New study questions the effectiveness of a TB vaccine

A new clinical study calls into question the use of a new tuberculosis vaccine for national vaccination programs. The vaccine MVA85A was found to be less effective in treating TB when compared alongside vaccinations for other diseases.

From Reuters Alert Net, writer Kate Kelland unpacks the study for us.

Martin Ota of the Medical Research Council Laboratories in Banjul, Gambia, who led the study, said the data should help doctors work out the best way to integrate the MVA85A into infant immunisation programmes in the future.

"We have a real opportunity to make sure that children are protected ... against tuberculosis by introducing effective and well-timed immunisation programmes," he said in a statement about the study. "This can only be achieved with robust information gathered from well-conducted clinical trials."

Standard childhood vaccinations are routinely given in developing countries as part of a plan known as the Expanded Programme on Immunisation (EPI).

It includes vaccines for diphtheria, tetanus and whooping cough, as well as the current vaccine for TB, Bacille Calmette-Guerin (BCG). The plan helps boost vaccine coverage by cutting the need for repeated visits to health clinics, which are often difficult to get to in poor, rural areas.

Although BCG protects against severe forms of TB in childhood, increasing rates of the disease in adults suggest its effect is not long-lasting.

TB is currently a worldwide pandemic that kills around 1.7 million people a year. The infection is caused by the bacterium Mycobacterium tuberculosis and destroys patients' lung tissue, causing them to cough up the bacteria, which then spread through the air and can be inhaled by others.

UK accused of covering up G-8 failure in TB pledge

Development policy of the UK was attacked today in a medical journal. The writers say that the UK government is covering up the failure of the G-8 to keep its commitment in cutting the spread of tuberculosis.

The G-8 pledged to help cut TB deaths by 50 percent by 2010, but that deadline has passed with only an 11 percent reduction.

From UTV News, we read more about the accusations against the UK.

In a hard-hitting attack on UK policy, published by the Journal of the Royal Society of Medicine, three experts based in Bangladesh say the UK's strategy against the disease is aimed at preventing its spread to the west, rather than tackling the living conditions in deprived communities where TB is endemic.

Bruce Currey, Professor Quazi Quamruzzaman and Professor Mahmuder Rahman, all based at Dhaka Community Hospital in Bangladesh, accuse the UK's department for international development of glossing over the deaths of nearly half a million people.

The Department for International Development's (DfID) factsheet on progress towards the Millennium Development Goals, issued in December 2008, claims that in southern Asia, "progress in halting and reversing the spread of tuberculosis" is "almost met, or on target". It describes mortality as moderate.

"The Crown's term 'moderate mortality' covers up an annual tuberculosis death toll, estimated by WHO, of almost half a million people (460,003), mostly poor, in south Asia," say Currey and colleagues.

The three experts praise the UK's leadership at the G8 meeting in Okinawa in 2000, which pledged to "Reduce TB deaths and prevalence of the disease by 50% by 2010".

But, they say, the commitment was then watered down. The Millennium Development Goals, formulated by the United Nations in September the same year, put tuberculosis in a category with other infectious diseases and committed to "have halted and begun to reverse the spread" of all of them by 2015‚ " five years later than the target the G8 named".

US to announce an increase in contribution to the Global Fund

The Obama Administration is expected to announce an increase in the amount the US contributes to the Global Fund for AIDS, Malaria and Tuberculosis. The US is already the largest contributor to the fund, but will begin giving 4 billion dollars over the next three years.

The 4 billion dollars still falls short of the 6 billion that many advocates were hoping for. The increase from the US will still not be enough to offset the decreases made by other governments during the global economic recession.

The US will call for some reforms to the Global Fund with the new money. The US wants the Global Fund to cut waste and to report to the US on any improvements during the next three years.

From the Wall Street Journal, writer Betsy McKay gives us this further description of the announcement.

The U.S.—the largest contributor by far to the Global Fund, with more than $5.1 billion donated since 2002—is pressing the organization to develop an "action agenda" with timelines and measurements, "so that all parties concerned ... can be held accountable," a senior administration official said Monday.

The U.S. will measure progress annually and as it considers contributions beyond 2013, the official said.

The Global Fund accounts for a quarter of international financing to combat HIV/AIDS, and the bulk of funds to fight tuberculosis and malaria. It is seeking to attract at least $13 billion, and as much as $20 billion, from more than 40 countries, private foundations and corporations between 2011 and 2013. Pledges for the past three years totaled $9.7 billion.

Global Fund officials welcomed the anticipated U.S. pledge and the push for reform. "We look forward to working with the U.S. to further enhance reforms we're already undertaking and to listen to any other suggestions for improvements," a spokesman said.

The U.S. pledge represents a 38% increase over the $2.9 billion it contributed between fiscal 2008 and fiscal 2010. Though it has been made for multiple years rather than on an annual basis, the pledge will be subject to Congressional appropriations each year.

Tuberculosis success in Nepal

Nepal has one of the most successful tuberculosis fighting programs in the under-developed world. In 1990, only 45 percent of people were cured of TB, now it up to 90 percent. In addition, Nepal has also seen improvements in other health factors such as malaria, maternal health, and AIDS.

Nepal achieves this health success through a centrally located strategy from its government. Instead of having several NGOs run their own programs within the country, Nepal asks for them to instead donate the money to their own health program.The Doctors in charge of the program also demand constant improvement in health results.

From the Guardian, writer John Donnelly is traveling with the World Health Organization to report on Nepal's progress.

Here, however, the government announced just last month that it would be working with donors in a new way – with three groups, DfID, the World Bank, and the GAVI Alliance – funneling money directly into a pooling arrangement for better maternal and child health. The hope is that the arrangement will reduce duplication and lead to better health outcomes. (And the government could even improve its performance: In the past year around 30 health ministry workers, including senior leaders, have attended workshops put on by the Ministerial Leadership Initiative for Global Health on how to better negotiate with donors).

In TB control, the government has cooperated closely with partners for several decades. But it wasn't until 1996 that things started to work well. That's when Nepal became one of the first countries in Asia to introduce the DOTS strategy, which calls for health workers to observe patients take their TB medicine every day for at least six months. It wasn't easy in a country as poor with so many remote villages, but strong central leadership at the time from the energetic Dr Dirgha Singh Bam and Dr Ian Smith, who later became WHO's first medical officer in Nepal – helped to build a national programme.

In the early 1990s, just 45% of TB patients were cured; today, that figure has doubled to 90%. Twenty years ago, a couple of hundred health facilities oversaw TB treatment; today, more than 4,000 sites, including tiny health posts in the mountains, administer the anti-TB drugs.

That's all positive, but health leaders remain concerned about new problems. There's HIV-TB co-infection; an estimated 40,000 people each year contract TB, which isn't much less than 15 years ago; and those with multiple-drug resistant (MDR) and extensively drug resistant (XDR) types of TB can't go to isolation wards because there are none.

So patients with MDR and XDR-TB walk into centres every day, and then go back into the community. Authorities wouldn't allow that to happen in London, or in many places around the world.

Putting people to jail because of tuberculosis

In an effort to stop the spread of tuberculosis, the government of Kenya puts some of the infected people in prison. The goal of this is to keep people on their medications, for stopping to take the pills could lead to drug-resistant infections of TB.

Advocates say that jailing those who are only sick is still a gross violation of human rights. Those who are in jail just to be kept on their medication regimen are in the same cell as criminals and cannot get the needed nutrition to fight TB.

From the IPS, writer Susan Anyangu-Amu takes a look at this sad practice.

Daniel Ngetich and Patrick Kipngetich are presently cooling their heels in a government of Kenya prison; unless a court orders otherwise, they will remain there for eight months until they finish their TB treatment.

Henry Ngetich, who was also arrested for defaulting on his treatment, was lucky enough to end up in hospital because he is in critical condition.

The move by the Kenyan government to arrest and incarcerate TB sufferers has been castigated by human rights organisations who term it a violation of their rights.

"Everyone has a right to quality medical care and this must be provided with dignity and respect," said Pascaline Kang’ethe the national coordinator, rights to health and HIV/AIDS at ActionAid International Kenya. "This is a case of discrimination and the move is bound to cause others in need of treatment to shy away fearing arrest."

Nelson Otwoma, the chief executive officer of Network of Persons Living with HIV/AIDS, said the two men are being held in prison in deplorable conditions and do not have access to the proper nutrition that is required for TB treatment.

"When we visited, we found them being held in the same room as other prisoners. They were not in isolation. To make matters worse they are being treated like common criminals and are handcuffed and under armed guard," Otwoma said.

Speaking to IPS, the head of the National Leprosy and TB control programme, Joseph Sitienei defended the government's action, saying they had acted to safeguard the interest of others after receiving complaints from family members.

"The public health officer in that region acted within law under the public health Act section 27 – which authorises him to take necessary action including detaining infectious patients to prevent the spread of a disease," Sitienei said.

New test can give tuberculosis results in two hours

A new test for tubercolosis can bring results within two hours according to a new study. The test can also check for drug resistant forms of the disease and is faster than any other test available.

From Reuters, writer Kate Kelland tells us about the study results.

In a study in the New England Journal of Medicine (NEJM), researchers said that when used on 1,730 patients with suspected TB and suspected drug-resistant TB, the Xpert MTB/RIF test successfully identified 98 percent of all cases.

It also identified 98 percent of patients with a form of TB resistant to rifampin, or rifampicin -- one of the most powerful TB drugs -- and achieved these results in less than two hours.

Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases described the test findings as "impressive" in terms of speed, accuracy and sensitivity.

"Within two hours, you can not only have a diagnosis, but you can also have a good idea of the range of drugs you can use," he told Reuters, adding that such capabilities were "unheard of" with current testing methods.

Doctors say current diagnostic testing for TB -- which involves microscopy in labs with trained experts and can take weeks -- has barely been improved in the last 125 years.

Tests for drug-resistant TB can take months and are notoriously insensitive, so new, more accurate tools to rapidly diagnose TB and its drug-resistant forms are urgently needed.

UN efforts to fight tuberculosis are not working

A new study published in the UK medical journal "The Lancet" says that the the way the World Health Organization fights tuberculosis is ineffective. There are more cases of TB that at any other time in history and the disease resulted in 2 million deaths last year. The journal article is calling on the WHO to use new tactics to fight the disease in addition to prescribing drugs to patients.

From this Associated Press article that we found at Google News, writer Maria Cheng tells us more about what "The Lancet" has to say.

For years, the World Health Organization and partners have fought TB largely with a program where health workers watch patients take their drugs — even though the agency acknowledged in a 2008 report that this treatment program didn't significantly curb TB spread.

Experts said TB isn't only a medical problem, but is intertwined with poverty, as it spreads widely among people living in overcrowded, dirty places. They said TB programs need to go beyond health and include other sectors like housing, education and transportation.

Some officials questioned whether continued U.N. programs could even combat TB. "The main priority for TB control is improved living conditions and economic growth, which is outside the control of the U.N.," said Philip Stevens, a health policy expert at International Policy Network, a London-based think tank. "TB cannot be tackled in isolation."

Stevens said the global health community also needs to be more vigilant about the drugs they buy for TB programs. According to a 2007 report from the Global Fund to fight AIDS, Tuberculosis and Malaria, half of the drugs the fund bought for poor countries didn't comply with their own drug quality standards.

Dr. Mario Raviglione, head of WHO's TB department, said the recent fall in TB was "very minor" and that the agency was trying to understand how better to fight the epidemic.

Still, WHO said their basic TB programs cured more than 36 million people between 1995 and 2008, and saved up to 6 million from dying of the potentially fatal lung disease.

Cases of drug resistant tuberculosis reach new highs

A new report from the World Health Organization says that cases of drug resistant tuberculosis is running at an all time high. As the cases of TB resistant to drugs increase, it also increases the chances of tuberculosis spreading out of control. The highest levels of drug resistant TB cases are found just outside of the European union.

From the Guardian, writer Sarah Boseley gives us more details on the WHO report.

The report shows that one in four cases in parts of Russia are drug-resistant. The WHO estimates that 440,000 people worldwide had multi-drug-resistant forms of the disease (MDR-TB) in 2008, the last year for which there are complete figures, and that a third of them died. MDR-TB is defined as cases in which the two most commonly used and most effective drugs, isoniazid and rifampicin, do not kill the bacteria causing the disease.

More alarming is extensively drug-resistant tuberculosis (XDR-TB), which was first identified in 2006 in a small group of people with HIV in South Africa, almost all of whom died. It is resistant not only to the two basic drugs but also to the second-line antibiotics, including fluoroquinolone, amikacin, kanamycin and capreomycin.

In poor areas such as KwaZulu-Natal, where XDR-TB was first seen, aggressive chemotherapy treatment lasting two years, which can still save lives, is unavailable.

The report warns that not enough is known even about the extent of drug-resistant TB and that the cost of checking the spread of the disease will be high.

Not all countries have the surveillance systems to pick up cases of XDR-TB, but in the 40 that were able to submit data to the WHO, 5.4% of all their drug-resistant cases were XDR-TB. In eight countries, such strains accounted for 10% of all resistant cases. So far, 58 countries have confirmed at least one case of XDR-TB.

Drug resistance in general is running at an all-time high, at 3.6% of all TB cases. Almost half of all the cases are in China and India. In 2008, an estimated 150,000 people died of drug-resistant TB.

A new tuberculosis detector

One of the problems of detecting tuberculosis in patients is that test results for the disease can take weeks to finish. Researchers in Colorado have developed a portable TB sensor that can give test results in minutes. The prototype was built out of scrap electrical parts from CD and DVD players. The researches hope the device will give patients their life saving drugs sooner.

Tuberculosis claims two million lives a year, most of those come from the under-developed world.

From Scientific American writer Adam Marcus describes the device to us.

This "field friendly" device relies on readily available and relatively low-cost components and can find the lethal pathogen in blood in just 20 minutes, says Diego Krapf, an applied physicist and assistant professor of engineering at Colorado State University in Fort Collins, who designed the new device. That is far faster than conventional methods such as sputum tests, which examine secretions from the lungs and bronchi and can take days—sometimes weeks—to return results. The new detector can identify active infection as well as dormant, or latent, microbes that might one day flare up into full-blown illness, the developers say. It also can distinguish between patients who carry TB and those who once were infected but have successfully fought off the illness.

"Our detector senses proteins, not an immune response against them," Krapf says. "The benefit of doing this is that while proteins mark the presence of disease, antibodies remain in the organism after the disease is long gone." So the new approach greatly reduces the chances of false positives.

A portable detector would greatly aid efforts to fight the infection in developing countries, particularly parts of Asia and Africa where as much as 40 percent of the population carries the microbe, says Robert Belknap, a physician and TB expert at the Denver Health Medical Center in Colorado. "If it works, it's truly portable and doesn't require special conditions, it would be a tremendous advance," he adds.

The device could overcome a few key failings of conventional TB screening. Long delays, in some cases up to six weeks, between test and result often force public health workers to waste time and resources on people suspected of having the infection but who, in fact, do not. Potential patients are frequently isolated—from their children, colleagues and others—for fear that they may spread the disease.

Those suspected of having TB may also be given potent antibiotics as a precaution—drugs that can cause serious side effects, including vomiting, headaches, rash and drug-induced hepatitis (liver inflammation). For these drugs to be effective, and to prevent the body's development of resistant bacteria, patients must take the medications on a strict schedule and complete the regime. The consequences of straying from the regimen are so high that public health authorities try to monitor TB patients to make sure they take their pills, an approach called directly observed therapy. Such programs require substantial money and manpower, and often fail for lack of both.

"An accurate, rapid, point-of-care test would help public health workers better focus resources quickly on the individuals who need it—including providing directly observed therapy—and avoid unnecessary medications and isolation in those who don't," Belknap says.

Study says to treat tuberculosis and AIDS at the same time

A new study about treating tuberculosis and AIDS has already changed treatment guidelines from the World Heath Organization. A study conducted in South Africa finds that patients who have both tuberculosis and AIDS have a better survival rate if the diseases are treated at the same time.

Most doctors have been choosing to treat TB first, because of drug side effects and adverse interactions. AIDS patients have to take a large number of pills to fight AIDS, while TB only requires one. Another reason that tuberculosis is ofter treated first is simply because tuberculosis can be diagnosed immediately, while an AIDS diagnosis waits for test results from a lab.

From this Reuters article, writer Gene Emery details the study's results further. The study was published in the New England Journal of Medicine.

About 33 million people worldwide are infected with HIV, the AIDS virus, and 9.2 million have recently been diagnosed with lung-destroying tuberculosis, according to the World Health Organization.

In many cases, HIV's suppression of the immune system allows the deadly tuberculosis bacterium to thrive. In South Africa, about 73 percent of TB patients also have HIV.

Yet doctors have been reluctant to treat both at once, often choosing to go after TB first. They have been concerned about drug interactions, overlapping side effects and the large number of pills that patients have to take each day.

...
They tested more than 600 patients with both TB and HIV.

The death rate was 5.4 percent a year for the volunteers who got treatment for both infections, compared with 12.1 percent for those whose TB was treated first, with HIV therapy beginning about six months later.

The results were so convincing that they already prompted the WHO to change its guidelines to call for treating both conditions at the same time.

China vs drug resistant TB

China has large problem with drug resistant tuberculosis. This strain of tuberculosis is usually caused by people stopping treatment, then the bacteria comes back stronger than ever. The problem is large enough in China that it threatens to put a huge dent in the country's health budget.

From the New York Times this Reuters article gives us one example of a TB sufferer and some stats.

Liu Zhongwu, a stonecutter working in southern China, for example, stopped taking his TB medication midway through a standard six-month course in 2007 because it was too costly.

"Even though one or two drugs were free, I had to pay 500 yuan ($73) a month for other drugs (to reduce side effects) and the side effects were bad, I suffered terrible gastric pain and had to stop work, I didn't even have energy to walk," said Liu.

It is precisely this sort of behavior that health experts are trying to stop because if the TB bacteria is not fully eliminated, it can mutate, resurge later and become resistant to the small arsenal of drugs that can fight the disease.

China has 4.5 million TB cases currently; and each year 1.4 million people fall ill with the disease. TB killed 160,000 people in China in 2008, according to the World Health Organization.

TB killed 1.8 million people across the world in 2008, or a person every 20 seconds. It is not only a scourge in poor countries but also in the West, where it has flared anew in the last 20 years because of AIDS, which weakens the immune system.

Some facts on tuberculosis

One third of the world's population has the tuberculosis bacterium, that translates to 2 billion people. Yet many people can carry the bacteria and not show any symptoms.

From this Reuters article that we found at the UK's Telegraph, writer Tan Ee Lyn gathered together some statistics on tuberculosis.

Tuberculosis is the world's seventh-leading cause of death. It killed 1.8 million people worldwide last year, up from 1.77 million in 2007. It is one of three primary diseases that are closely linked to poverty, the other two being Aids and malaria.

Some facts about tuberculosis:

* It is spread easily through the air. When infectious people cough, sneeze, talk or spit, they expel the bacteria. Just a small amount is enough for transmission. Someone in the world is newly infected with TB every second.

* Nearly all TB infections are latent, with carriers showing no symptoms and they are not infectious. However, one in 10 will become sick with active TB in his or her lifetime due primarily to a weakened immune system.

* Of the 1.8 million deaths in 2008, or 4,930 deaths a day, half a million were Aids patients. TB affects mostly young adults in their most productive years. The vast majority of TB deaths are in the developing world. More than half occur in Asia.

* The World Health Organization estimates that 9.4 million people developed active TB in 2008, up from 9.27 million in 2007 and 9.24 million in 2006. Among the 15 countries with the highest TB incidence rates in 2007, 13 were in Africa, while half of all new cases were in six Asian countries - Bangladesh, China, India, Indonesia, Pakistan and the Philippines.

* TB is the seventh-highest cause of mortality in poor countries.

A new method of treating tuberculosis in South Africa

A new program started by Medecins Sans Frontieres is helping to make the treatment of tuberculosis easier on it's patients. In South Africa, those sick with TB were effectively quarantined in hospitals to prevent the spread of the virus, but once people realized that they would be locked up for a long time many did not come forward for treatment. The MSF program treats the people in their homes, but they must promise not to leave the homes.

From the New York Times, reporter Celia Dugger explains the new treatment further.

Under South Africa’s current policy, Ms. Vani would normally have been whisked away to a hospital after tuberculosis was diagnosed and isolated from the public for a grueling regimen of toxic, hard-to-tolerate pills and injections, lasting months.

In the neighboring Eastern Cape Province, patients have effectively been imprisoned in a hospital encircled by fences topped with razor wire, and dozens of them have escaped in desperate bids to reunite with their families. Both the Eastern Cape and Western Cape Provinces have sought court orders to compel the return of runaways.

But in this case, Ms. Vani is being treated in a local clinic and lives at home under a pilot program run by Doctors Without Borders and supported by both the city of Cape Town and Western Cape Province. The idea is to show that such patients can be successfully treated in an impoverished community like Khayelitsha even while they are still infectious.

For Ms. Vani to continue in the program, Ms. Beko had to ensure that the young woman could live at home during her treatment with minimal risk of infecting others. Tuberculosis spreads through the air when patients cough and sneeze, and the germs could get trapped in the tiny room where Ms. Vani lives alone.

“They may send you to the hospital, as there are no windows in the house,” Ms. Beko said with a doubtful shake of her head.

Ms. Vani, eager to avoid a long-term hospitalization, promised that she would remain alone in the house and only see friends outside in the open air. “I already told my boyfriend it would not be good for him to sleep over,” she said through a paper mask that covered her mouth.

Drug-resistant tuberculosis is a mounting global health threat. The World Health Organization reported the highest rates of it ever last year. Some 500,000 of the 9 million new cases of tuberculosis in 2007, the most recent estimates, failed to respond to the standard, inexpensive first-line drugs. About 150,000 people died of drug-resistant TB.

Not your usual story about a conference

The 36th International Conference on Global Health started today in Washington, but one of the presenters today had a very unique perspective.

Winston Zulu is a tuberculosis survivor who is also HIV-positive. Zulu's talk was about eradicating tuberculosis to sustain the lives of those who are HIV-positive in Africa. Zulu makes the case that TB damages the immune system and brings those with HIV into AIDS creating a double jeopardy across the continent.

From the Voice of America, reporter Howard Lesser was at the conference to make note of Zulu's remarks.

Zambian-born Winstone Zulu became HIV-positive in 1990 and seven years later contracted tuberculosis. Four of his brothers died from TB, but with careful diagnosis and medication, Zulu survived TB and keeps his HIV in check with a regimen of first-line anti-retroviral drugs (ARV’s). A participant in the Washington conference, he explains that the links between HIV/AIDS and tuberculosis are alarmingly high and require greater international attention.

“It’s very, very important, especially in Africa, where the leading killer of people with HIV is tuberculosis. And basically what that means is that if you see all the statistics that talk about the number of people that have died in Africa from AIDS, and then you factor in TB and say, look, if we would have treated TB, then that would have changed the picture completely. And this is why it doesn’t make any sense to me for anybody in Africa to do AIDS work without putting in TB,” he says.

A growing body of evidence from sub-Saharan Africa points out that coming down with TB severely weakens immune systems and puts the lives of people living with HIV-positive conditions in great jeopardy. Describing himself as a global TB/HIV prescient advocate, Winstone Zulu notes that the unsettling experience of losing four brothers to the same disease is not as uncommon as it may seem in Zambia, where illness frequently claims the lives of multiple siblings within the same family.

Zulu claims it is urgent for healthcare providers to step up treatment and diagnosis of TB.

“I always challenge people and say, look, you can keep people living with HIV alive by treating tuberculosis. And because it’s the leading killer of people living with HIV in Africa, that’s a big achievement,” he observes.

Zulu cites poverty and HIV as the main factors that account for two-thirds of HIV-positive Zambians also suffering from tuberculosis, which readily spreads among people who infect others within a community. Some of the main stumbling blocks in treating TB patients and stopping transmission are inadequate diagnosis and improper medication.

“TB is the only disease that if left untreated, someone can infect 15 others within a year. So treating it also works as a prevention so that others won’t catch it,”

A good primer on Tuberculosis

Today's Guardian has a good article that answers some basic questions about Tuberculosis. Our snippet contains the first few questions, but we encourage you to follow the link to the full article for more. Reporter Ruth McNerney compiled the Q and A.

What is TB?

Tuberculosis (TB) is a disease caused by a small bacterium called Mycobacterium tuberculosis. The most common form of the disease is when it damages the lungs, but it can affect many parts of the body, when it is called extra-pulmonary disease. TB is highly infectious and is usually caught by breathing in bacteria from the air. People with untreated disease in their lungs or throat expel the bacteria as small droplets when they cough, sneeze or even during talking. These tiny droplets can remain suspended in the air for long enough to be inhaled by other people in the vicinity. The bacteria have tough waxy coats and can survive this process. Once inside the lung the bacteria can transfer to other parts of the body. Most people are able to control the infection and do not develop the tuberculosis disease, but between one and two in every 10 infected people will get sick and require treatment. Sometimes it takes years for symptoms to emerge, a condition known as latent TB. It is not understood why some people stay well while others become ill. People with damaged immune systems have a much higher risk of developing tuberculosis disease.
What are the symptoms?

The classic symptom of TB is a cough that gets worse over a period of weeks or months. Other symptoms include fever and weight loss. Coughing blood is a strong indicator of lung damage caused by TB. Tuberculosis can affect many parts of the body and symptoms are non-specific. When it affects the central nervous system, a form of the disease that is often fatal in children, the symptoms include fevers and headaches.
How many people are affected worldwide?

It has been suggested that one third of the world's population has at some time been infected by the TB bacteria. During 2007 there were an estimated 13.7 million people with tuberculosis disease and 1.75 million deaths worldwide. It is a disease of poverty, with less than 10% of cases occurring in the wealthy industrialised countries. The countries hardest hit by the epidemic are those of sub-Saharan Africa, where high rates of co-infection with HIV and weak public health systems have contributed to a dramatic rise in the number of cases.
How big is the problem in Uganda?

It is estimated that during 2007 there were 132,000 people in Uganda with active TB and 29,000 deaths from the disease. The amount of drug-resistant disease is not known. In a recent study undertaken at Mulago hospital in Kampala, of 409 "re-treatment" patients who had not been cured by previous attempts at treatment, 52 were found to have multi drug-resistant TB (MDR-TB).

TB could "spiral out of control"

Officials from the World Health Organization are warning that tuberculosis cases could become drug resistant and "spiral out of control" They say that drugs will be of little help for the most recent version of medicines used to fight TB is 50 years old.

From this McClatchy Newspapers article that we found in the News and Observer, reporter Tim Johnson reports on the warnings issued at a health forum taking place in Beijing.

"The situation is already alarming, and poised to grow much worse very quickly," said Dr. Margaret Chan, director-general of the World Health Organization.

With Bill Gates at her side, Chan urged health officials from 27 countries at a three-day forum on drug-resistant TB to recognize the warning signs of what looms ahead, saying that traditional drugs are useless against some strains of tuberculosis and health care costs for treating those strains can be 100 to 200 times more than for regular tuberculosis.

"This is a situation set to spiral out of control. Call it what you may: a time bomb or a powder keg. Any way you look at it, this is a potentially explosive situation," Chan warned.

Gates, the software magnate turned philanthropist, said scientific overconfidence has led to a lack of innovation and urgency in fighting tuberculosis, which affects nine million people each year, killing nearly two million of them.

"The most commonly used diagnostic test is today more than 125 years old," Gates said. "The vaccine was developed more than 80 years ago, and drugs have not changed in 50 years.'

Later in the day, Gates offered a grant of $33 million to China's ministry of health to finance what he called an innovative pilot program for TB prevention that could be used in other nations. The program uses new systems to reduce pill intake, offers incentives for doctors to monitor TB, and funds development of new diagnostic tests.

China has about 1.5 million cases of TB each year. Under the pilot program, TB patients will get medicine kits with built-in reminder alarms as well as receive cell phone text messages reminding them to take their medicines.

Tuberculosis amongst the homeless in America

Most often the disease tuberculosis is associated with poverty in the under-developed world. But it does exist in America, and our homeless population is often at risk.

From the Stockton Record, writer Jennifer Torres details a new tuberculosis scanning program that is ongoing in California homeless shelters.

Tuberculosis affects far fewer Americans than it does residents of developing countries. Still, the United States has experienced somewhat recent epidemics; the number of tuberculosis cases reported nationally rose sharply in the late 1980s and early 1990s, an increase linked in part to the spread of HIV as well as increased immigration, poverty and homelessness.

Rates of tuberculosis - a contagious disease caused by bacteria, which typically affects the lungs - have dropped in the years since, but progress, at least in California, has slowed.

Now, as poverty continues to spread and funding for prevention programs is threatened, some public health advocates warn that gains in fighting the treatable disease could be lost.

San Joaquin County has the fourth-highest tuberculosis rate in California, according to the most recent data available from the state Public Health Department. It is one of 10 counties with a tuberculosis rate higher than the statewide average of 7.2 cases per 100,000 residents. (That rate, meanwhile, is much higher than the U.S. average of 4.4.)

"I think it's good that they check us for tuberculosis," Carlos Salazar said as he put his public health card back into his wallet and carried his backpack to a bed at the homeless shelter. Salazar, originally from Guatemala, has lived in the United States for 19 years and at the homeless shelter for about two months. "If they find out you have it, you can get the right treatment."

Since fall 2007, single men at the Stockton shelter have been required to be tested for tuberculosis through the county public health office within three days of checking in. If their test comes back negative, they receive a clearance with their photo on it.

Only a couple of donors giving to only a couple of diseases

A new study reveals that when it comes to the diseases of poverty, there are too few donors giving for too few diseases.

The study wanted to determine how much money is spent and who is spending it to battle the diseases of poverty. The study was conducted by the George Institute for International Health, Australia.

The institute finds that 80% of all of the money donated goes to AIDS, tuberculosis and malaria. However, there are 27 different diseases total that effect those in poverty. A vast majority of the money comes from the Bill and Melinda Gates Foundation and the US National Institutes of Health.

TropiKA has the full details on the survey from writer Paul Chinnock.

The failure to provide an equivalent level of support to research on the other 27 diseases also examined in the project is of great concern. The authors of the report say that: “...the concentration of funding on AIDS, TB, and malaria ... suggests that investment decisions are not only influenced by scientific or epidemiological considerations, but may also be influenced by factors such as the presence of PDPs [product development partnerships] or civil society groups with active advocacy, fundraising, and investment activities”.

The project, the ‘G-FINDER survey’ is being conducted by the George Institute for International Health, Australia. According to the report (which appears as a ‘Policy Forum’ article in PLoS Medicine) pneumonia and diarrhoeal illness, which are major causes of mortality in developing countries, received less than 6% of funding. Kinetoplastid diseases such as sleeping sickness, leishmaniasis and Chagas’ disease, which affect more than 13 million people worldwide annually, receive less than 5% of global health funding, amounting to $125 million. Typhoid receives $9 million, 0.4% of total funds. The authors say that the funding provided “was not enough to create even one new product” to address many of these diseases.

Another worrying finding is that the number of donors was limited, with just two funders – the US National Institutes of Health and the Bill and Melinda Gates Foundation – accounting for 60% of the funds provided. These two bodies mainly focus on HIV/AIDS, malaria and tuberculosis. With regard to more neglected diseases, other funders often dominate; for example nearly 90 per cent of funding for the blinding bacterial eye infection trachoma comes from the Wellcome Trust. Such almost total dependency on one donor has been described as an ‘eggs in one basket approach’.

Tuberculosis linked to International Monetary Fund loans

from the New York Times

Oh wow... how did I miss this one. Thanks to Blog The Debt for calling this to my attention

By NICHOLAS BAKALAR

The rapid rise in tuberculosis cases in Eastern Europe and the former Soviet Union is strongly associated with the receipt of loans from the International Monetary Fund, a new study has found.

Critics of the fund have suggested that its financial requirements lead governments to reduce spending on health care to qualify for loans. This, the authors say, helps explain the connection.

The fund strongly disputes the finding, saying the former communist countries would be much worse off without the loans.

“Tuberculosis is a disease that takes time to develop,” said William Murray, a spokesman for the fund, “so presumably the increase in mortality rates must be linked to something that happened earlier than I.M.F. funding. This is just phony science.”

The researchers studied health records in 21 countries and found that obtaining an I.M.F. loan was associated with a 13.9 percent increase in new cases of tuberculosis each year, a 13.3 percent increase in the number of people living with the disease and a 16.6 percent increase in the number of tuberculosis deaths.

The study, being published online Tuesday in the journal PLoS Medicine, statistically controlled for numerous other factors that affect tuberculosis rates, including the prevalence of AIDS, inflation rates, urbanization, unemployment rates, the age of the population and improved surveillance.

The lead author, David Stuckler, a research associate at Cambridge University, defended the study against the fund’s criticisms, noting that the researchers considered whether increased mortality might have led to more loans rather than the other way around.

Instead, they found that the increase in tuberculosis mortality followed the lending; each 1 percent increase in credit was associated with a 0.9 percent increase in mortality. And when a country left an I.M.F. loan program, mortality rates dropped by an average of 31 percent.

Link to full article. May expire in future.

Poverty Leads to High TB Defaulter Rate

from All Africa

BuaNews (Tshwane)

By Gabi Khumalo
Durban

Poverty is among the main reasons for the high treatment defaulter rate among Tuberculosis (TB) patients.

Speaking to BuaNews during the South African TB Conference, currently underway in Durban, TB Free Advocacy Communication and Social Mobilisation Manager, Leko Nkabinde said due to poverty, most people were surviving on social grants they received for their illnesses.

They however deliberately neglected to take their TB treatment as required so that they could continue to receive the grant.

"Poverty levels are so high and some people do not want to be cured in order to continue receiving the grant.

"You find a person continuing to drink alcohol knowing that you can't consume it whilst on medication," said Ms Nkabinde.

She said there was a need for intensive treatment counselling for patients to understand the importance of completing their medication.

They do not take their treatment seriously and as soon as they feel better after two months, they stop taking the medication thinking that they have been cured, Ms Nkabinde told BuaNews.

TB Free is an organisation that was formed in 2004, to increase TB treatment compliance through training of Directly Observed Therapy (DOT) support in the country.

"Our goal is to ensure that every man, woman and child knows that TB can be cured and knows where to go for help."

The organisation, which operates in nine provinces, works with the Department of Health to train people from clinics.

After training, the trainees are sent back to the clinics and are then deployed to the communities to provide DOT support to patients.

The organisation also visits schools spreading TB messages to learners so that they become foot soldiers.

"Our aim is to increase the TB cure rate by 10 percent and the defaulter rate by 10 percent," said Ms Nkabinde.

Link to full article. May expire in future.