparing the two treatment methods. "The shorter treatment plan uses different doses of existing drugs which were previously used for leprosy. "So we hope there will be time for production to scale up, while countries get systems in place for the new guidelines, although it's possible there could be some supply issues."

David Lister, an MSF TB Doctor working in Uzbekistan, co-ordinated one of the studies and described the huge difference it made. He said: "The prospect of two years of TB treatment drives parents to hide their children from treatment, teenagers to abandon their ambitions and adults to decide between providing for their family or getting healthy. "The fear of relentless suffering due to side-effects manages to outweigh any hopes of cure and returning to a normal life. "But when I say, 'it's only nine months' they say, 'I can do that'."

http://www.bbc.co.uk/news/health-36271084
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waltky · Sep 27, 2016

Children's TB drug launched in Kenya...

TB drug designed for children launched in Kenya
Tue, 27 Sep 2016 - Kenya launches the world's first child-friendly drug, raising hopes for thousands affected by the world's deadliest infectious disease.

The new pill is a combination of three drugs used to treat tuberculosis, mixed in the right dosage, and is fruit-flavoured to appeal to children. Until now, the global TB Alliance says pills designed for adults have been split to get the dosage for children. Every year, about a million children fall ill with TB, which is the world's deadliest infectious disease. In 2014, an estimated 140,000 children died of TB, according to global figures from the World Health Organization (WHO). Kenya is the first country to roll out the new drug nationally, with more countries expected to follow over the next three years.

Experts say the new treatment will be more effective because the components have been measured accurately and the pill is not bitter-tasting. What is it like to live in a TB hotspot? Anne Soy, BBC Africa health correspondent: At Majengo slum in Kenya's capital, Nairobi, a dark corridor leads to Helen Chebet's one-roomed home, where she lives with her family of six. The mud-walled building, reinforced with rusty iron sheets, has very few windows and the only source of natural light in the space she rents comes from a tiny transparent panel installed in the roof. Living conditions like these, crowded and with poor ventilation, are cited as contributing factors to the transmission of tuberculosis.

African boy stands next to medicine tray

This year, both Ms Chebet and her two youngest children were diagnosed with tuberculosis, after several failed attempts to treat for other possible infections. Her 15-month-old daughter Chepkoech was put on a six-month course of antibiotics, which required her to take six tablets a day. Ms Chebet tried to hide the drug in the toddler's food, but her strategy did not work. "One particular drug was difficult to split and dissolve in water... I had to grind it," Ms Chebet says adding that Chepkoech could only stand the bitter-tasting drugs for the first two months.

The new drug dissolves easily in water, making it easier to take every day for the six-month treatment period. "Caregivers can easily give up knowing how difficult it is to give children such medicine," Kenya's head of TB programmes Dr Enos Masini told the BBC. It is not only Kenya, which begins rolling out the drug for free from 1 October, where TB sufferers are expected to benefit. More than 20 countries have expressed interest in introducing the pill, says Dr Cherise Scott from the TB Alliance, the global non-governmental organisation that spearheaded the production of the new drug. "The new child-friendly pill will boost survival," Dr Scott adds. Africa has the highest prevalence of TB of any continent. The global TB death rate has dropped by almost a half between 1990 and 2015, the WHO says.

Tuberculosis symptoms
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