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New Report Identifies Inequalities in Immunization Coverage Worldwide

On Monday, May 21, 2012, ACTION and Save the Children United Kingdom released a report, Finding the Final Fifth: Inequalities in Immunisation, presenting data detailing levels of inequalities in immunization coverage. Despite progress towards global goals, routine immunization still fails to reach nearly a quarter of children, leaving more than 19 million children without access. More than one-third of all unimmunized children live in India alone.

Moving from global inequalities in immunization coverage — noting that children in low-income countries have immunization rates nearly 14 percentage points lower than children in high-income countries, the report also highlights national inequalities in coverage. A poor child in Nigeria, for example, is nine times less likely to be immunized than a rich child. Within countries, children’s immunization status is closely tied to wealth, educational status of the mother, and whether they live in an urban or rural setting.

ACTION partnered with Save the Children United Kingdom to pursue this research in line with our vision of a world where all people achieve their right to access life-saving services. Preventing illness is one of the most cost effective approaches to public health, and ACTION believes in a world where no child dies of a vaccine-preventable death. Currently 17 percent of all child deaths under five could have been prevented with a vaccine that most countries provide for free. Through this report, ACTION details the profile of unimmunized children and finds that they tend to be the most at risk — either due to their distance to health services, the cost of treatment should they get sick, or other compounding factors like being malnourished.

According to UNCIEF, an equity-based approach to child survival is not only the key to achieving Millennium Development Goal 4 of reducing child mortality by two-thirds, but is also cost-efficient and morally just. Relying on national level data can often mask growing inequities at the sub-national level. Reducing child deaths cannot be accelerated without a tailored approach to reaching the unreached.

This week marks the 65^th World Health Assembly where world leaders will decide whether to endorse a Global Vaccine Action Plan (GVAP). While the GVAP cites the importance of equity as a core objective, ACTION believes that much more attention and funding will be needed to realize the goal of reaching every child with basic immunization services. While new vaccines have the immense power of preventing diseases which are the leading causes of death for children under 5, unless we focus on reaching every child with even a basic set of immunizations we will not achieve the impact that matters most — giving every child an equitable chance at leading a healthy, productive life.

Dr. Jim Yong Kim elected as President of the World Bank

On Monday, April 16, 2012, the Executive Board of the World Bank Group named Dr. Jim Yong Kim as its next president. Dr. Kim will assume the role on July 1, succeeding the Bank’s current president, Robert Zoellick. ACTION Director Kolleen Bouchane issued the following statement in response.

Congratulations to Dr. Kim for being selected as the next president of the World Bank Group. The World Bank is the world’s largest international development institution. The job is among the most important — and the most challenging — in the international development arena. As an individual who has dedicated his life to improving the wellbeing of poor communities around the world, Dr. Kim has the right leadership qualities and experience to succeed in the role.

Dr. Kim’s trailblazing work at Partners in Health and the World Health Organization, where he proved that it was feasible to deliver world-class healthcare to impoverished communities in the most neglected and least developed places on the planet, demonstrates that he has both the vision and the drive to lead the Bank in this critical moment. His pioneering research in delivery science shows that he will focus the Bank’s efforts on those activities that will deliver the greatest and most enduring impact. With Dr. Kim’s appointment, today will no doubt be looked back upon as a landmark day in the long fight against extreme poverty. ACTION wishes him the best of success and stands ready to assist him in our capacity as advocates for global health.

ACTION Celebrates Nomination of Dr. Jim Kim to Head the World Bank

ACTION and ACTION Partners

ACTION is thrilled with the nomination of Dr. Jim Yong Kim to head the World Bank. Jim Kim possesses a deep commitment to addressing the political, social, and economic barriers to a more equitable and humane world. 

With over two decades of experience serving the poor in developing countries, and with a powerful record of taking life-saving health strategies to scale, Jim Kim is uniquely well suited to lead the World Bank to deliver on its stated mission of lifting people out of poverty. Jim Kim a physician and anthropologist, was co-founder of Partners in Health a non-profit health care organization committed to providing community based health care, which has served more than 2.4 million people around the world.^[1] In 2004 Kim directed the World Health Organization's HIV/AIDS department and led the "3x5" initiative, which set the bold target of putting three million people on AIDS anti-retroviral treatment by the end of 2005. Critics said it was impossible to expand treatment to millions of people in only a few years, but Kim maintained, "We need to bring a sense of urgency that matches the devastation of the epidemics that we face."^[2] In no small part, because of Kim's early and visionary leadership, 6.6 million people in developing countries now have access to life-saving treatment. 

Kim clearly shares ACTION's vision for global health equity - perhaps the most critical element to achieving the World Bank's mission to reduce global poverty. Kim is also well known for his contributions to fighting tuberculosis, demonstrating that quality, life-saving treatment could be effectively delivered in resource poor settings.

As we approach World TB Day - with proven TB treatment and powerful new tools still under-resourced, and millions still suffering needlessly from a curable disease - ACTION welcomes the opportunity to have such a visionary leader to help tackle the most important challenges of our time.

[1] Partners in Health 2011 Annual Report p.4 http://parthealth.3cdn.net/283c794b2e83589919_b4m62spy6.pdf

[2] http://www.hsph.harvard.edu/now-archive/mar17/

This World TB Day, Global Fund Emergency Donor Meeting Critical for Continued TB Successes

ACTION and ACTION Partners

March 22, 2012 - This World Tuberculosis (TB) Day, ACTION partners around the world will commemorate the day with their attention fixed squarely on world leaders and the need to end the funding crisis of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

ACTION partner organizations and global health advocates from around the world have been calling for an emergency donor meeting ever since the Global Fund Board decided to cancel the next round of funding (Round 11) last November. The G20 Summit in Mexico in June could provide an important opportunity for the Global Fund's existing and new potential donors to convene and recommit to mobilizing sufficient resources for countries to maintain and scale up services. 

For nearly a decade ACTION partners and allies have been working together to raise attention to the global TB epidemic. Our awareness raising on the problems of and solutions to TB has always included our moral outrage that a preventable and curable disease still takes the lives of nearly 2 million people each year. As Congressman Engel from New York noted Tuesday in a Congressional Briefing on Capitol Hill, "The fact that we have not eliminated TB yet is a sin."

Never has the outrage of ACTION organizations and other global health advocates been so strong as in the months since the November cancellation of the next round of funding for the Global Fund. 

"We would like World TB Day to be an annual celebration of progress," notes ACTION Director Kolleen Bouchane. "However, the increasing fragility of continued progress makes such celebration difficult. Instead, organizations in the ACTION partnership continue to press their leaders to end the Global Fund's funding crisis and to change the conversation from the limits of resources to what we can be doing to actually end these diseases."

CITAM+, ACTION'S PARTNER in Zambia, reports that the impact on people living with TB-HIV could be devastating. In Zambia approximately 80 percent of people with TB are coinfected with HIV. In 2010 alone more than 45,000 Zambians were infected with TB[1], an airborne killer that does not discriminate. 

Though Zambia made progress in their TB-HIV response, with 39 percent of co-infected patients receiving treatment, this will be greatly hampered when the country's Global Fund TB grant comes to an end in June 2013.[2] Patients currently on treatment are at risk, and Zambia will not be able to diagnose and treat more people or scale up preventative therapy. 

Carol Nyirenda, Executive Director of CITAM+ noted that "Community organizations in Zambia that play a critical role in the disease response are at risk of closing, leaving thousands without treatment or support services and many without jobs. Hospices that care for HIV+ people will completely shut down without the Global Fund, leaving people literally without the care they have come to depend on. Community health care workers, who help people adhere to treatment and provide support will also be gone. This will increase the risk for drug resistance for people who are currently being treated." 

In total, more than 10,000 TB patients and more than 130,000 HIV patients are at risk in Zambia due to the Global Fund funding crisis.[3]

And that is just one country. 

But there is some progress. Tuesday, in the same Capitol Hill briefing as Representative Engel, Dr. Mario Raviglione of the Stop TB Department at the World Health Organization affirmed that our "next TB target should be zero," and in recent months key donors such as the U.S., UK, Japan, Germany, and Spain have expressed renewed interest in convening to reconfirm their existing pledges and make new commitments to the Global Fund. Without this meeting and a new funding opportunity, it is unclear how disaster can be averted in countries like Zambia.

 This World TB Day, we need to be reminded that zero deaths from TB, the largest killer of those with HIV/AIDS, is within the limits of science. The limits ACTION partner organizations and others continue to push are those of political will and resources. We need to acknowledge the science, change the conversation, eliminate the global health inequities, and save more lives. We need to fund the largest funder or TB programs, The Global Fund to Fight AIDS, Tuberculosis and Malaria.

[1] Unpublished dates STOP TB partnership www.stoptb.org

[2] Ibid

[3] International HIV/AIDS Alliance (2012). Don't Stop Now: How Underfunding the Global Fund to Fight AIDS, Tuberculosis and Malaria Impacts the HIV response. < http://www.aidsalliance.org/includes/Publication/Alliance%20global%20fund%20report_V6.pdf>

Global Fund Welcomes $340 Million Contribution by Japan

The Global Fund to Fight AIDS, Tuberculosis and Malaria

13 March 2012 

Highest Contribution Ever Made by Japan, Leading Supporter of the Global Fund 

Geneva - The Global Fund to Fight AIDS, Tuberculosis and Malaria today welcomed a $340 million contribution by Japan, the highest amount that Japan has ever made in 10 years of vigorous support for the Global Fund. Japan is now making its first payment of US$ 216 million for its 2012 contribution.

"Japan has always been a leader in the fight against disease, but this is a great vote of confidence in our commitment to saving lives," said Gabriel Jaramillo, General Manager of the Global Fund. "We recognize Japan's determination to see real advances in global health, and we are equally determined to deliver."

This new contribution represents a significant increase over Japan's previous highest contribution of US$ 246 million in 2010. In 2011, Japan's contribution was reduced to US $114 million following the earthquake and tsunami that devastated northeast Japan in March of last year, but this new contribution demonstrates that Japan's commitment to the Global Fund remains steadfast.

Former Prime Minister Naoto Kan announced in January at the World Economic Forum in Davos, Switzerland, that Japan would contribute US $340 million as part of its pledge of US$ 800 million to the Global Fund  announced at the third Replenishment Conference in 2010.

Japan's leadership in the Global Fund began when a summit of G8 nations called for the creation of such a global financing organization in 2000 in Okinawa, Japan.

The contribution received this week raises Japan's contributions to the Global Fund to more than US$ 1.6 billion since its creation in 2002.

*****

The Global Fund is a unique, public-private partnership and international financing institution dedicated to attracting and disbursing additional resources to prevent and treat HIV and AIDS, TB and malaria. This partnership between governments, civil society, the private sector and affected communities represents an innovative approach to international health financing. The Global Fund's model is based on the concepts of country ownership and performance-based funding, which means that people in countries implement their own programs based on their priorities and the Global Fund provides financing on the condition that verifiable results are achieved. 

Since its creation in 2002, the Global Fund has become the main financier of programs to fight AIDS, TB and malaria, with approved funding of US$ 22.6 billion for more than 1,000 programs in 150 countries (as of 1 December 2011). To date, programs supported by the Global Fund are providing AIDS treatment for 3.3 million people, anti-tuberculosis treatment for 8.6 million people and 230 million insecticide-treated nets for the prevention of malaria. The Global Fund works in close collaboration with other bilateral and multilateral organizations to supplement existing efforts in dealing with the three diseases.

For more information, please contact:

ANDREW HURST

Acting Communications Director

Mobile: +41 79 561 6807

E-mail: andrew.hurst@theglobalfund.org

Fund to Fight Key Diseases Running Low

Providence Journal
March 1, 2012
Fund to fight key diseases running low
Richard Feachem

San Francisco -- A study just published in the Lancet, a British medical journal, found that malaria killed 1.2 million people in 2010. That is nearly double the World Health Organization's official estimate.

Compounding this tragic news is that the Global Fund to Fight AIDS, Tuberculosis and Malaria - the largest and arguably the most effective financier of malaria control - is running out of money. It has suspended new grants until 2014 - grants that would have provided millions of families with protective bed nets, life-saving medicines and vital health-care services. 

Unless we make a concerted and immediate effort to support the Global Fund, the tremendous gains it has made in the past decade will be lost. The United States should convene an emergency donor meeting to address the Global Fund's resource gaps and ensure that it can operate at full capacity.

Ten years ago, HIV/AIDS, tuberculosis and malaria were crushing burdens on development, killing over 6 million people a year and draining billions of dollars from the global economy. In the developing world, HIV was a death sentence. Only about 50,000 Africans were on anti-retroviral treatment. After five decades of spotty results, aid was still primarily directed by Western technocrats with little accountability for results.

The Global Fund was created in 2002 to change all of this. It had two fundamental goals: to mobilize massive new resources against HIV/AIDS, tuberculosis and malaria, and to shatter old development-assistance models by being transparent, accountable and demand-driven. On both, the Global Fund has been an unambiguous success.

To date, the Global Fund has disbursed $15 billion to programs in 150 countries. These grants have provided 230 million insecticide-treated bed nets and 170 million antimalarial treatments. While the new data have counted adult malaria deaths, increasing the total number of deaths reported, it also shows that these investments have saved more than half a million lives. Taking everything into account, malaria deaths actually decreased, from 1.8 million in 2004 to 1.2 million in 2010. 

Global Fund investments have also provided antiretroviral treatment for 3.3 million people living with HIV/AIDS. Nearly half of all people currently on AIDS treatment in low- and middle-income countries depend in some way on the Global Fund to stay alive.

Further, its grants have let health officials treat 8.6 million cases of tuberculosis, saving more than 4 million lives. Thanks in large part to these efforts, the number of tuberculosis deaths has reached lowest point in 10 years.

Through all of this, the Global Fund has remained true to its founding principles. Grant recipients - not donors - lead the process of identifying and addressing national health challenges. Civil-society groups, public officials and the private sector are equal partners in developing sound proposals and implementing effective programs. Scores of sensitive documents are published online, including extensive and detailed financial information.

This is why the Global Fund's model has been consistently validated by diverse organizations. Just last month, Publish What You Fund, a project of the nonprofit Global Campaign for Aid Transparency, ranked the Global Fund second among 58 donors surveyed for its commitment to transparency. And last year, the Global Fund earned top marks in the Department for International Development's aid review for its "excellent track record for delivering results" that provided, "very good value to the ... taxpayer."

The news of malaria's revised death toll, and the striking downward trend in annual deaths, show that we need the Global Fund now more than ever. Yet instead of planning to end malaria, we are praying that our families and friends survive the next rainy season. 

Instead of creating the AIDS-free generation that President Obama envisions, we face scenarios in which millions now on   treatment may be left for dead. Instead of modeling the elimination of tuberculosis, we are worrying about the rising tide of drug resistance.

 It is time for governments to take an honest look at their foreign-aid programs. They would be hard-pressed to find a better return on investment than what we have seen from the Global Fund. After 10 years, the Global Fund has unequivocally proven to be responsive, innovative and highly effective in its approach to aid. The United States should convene an emergency donor conference to mobilize new resources for the Global Fund. This is an investment we must continue to make. 

Richard Feachem, M.D.(FeachemR@globalhealth.ucsf.edu) is director of the Global Health Group at the University of California at San Francisco and formerly the founding executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

This article ran on page B6 in the print edition of the Providence Journal on March 1, 2012.

NIH to Join Multi-center Clinical Trial of New Tuberculosis Vaccine

Aeras

Aeras leverages US government clinical trial networks designed for HIV research to support TB vaccine development

ROCKVILLE, MD, USA, January 31, 2012  — Aeras announces today that the National Institute of Allergy and Infectious Diseases (NIAID), part of the United States National Institutes of Health (NIH), has joined as a partner for a Phase II proof-of-concept clinical trial of a tuberculosis vaccine candidate jointly developed by Aeras and Dutch biopharmaceutical company Crucell.

NIH has a long history of supporting TB vaccine development. However, this is the first time that NIH is leveraging its HIV/AIDS clinical trial networks to advance a tuberculosis vaccine candidate. Along with the recent announcement of NIAID's new partnership in a Phase III TB drug trial, this collaboration follows the NIAID plan to leverage infrastructure originally intended for HIV-related clinical trials to also advance tuberculosis vaccine and therapeutic research for both HIV uninfected and infected populations.

One-third of the world's population is infected with tuberculosis. Infants and people who are immune compromised, including those with HIV infection, are at higher risk of developing active TB. Safe and effective vaccines hold promise for protecting these at-risk populations.

"NIAID's involvement in this important clinical trial will maximize return on U.S. government investment in clinical research infrastructure while accelerating progress against the world's deadliest infectious disease after HIV/AIDS," said Mary Woolley, CEO and President of Research!America, the nation's largest not-for-profit public education and advocacy alliance committed to research.

The clinical trial, which began in October 2010, has already enrolled infants at three sites in Kenya, South Africa and Mozambique. The goal of the trial is to evaluate the safety and efficacy of vaccine candidate AERAS-402/Crucell Ad35 in HIV-uninfected infants. Significant support for the trial is also provided by the European and Developing Countries Clinical Trials Partnership (EDCTP) and European Member States.

The first NIAID-supported site to join the clinical trial is the Perinatal HIV Research Unit (PHRU) located in Soweto, South Africa at the Chris Hani Baragwanath Hospital. The research site is a member of NIAID-funded clinical trial networks including the HIV Vaccine Trials Network (HVTN), the HIV Prevention Trials Network (HPTN) and the International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT).

"Our novel collaboration with NIAID comes as multiple TB vaccine candidates are poised to enter efficacy trials requiring thousands of participants and significant investment, as well as complex infrastructure and sophisticated expertise," said Jim Connolly, President and CEO of Aeras.

"We are grateful for the partnership of one of the most well-respected biomedical research institutes in the world, and the opportunity to utilize well-established clinical sites," he added.

###

About the Clinical Trial Field Sites

The clinical trial is also ongoing in Kenya led by KEMRI/CDC; in South Africa led by the South African Tuberculosis Vaccine Initiative (SATVI); and in Mozambique led by the Manhica Health Research Centre (CISM). To learn more click on their names to view their websites. 

Follow this link to read more about Phase IIb clinical trials.

About AERAS-402/Crucell Ad35

In 2004, Aeras and Crucell began joint development of this vaccine candidate. AERAS-402/Crucell Ad35 has been tested in 13 completed or ongoing early-stage clinical trials. These trials include healthy adults and infants as well as adults with HIV infection and adults with recently treated pulmonary tuberculosis. The vaccine candidate has been shown to be immunogenic and to have an acceptable safety profile in these studies.

About Tuberculosis

Tuberculosis is the world's second deadliest infectious disease, with 8.8 million new cases diagnosed in 2010. According to the World Health Organization (WHO), an estimated 1.4 million people died from TB in 2010. An estimated one-third of the world's population has been infected with the TB bacillus. Current guidelines require a minimum of six to nine months of treatment. The current TB vaccine, Bacille Calmette-Guérin (BCG), developed 90 years ago and given to newborn infants, reduces the risk of severe forms of TB in early childhood but is not very effective in preventing pulmonary TB in adolescents and adults - the populations with the highest rates of TB disease. TB is changing and evolving, making new vaccines more crucial for controlling the pandemic. Tuberculosis is now the leading cause of death for people living with HIV/AIDS, particularly in Africa. Multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) are hampering treatment and control efforts.

About Aeras

Aeras (www.aeras.org) is a non-profit product development organization dedicated to the development of effective vaccines and biologics to prevent TB across all age groups in an affordable and sustainable manner. Aeras has invented or supported the development of six TB vaccine candidates, which are undergoing Phase I and Phase II clinical testing in Africa, Asia, North America and Europe. Aeras receives funding from the Bill & Melinda Gates Foundation, other private foundations, and governments. Aeras is based in Rockville, Maryland, USA where it operates a state-of-the-art manufacturing and laboratory facility, and Cape Town, South Africa.

About the National Institute of Allergy and Infectious Diseases

NIAID conducts and supports research-at the US National Institutes of Health, throughout the United States, and worldwide-to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. For more information about NIAID visit www.niaid.nih.gov/.

Related Links

• View NIH's press release on the collaboration

Related Stories

• Aeras and Crucell Announce Phase II Clinical Trial Start in Kenya

Zambia-based CITAM+, a Community Initiative for TB, HIV/AIDS & Malaria, Joins ACTION Partnership

ACTION is excited to announce that Zambia-based Community Initiative for TB, HIV/AIDS & Malaria (CITAM+) has joined the ACTION partnership. With the addition of CITAM+, ACTION now consists of nine advocacy organizations based around the world that are dedicated to empowering ordinary people to become sophisticated advocates who profoundly affect their country's political process in order to improve health and save lives.

Executive Director of CITAM+ Carol Nyirenda is a leading international advocate and media spokesperson who has played an important role in advancing policies and increasing funding for TB and health programming in her home country of Zambia, on the African continent, and globally.

As a survivor of TB-HIV co-infection, Carol has tremendous knowledge of the critical needs and challenges faced by low- and middle-income populations. Carol's commitment and knowledge have propelled her into leadership positions on many national and international bodies, to help drive innovative solutions to address health challenges, and to give affected communities a voice and representation in the larger health community.  She has represented affected communities on the boards of UNITAID, the Global Fund to Fight AIDS, TB and Malaria, and the International Union Against Lung Disease and Tuberculosis.

At the country-level, Carol sits on the Board of the Treatment Advocacy and Literacy Campaign (TALC), and is a founding member of both the Coalition of "Zambian Women Living" and "Act Up Lusaka". She also represents TB constituency on the Global Fund Country Coordinating Mechanism (CCM). Through these positions she spearheads national and international advocacy efforts around TB-HIV, one of which resulted in the Zambian government's ultimate decision to implement WHO recommendations for collaborative TB-HIV activities.

Carol worked to establish CITAM+ in 2005, which develops sustainable TB-HIV support groups in and around Lusaka. Through this organization, Carol was instrumental in developing a comprehensive TB-HIV plan, which included community outreach and policy analysis to help ensure HIV groups incorporate TB counseling and services into their programming, and become educated about the growing co-infection epidemic in Zambia. CITAM+ currently holds a seat on the TB/HIV Joint Collaborative Body hosted by the Zambian Ministry of Health.

With the addition of CITAM+, ACTION continues to expand its global reach and improve its ability to fight TB and other global health issues.

ACTION partners selected to serve on new Global Fund for AIDS, TB, and Malaria Committees

ACTION.org

By: Jove Oliver

ACTION is excited to announce that two members of the ACTION partnership, Joanne Carter, Executive Director of RESULTS Educational Fund, and Allan Ragi, Executive Director of the Kenya AIDS NGO Consortium, have been appointed to serve on newly created Global Fund committees. Joanne will act as the Developed Country NGO representative on the Strategy, Investment and Impact Committee (SIIC), while Allan will be the Developing Country NGOs representative on the Finance and Operational Performance Committee (FOPC).

The SIIC and FOPC are two of the three committees created at the Global Fund's Twenty-Fifth Board meeting in Accra, Ghana, as part of a continued effort to reform their governance structure and fully implement recommendations made by the High Level Panel to streamline the committee structure. The Finance and Operational Performance Committee (FOPC) is mandated to provide oversight of the Fund's financial resources and ensure optimal performance in the operations and corporate management of the Secretariat, while the Strategy, Investment, and Impact Committee (SIIC) is chartered to provide oversight of the strategic direction of the Global Fund and ensure the optimal impact and performance of its investments in health.

These appointments, as well as the selection of Lucy Cheshire, a close ACTION ally, as the Communities representative on the SIIC, are an exciting opportunity for ACTION to contribute to the Global Fund's work of increasing efficiency, inclusion, and effectiveness.

"Our ACTION partners have been committed to the life-saving work of the Global Fund since its inception a decade ago." said ACTION Director Kolleen Bouchane. "ACTION is excited to be represented on the new committees by Joanne Carter and Allan Ragi, brilliant leaders within our partnership and on global health. In this moment of funding uncertainly for the Global Fund, just as the end of AIDS has become a real possibility, their work - the work of all those committed to seeing the Global Fund sustain and scale-up - is absolutely critical."

To date, the Global Fund has committed US$ 22.6 billion in 150 countries to support large-scale prevention, treatment and care programs against AIDS, TB, and Malaria.

More information on these new committees can be found here

AIDS 2012: Submit A Workshop Proposal

Impact the profile of TB-HIV at the conference

WHY SHOULD I SUBMIT A WORKSHOP?

1. TB is the largest killer of people with HIV/AIDS but underrepresented in the conversation.
2. By submitting a proposal, you can raise the visibility of TB/HIV at the conference and help drive action that saves lives from co-infection.
3. To share specific skills and showcase your organization.

HOW DO I SUBMIT A WORKSHOP?

1. Visit the AIDS 2012 website and create a profile http://www.aids2012-abstracts.org/workshop/.
2. Review workshop submission requirements.
3. Submit online between DECEMBER 1, 2011 - FEBRUARY 15, 2012
4. For further information, contact Mandy Slutsker, ACTION Senior Project Associate at mslutsker@results.org

Scientific Development

These workshops will help participants develop skills and collaborative learning around the latest scientific research, emerging technologies, and breakthroughs in policy and programming. It is a great opportunity to highlight advances in research and scale-up of evidence based approaches, including TB-HIV.

Leadership & Accountability Development

These workshops should provide participants with innovative skills to assess and measure the commitments and actions of leaders. Workshops should challenge individuals and organizations to consider the ways they go about developing leadership and accountability and what outcomes they hope to achieve by doing this.

Community Skills Development

This series of workshops will showcase effective community empowerment programs that add value to public health outcomes in treatment, prevention, care, and support. Participants will broaden their knowledge and skills to be able to implement effective programs in their communities. 

For an example of a successful workshop proposal visit

http://www.aids2012.org/WebContent/File/AIDS2012_Guide_to_Submitting_a_Good_Workshop.pdf

AIDS 2012: Call for Abstracts

In July 2012 tens of thousands of HIV researchers, policy makers, and advocates will attend the 19th International AIDS Conference in Washington, D.C. We invite you to submit abstracts for symposia that will bring TB-HIV to the forefront of the conference agenda.

Why Should I Submit An Abstract?

1. TB is the largest killer of people with HIV/AIDS but underrepresented in the conversation.
2. The volume of abstracts on a particular subject (TB-HIV, for example) directly affects the visibility of
   that subject at the conference.
3. To showcase your research.

How Do I Submit An Abstract?

1. Visit the AIDS 2012 website http://www.aids2012.org and review submission guidelines.
2. Submit online between December 1, 2011 - February 15, 2012.
3. For further information, contact Mandy Slutsker, Senior Project Associate, ACTION at mslutsker@results.org

What Are the Submission Categories?

Track A: Basic Science

This track addresses basic science around disease progression, morbidity and mortality. It is a great opportunity to highlight advances in basic research on the influence of opportunistic infections, including TB, on HIV disease course and immune control. Emphasis is being placed on new technologies and diagnostic tools.

Track B: Clinical Science

This track focuses on the long-term goals of providing HIV care, treatment and prevention. Abstracts should focus on the latest research findings, complexities, and controversies related to the prevention, diagnosis and treatment of opportunistic infections, including TB.

Track C: Epidemiology and Prevention Science

This track addresses recent advances in the epidemiology of HIV/AIDS prevention. Sessions in this track will foSubmissions in this track examine the ways in which HIV programs affect both clinical and non-clinical outcomes including health indicators, economic growth, and health systems functioning. Science from this track may evaluate the impact of prevention, care and treatment program scale-up and implementation and aims to inform resource allocation among different sectors in the fight against HIV. cus on HIV prevention research at both individual and population levels. Topics of particular interest include HIV testing, treatment as prevention, pre-exposure prophylaxis, and microbicides.

Track D: Social Science Human Rights and Political Science

Track D encompasses a wide range of social and behavioral science disciplines. Abstracts should provide qualitative and quantitative assessments of social, political, behavioral and human rights factors that influence HIV risk, vulnerability, response and impact. Submissions from community-based program implementers and advocates are encouraged.

Track E: Implementation Science, Health Systems and Economics

Submissions in this track examine the ways in which HIV programs affect both clinical and non-clinical outcomes including health indicators, economic growth, and health systems functioning. Science from this track may evaluate the impact of prevention, care and treatment program scale-up and implementation and aims to inform resource allocation among different sectors in the fight against HIV.

DOWNLOAD A PDF OF THIS ABSTRACT HERE

Global Fund Forced to Cancel Funding Round, Jeopardizing Health of Millions

ACTION and ACTION Partners

By: Jove Oliver

November 23, 2011 - As a consequence of donor governments' failure to fulfill their financial pledges to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the fund's Board cancelled plans to fund new grants to fight the three pandemics until 2014. The Board also announced it does not have the cash on hand to fund some previously approved grants. This financing shortfall has created an emergency in the international fight against AIDS, tuberculosis, and malaria-the world's three leading infectious killers.

"Donors have triggered a genuine crisis in the response to the world's three biggest infectious disease pandemics," said ACTION Director Kolleen Bouchane. "Their failure to make good on their financial pledges to the Global Fund will absolutely mean lives lost. This is a devastating breach of responsibility that will greatly limit access to proven life-saving interventions. It is not clear that the scale of this potential tragedy is fully realized by political leaders."

The emergency comes immediately on the heels of an announcement from the administration of President Barack Obama, which made supporting the rise of an AIDS-free generation an official goal of U.S. policy. Secretary of State Hillary Clinton made the announcement in a high-profile speech on November 8. The U.S. Government is the biggest donor to the Global Fund, providing roughly a third of the fund's total resources.

"In the U.S., all eyes are now on President Obama to step in and respond to this emergency by rallying Congress and other donor governments to fulfill their obligations," said Bouchane. "It is outrageous that the commitments and progress made over the last decade may now be fatally undermined by this funding shortfall, just as we were all beginning to talk seriously about the end of AIDS."

The Global Fund is the world's largest international financier of programs to treat TB and malaria, and the second-largest for HIV/AIDS. January 2012 is the 10^th anniversary of the Fund's existence.

In countries fighting these diseases around the world, governments and civic organizations were well into the process of developing proposals to submit to the Global Fund for its upcoming round of grant funding. Proposals were to be reviewed and approved in 2012. The cancellation of new grant-making until 2014 will effectively halt programs that provide basic services to treat AIDS, TB, and malaria in countries most ravaged by the diseases.

In a small country facing major health challenges like Burundi, the impact could prove catastrophic. The Burundi national TB program is almost entirely funded through early grants from the Global Fund and was slated to apply for renewal funding next year. Other countries that were set to apply for new funding to continue expanding services include Botswana, Tanzania, Zambia, Malawi, Guyana, and dozens of others. All will be negatively impacted.

"With the cancellation of new grant funding, the whole fight against tuberculosis in the East African country of Burundi is in danger," said Patrick Bertrand, of ACTION partner Global Health Advocates in France, which has ties to treatment programs across Francophone Africa. "People in Burundi will die unnecessarily from a curable disease as a consequence of this new funding suddenly evaporating. The ensuing drug shortages will almost certainly give rise to drug-resistant strains of TB, which no one will be able to stop from spreading."

ACTION, founded to fight tuberculosis, is an international partnership of advocacy organizations working together to mobilize resources and influence policies to address urgent global health challenges.

Tuberculosis is thriving in Texas

Houston Chronicle

After a frightful outbreak, Ennis High School students infected with tuberculosis have been allowed back to school. Thanks to the state's effective response - and cutting-edge medical technology and public health actions - the sick kids will almost certainly recover, and this crisis will soon be behind us.
The outbreak reminds us that tuberculosis is thriving in Texas and beyond our borders. Last year, there were 1,385 cases across the state, and 402 cases in the Houston area alone.

Worldwide, there will be almost 10 million tuberculosis cases causing 1.4 million deaths in 2011. An increasing number of tuberculosis germs have become resistant to the only available drugs. If we're ever going to end this disease, we must develop new tools for diagnosis and treatment - and we must do a better job of protecting children.

Tuberculosis is caused by bacteria that attack the lungs. The germs spread through the air when an infected person coughs or sneezes.

The traditional method of diagnosis in developing countries is for a sick patient to cough up phlegm, which a lab technician using a microscope visually searches through for the tiny bacteria.

This diagnostic method dates back to the turn of the century - the 20th century. More than 100 years later, it is still the foundation for controlling tuberculosis in most developing countries. It has never worked well, and it is even less effective with children, as they often have trouble producing phlegm and the germs are rarely seen.

Children also have less developed immune systems, so the bacteria tend to spread beyond their lungs, infecting the brain and other vital organs. These forms of tuberculosis are even harder to diagnose.
As a result, children receive little attention in tuberculosis control programs in countries where the most cases occur. This situation is just plain tragic. Because cases of childhood tuberculosis are massively underreported, official estimates are scarce and children are underrepresented in research and clinical trials for new diagnostic tests and drugs.

The World Health Organization published its annual global tuberculosis control report last week in Washington, D.C., and - shockingly - didn't say one word about the number of children infected or dying with tuberculosis. Estimates suggest that about 1 million children develop tuberculosis each year, and more than 250,000 die.

With foreign aid under threat, there is plenty that developing countries can do with limited resources. The experience at Ennis High School is instructive. If someone is diagnosed with tuberculosis, family members, close contacts and schoolmates should be proactively screened for the disease. Unfortunately, this rarely happens now where childhood tuberculosis occurs most frequently.

We must invest in better technologies to control - and end - tuberculosis here and abroad. We need better drugs, more accurate diagnostic tests and a better vaccine. The newest drug was developed before the first moon landing, and our only vaccine predates World War I. We must develop a rapid, accurate test to diagnose the disease in children. Tuberculosis in children will persist in Texas and worldwide if these advances do not occur.

It is heartening to see our health system mobilized so efficiently to protect the kids at Ennis High School and throughout Texas. But we can and must do more to help those affected by this disease beyond our borders. We cannot eliminate tuberculosis as a threat in Texas unless it is controlled throughout the world. Our safety depends upon it.

Starke is professor of pediatrics and director of the Children's Tuberculosis Clinic at Baylor College of Medicine in Houston

Candlelight Vigil and Services for Winstone Zulu

Services will take place at 12.00 pm Lusaka time on Saturday, October 15 at the Cathedral of the Holy Cross and burial on the same day at Leopards Hill Memorial Park.

In addition, there is a candlelight vigil tonight (Friday October 14th, 2011) in Zambia - starting at 6.00 pm Zambia time and going throughout the night. Imagine Winstone looking down with that smile and seeing not only all the lights in Zambia but in the US, Canada, UK, Japan, France, Australia, India, Kenya and all the places in the world where he touched someone - which would literally be everywhere. Think about lighting a candle in your own home, office, or where you might be during this time so we can stand in solidarity with our brothers and sisters in Zambia!

President Sata (new President of Zambia) released an official statement today and there are several other statements coming out of Zambia.Llocal NGOs are hoping to film the funeral services and link to YouTube so you can keep an eye out for that on our videos page.

Nigeria: TB Cases Drop, but Progress Face Poor Funding

The number of people falling ill with tuberculosis or dying from the disease is declining around the world for the first time in 10 years, according to the World Health Organisation.

Data reported from 198 countries in the WHO 2011 Global Tuberculosis Control Report published yesterday, showed the number of people who fell ill with TB dropped to 8.8 million last year--down from a peak of 9 million in 2005.Deaths from TB fell from 1.8 million in 2003 to 1.4 million last year, a reduction of nearly 400,000. Between 1990 and last year, death rates from TB dropped 40%.

WHO concluded all regions, except Africa, were on track to reduce mortality by half by the year 2015.

It also warns that funding problems and drug resistance could hamper current progress.

Fewer dying, fewer ill

In 2009, 87% of patients treated were cured, with 46 million people successfully treated and seven million lives saved since 1995, according to the report.

United Nations secretary-general Ban Ki-Moon said the reduction in numbers of TB deaths and illness was a major progress, but insisted it was "no cause for complacency."

"Too many millions still develop TB each year, and too many die. I urge serious and sustained support for TB prevention and care, especially for the world's poorest and most vulnerable people," said Ban.

Serious decline was in large countries, including Kenya and Tanzania, where TB burden is estimated to have been falling for most of the last 10 years after a peak linked to HIV epidemic.Similar declines have also been reported in Brazil and China where TB deaths fell almost 80% in two decades--from 216,000 to 55,000.

WHO's director-general Margaret Chan said strong leadership and domestic financing, with robust support from donors, had started to make a "real difference" in combating TB.

She added, "The challenge now is to build on that commitment, to increase the global effort - and to pay particular attention to the growing threat of multidrug-resistant TB."

Domestic funding allocated to TB is expected to increase by 80% next year, though many low income countries still rely on external funding.

High burden of TB, HIV, drug resistance

Nigeria is among countries concluded to have a high burden of tuberculosis, along with HIV and cases of TB resistant to drugs--so-called multidrug-resistant TB (caused by resistance to the most effective anti-TB drugs isoniazid and rifampicin).

Mortality rate from TB alone stood at 21 per 100,000 population, nearly 33,000. But prevalence of TB combined with HIV averaged 320,000 last year.

Some 40% of all cases on average was detected in 2010. In all, there were 81,454 new cases, more than 1000 in children under age 15.

At least 2,667 cases of retreatment were reported--8% of them came from treatment after failure, another 18% from treatment after default.

Some 22% of the new cases reported were showed multi-drug resistance. Among patients under retreatment, multidrug-resistant TB accounted for 94%.

Funding shortages

WHO blames funding shortages for stalled progress in TB intervention. It said funding available for the programme in Nigeria--some $28 million--fell below $39 million budgeted.

Some $43 million is budgeted for TB next year, but only $26 million may be available for funding.

WHO suggests that the cost of treatment a patient under the DOTS programme will drop to nearly $200 next year in budgeting.DOTS is Directly Observed Treatment Short course, the recommended strategy for TB control.

Cost of treating multidrug-resistant will also drop, but remain far higher than regular TB. Each patient with resistant TB will require slightly less than $35,000.

Government funding of TB treatment for 2012 is expected to increase slightly over 2011, while funding from sources as Global Fund will shrink. But the highest proportion of funding is still expected to come from Global Fund and other grants.

WHO, however, spoke of developments in drugs, diagnostics and vaccines to combat TB. Results from three Phase III drugs are expected between 2012 and 2013 and could reduce time spent on treatment courses. Results of two other trials on multidrug-resistant TB are expected next year.

The story of Shanta, neighbor and care provider: How BRAC is making tuberculosis history

BRAC

Shanta, a resident of Badda, a vibrant slum in northern Dhaka, is a face of the new Bangladesh. Every day she finishes her morning tasks at home and heads out into the bustle to begin her work. Around her, the streets pulse with energy: vendors offer freshly cut grapefruit and guava, stores and stalls spill over with cheap household items imported from China, cell phone ring tones sound endlessly. Once a country of villages, Bangladesh has been transformed as the promise of economic opportunity draws the rural poor to Dhaka, population 15 million and rising.

Rapid urban migration has squeezed the capital. Increasingly horrendous traffic chokes the roads, and power outages, a lack of basic sanitation and a dearth of public services are the norm here. Conditions are ripe for the spread of tuberculosis (TB), an airborne bacterial infection that kills about 5,000 people every day around the world. But there is also hope and opportunity: It is here in Bangladesh that BRAC, the world's largest anti-poverty organization, has developed a successful approach for confronting the threat of TB, described in its upcoming book, Making Tuberculosis History: Community-Based Solutions for Millions.

Shanta is a living embodiment of the organization's success. She is part of BRAC's all-female army of 80,000  "community health promoters" (shasthya shebika in Bangla) - lay practitioners who form the pillars of BRAC's anti-TB strategy. Shanta and tens of thousands like her visit households in their communities every day, selling simple health products like vitamins and sanitary napkins, while inquiring about persistent coughs, fevers, and other symptoms of TB. These women identify individuals with symptoms, and with BRAC's help, facilitate testing and diagnosis.

For those who test positive, a lengthy course of drug treatment begins. This is where Shanta's work becomes crucial, for one of the most worrying aspects of TB treatment is the potential development of dangerous drug-resistant strains. In order to prevent that, patients must complete the full course of drug treatment. Though medication is provided for free by the government, BRAC requires most new patients to hand over a small deposit, returned only after taking the medicine regularly for six months, ensuring the bacterial infection is eliminated completely. Shanta, like other community health promoters, makes sure the patients take their medication each day as prescribed.

"Patients usually want to stick to the treatment," says Shanta. But unexpected disruptions, mobile lifestyles and stress often make it difficult. People need a support mechanism that's nearby and flexible. Patients, too, admit that without her help, they'd likely forget to take the medication sometimes. If they need to travel outside the slum - back to their home villages for a few days, for instance - Shanta gets involved, helping them plan the trip, often identifying a temporary guardian to make sure they continue with the required dosages.

For those TB patients living in the surrounding streets of Badda, Shanta is both a friendly neighbor and care provider. Patients confide in her, often sharing personal matters during visits to her home, where they come for daily treatment. (Most live within a five to 10 minute walk and like to stop by on their way to work.) If unable to come, they call her mobile phone, and she usually responds with a personal visit. For every patient of hers that successfully completes treatment, Shanta receives 150 Bangladeshi takas (US$2) from BRAC, helping her support her own three children.

Building on its success in providing health care to rural communities, BRAC has trained an urban cadre of health promoters to reach slum dwellers as villagers increasingly pack up for the cities. The organization now accounts for about 66 percent of all TB cases treated in Bangladesh.

Emerging from its earliest experiments providing TB treatment to rural villages lacking access to government health care in the 1980s, BRAC's method has brought it under fire. Numerous public health experts, government officials, donors and human rights activists pushed BRAC to change its delivery strategy, which usually involves a bond system whereby patients put down a small deposit prior to beginning treatment, returned only if they complete the full course. The organization refused, citing program data and research that supported its approach.

Simply put, BRAC's model works. With adherence an Achilles' heel for treating infectious diseases like TB, BRAC has found a way to engage patients and motivate them to continue the full course of treatment. It has tested the model in the field, defended it from critics, and scaled it up to become one of the largest such programs in the world - thanks, in large part, to women like Shanta. BRAC has brought similar methods to Afghanistan with great success, and has promising pilots underway in Uganda and Liberia.

Since 1994, Bangladesh's National Tuberculosis Program has led a consortium of non-governmental organizations in creating systems that offer free treatment to all. This partnership has expanded since the arrival of resources from the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2004, reaching deeper into communities across the country. In 2010, over 45 partners participated in national anti-TB efforts, treating 150,000 patients.

BRAC launches Making Tuberculosis History, on October 27 at the 42^nd Union World Conference on Lung Health in Lille, France. For more information, write to makingtbhistory@bracusa.org.

Next in the series, we'll feature the story of Shahida, one of Shanta's patients.

Not missing a dose: Shahida, a patient, recounts her experience with BRAC

BRAC

Shahida usually speaks quickly, her raspy voice sharpening every word. But she smiles and softens when asked if she'd rather just take her tuberculosis medications at home. "No," she says matter-of-factly. "I'd forget to do it every day."

As it stands, Shahida has yet to miss a single dose, a testament to the effectiveness of the anti-TB program of Dhaka-based BRAC, the world's largest development nonprofit, as detailed in an upcoming book Making Tuberculosis History: Community-Based Solutions for Millions.

Halfway through her six-month treatment course, Shahida, a resident of the northern Dhaka slum of Badda, continues her treatment under the watchful eye of her neighbor Shanta, one of BRAC's "community health promoters," or shasthya shebikas - an army of 89,000 trained lay practitioners who form the centerpiece of BRAC's anti-TB strategy.

Shahida's symptoms have already disappeared. In fact, she feels completely cured. For many, this would be the signal to stop taking the medicine, but Shahida knows, from her conversations with Shanta, the importance of finishing the full course. Not only will it prevent relapse, but failure to complete the treatment would encourage the emergence of dangerous drug-resistant strains of the bacteria that causes tuberculosis. The growth of drug-resistant strains is one of the greatest fears of global health advocates as TB continues to kill 5,000 people daily worldwide.

So Shahida continues her daily visits to Shanta's house. She sees the positive side: "It's nice to see her every day," Shahida says.  "It provides a short break from all my daily chores. We usually end up talking about other things going on in the community."

It all began with a persistent fever. Shahida fell ill in May with a high temperature that didn't subside even after several days of medication. She wasn't coughing, so when she approached the doctor at a nearby clinic, TB wasn't even on her mind. But X-rays clearly indicated she had the disease.

Recognizing Shahida might be unable to afford the required treatment, the doctor recommended a visit to BRAC, which provides medications at no cost thanks to its partnership with Bangladesh's National Tuberculosis Program. A sputum test at Shahida's local BRAC branch office confirmed the diagnosis. Here, Shanta entered the picture: The patient and her shasthya shebika neighbor agreed on a time for daily visits.

Shahida prefers to keep her illness private, sharing it only with family. Though she does not buy anything else from Shanta - the shasthya shebikas have a basket of health products for sale, like vitamins and sanitary napkins - she's able to visit her regularly without eliciting suspicions from others in the community. The two women have developed a comfortable rapport.

In urban areas, local pharmacists, physicians and drug sellers (often untrained) are the first place poor people go for health care. These are often conveniently located in or near the slums and are open in the evenings, when public facilities are closed. A strategy employed by BRAC and other organizations working with the National Tuberculosis Program is to engage these providers in training and orientation to teach them about TB, the importance of adherence, and the availability of free treatment options.

Within the neighborhood of Badda alone, diverse options exist. BRAC tries to reach as many of these providers as possible, from the proper pharmacy shop to the individuals selling health products in rickshaw garages. Particularly in the complex context of Dhaka's unregulated and fragmented health care system, these partnerships create important pathways for patients to access quality TB services.

Partnership and engagement with health care providers are just two of many strategies BRAC is using for urban TB control. Learn about how BRAC works with garment factories to reach another vulnerable population.

Making Tuberculosis History, the comprehensive book on BRAC's experiences with TB, comes out on October 27. For more information, write to makingtbhistory@bracusa.org.

Next in the series, we'll feature the story of Rana, a garment worker who contracted TB.

Rana, the garment worker: No longer stigmatized, TB patients open up about their experiences

BRAC

A chronic smoker, Rana wasn't too alarmed when he first developed a persistent cough. Within a few weeks the Bangladeshi garment worker's health had worsened, however. He began vomiting and found himself unable to go to work at the factory. A local doctor suspected tuberculosis (TB), but Rana couldn't afford the recommended X-ray diagnosis.

It's a typical story in Dhaka, and one where BRAC, the world's largest antipoverty organization, plays a crucial and potentially life-saving role. The doctor recommended Rana seek a free diagnosis at the local office of BRAC, whose successful anti-TB efforts are the subject of the forthcoming Making Tuberculosis History: Community-Based Solutions for Millions. First developed in the 1980s, BRAC's anti-TB program now covers 91 million people in Bangladesh alone.

The nearest BRAC office lay several kilometers from Rana's home in Badda, a slum in northern Dhaka, but he wasn't sure exactly where. Asking for directions along the way, he made his way through the labyrinth of narrow streets - a sprawling neighborhood of informal shops and dwellings that has cropped up beside the main road and factories as Dhaka's population soars due to migration from the countryside.

At BRAC, the test results came out positive for TB. Thanks to a BRAC-administered government program, Rana would have access to daily drug treatment for six months, but it would need to be supervised. Rana worried that he'd be unable to get to the BRAC office every day for treatment, so Mofiz, the local program organizer, connected him with Sirina, one of BRAC's community health promoters (or shasthya shebikas) living near his house.

Now, on his way to work each morning, Rana stops by Sirina's to quickly swallow the pill with a glass of water. Mofiz has also visited occasionally to make sure his health is improving. With four of six months of treatment already complete, Rana no longer experiences any symptoms, yet the system ensures that Rana and other patients finish their prescriptions, thus eradicating the bacteria completely and preventing the growth of drug-resistant TB strains.

Rana also faced the matter of employment. Upon diagnosis, he duly informed the factory supervisor that he'd contracted TB. His manager suggested that he take a few days off to begin the treatment; Rana was relieved at not being isolated from either his employer or the other workers on his floor.

Stigma is often cited as a concern for avoiding diagnosis and treatment of TB. Before medication became widely available, many considered it a fatal disease. Even those who recovered often experienced continued alienation. Some thought the disease had a genetic component, so a husband might abandon a wife who survived the illness, while unmarried survivors faced challenges finding a partner. That Rana and other patients, such as Abhur, a rickshaw driver who successfully completed his treatment, openly shared their condition with others in their community marks huge progress in combating the social dimensions of the disease.

Women in Bangladesh still experience greater levels of psychological and social consequences, however, which is one reason communications and social mobilization activities remain a central part of BRAC's strategy for TB control. The organization's all-female cadre of 80,000 shasthya shebikas, who sell health products while proffering advice on diagnosis and treatment, creates a frontline option that gives women access to TB services without having to travel, get money from their husbands, or see a male provider.

Treatment of male TB patients, meanwhile, carries its own set of concerns, including an alarmingly high rate of tobacco product usage among men. The long-term health consequences of smoking or chewing tobacco are not immediately visible, so individuals are unlikely to try quitting on their own. BRAC is informally piloting tobacco cessation support as part of its TB treatment package in a few areas of Dhaka, including Badda. Both Rana and Abhur, for instance, have smoked for years but are attempting to quit after counseling from Mofiz and their shasthya shebikas. "It's not easy to quit," Rana says, "but BRAC told me if I want to live, I need to try."

In Bangladesh's transition to a middle-income country, chronic disease prevention and management will likely replace infectious disease control as top priorities. Supporting Rana and Adhur in quitting smoking is yet another example of BRAC's experimentation with shasthya shebikas to extend its community-based approach so that it continues to have a powerful impact even in changing times. In Making Tuberculosis History: Community-Based Solutions for Millions, the authors also explore how BRAC might apply its anti-TB methods to other pressing health issues, including HIV/AIDS and hypertension.

Making Tuberculosis History, the comprehensive book on BRAC's experiences with TB, comes out on October 27. For more information, write to makingtbhistory@bracusa.org

WHO Urges Russia to Step Up TB Fight

http://www.themoscowtimes.com

The World Health Organization has challenged Russia to compete with neighboring countries for the best national plan to fight drug-resistant tuberculosis - and offered money to boot.

Russia has the third-highest rate of tuberculosis of all countries in Europe and the former Soviet Union, after Moldova and Romania, according to the latest data compiled by the WHO.

The WHO action plan urges European and CIS countries to draft national programs to adopt quicker and more expensive methods of tuberculosis detection that can reduce the time between a medical exam and the results from two months to two hours, Zsuzsanna Jakab, the WHO's regional director for Europe, said at a conference of state health officials and nongovernmental activists from Europe and the CIS.

The action plan also calls for universal access to the prevention, diagnosis and treatment of drug-resistant tuberculosis by 2015 and tailored services for specific segments of the population, including migrants, drug users and prisoners, according to a WHO booklet distributed at the conference Monday.Implementation of the plan will cost an estimated $5 billion for the whole of Europe and the CIS, but will save about $12 billion for member states in the WHO European region, which includes Europe and the CIS, the booklet said.

Countries with the best programs will be eligible for financing from the Global Fund to Fight Aids, Tuberculosis and Malaria, the European Commission and other international agencies, the booklet said.

The plan is expected to help avert 263,000 cases of drug-resistant tuberculosis in the region and treat another 127,000 cases successfully, it said.

More than 128,000 new cases of tuberculosis and microscopy-confirmed tuberculosis relapses were registered in Russia, or 90.7 cases per 100,000 people, compared to 102.4 cases in Moldova and 101.7 in Romania in 2008, the latest year for which data are available.

A total of 63.1 new tuberculosis cases were registered in Lithuania that year, but all other European countries had less than eight new tuberculosis cases per 100,000 people that year.

Turkmenistan’s TB lab services use new luminescent microscopy

http://en.trend.az

All regional TB laboratories in Turkmenistan will from now on perform luminescent (light-emitting diodes, LED) microscopy for detection of tuberculosis (TB), using luminescent microscopes and reagents that have been procured by the United Nations Development Programme (UNDP) project on strengthening TB diagnostics and treatment in Turkmenistan implemented in partnership with the Ministry of Health and Medical Industry of Turkmenistan, UNDP in Turkmenistan said.

The project also plans to support training of laboratory staff and introduction of appropriate quality assurance, and to follow up the effect of TB case detection rates and treatment outcomes.

With the project support, the expanded use of LED microscopy in Turkmenistan will facilitate the achievement of the national targets for TB control set by 2015, as well as the achievement of Millennium Development Goal 6 and the Stop TB Partnership goal, which is to reduce dramatically the global burden of TB by 2015.

The project "Strengthening and expanding of qualified services on TB diagnostics and treatment in Turkmenistan" is funded by the Global Fund to Fight AIDS, tuberculosis and malaria. Its goal is to reduce the burden of tuberculosis in Turkmenistan by consolidation of DOTS framework, its expansion by introducing and scaling up the management of drug-resistant tuberculosis and strengthening the health system performance for effective TB control.

TB smoking toll’could reach 40 million by 2050

http://www.bbc.co.uk/news/health/

Smokers are about twice as likely to get the lung infection and die from it, compared with non-smokers.

Many of the new TB cases will be in Africa, the eastern Mediterranean and Southeast Asian regions, according to projections published in the BMJ.

A lung charity said global efforts to fight TB are being undermined by the tobacco industry's "aggressive promotion" of smoking in some places.

Dr John Moore-Gillon is a TB specialist and honorary medical advisor for the British Lung Foundation.

He said: "It is nearly 20 years since the World Health Organization declared tuberculosis to be a 'global health emergency'.

"Since that time rates have risen rather than fallen, and smoking increases the risk of getting - and dying from - TB.

"Concerted international efforts are now under way to try and turn the tide of TB, but this important research shows that all these efforts may be undermined by the tobacco industry's continuing aggressive promotion of smoking in many parts of the world."

Mathematical model

Nearly a fifth of people in the world are smokers; many in countries with high rates of TB where multi-national tobacco companies have expanded their markets.

Smoking is a known risk factor for TB, and may reduce the ability of the lungs to fight off infection.

Dr Sanjay Basu and colleagues from the University of California set out to predict the impact of smoking on future TB rates.

According to their mathematical model, worldwide smoking could lead to 40 million extra deaths from TB from 2010 to 2050.

If current smoking trends continue, the number of new cases of TB will rise by 18 million.

Smoking alone could undermine the worldwide goal of reducing TB mortality by half between 1990 and 2015, they say.

Writing in the BMJ, the team concludes: "Tobacco smoking could substantially increase tuberculosis cases and deaths worldwide in coming years, undermining progress towards tuberculosis mortality targets.

"Aggressive tobacco control could avert millions of deaths from tuberculosis."

Contagious

Tuberculosis is a contagious infection that mainly affects the lungs, but can spread to other parts of the body.

If not treated, it can damage the lungs to such an extent that a person cannot breathe properly.

Sometimes, people do not experience any symptoms for many months or even years after being infected.

TB can treated with antibiotics but is sometimes fatal.

HIV/AIDS, Tuberculosis And Malaria Are Still Emergencies

Communities Living with HIV, Tuberculosis and affected by Malaria Delegation of the Board of the GFTAM

The Communities Living with HIV, Tuberculosis and affected by Malaria Delegation (Communities Delegation) of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) welcomes the report of the High-Level Independent Review Panel (HLP) and acknowledges the recommendations put forth in strengthening fiduciary controls and oversight mechanisms at all levels of the Global Fund, which are consistent with its values of transparency and accountability. 

The comprehensive findings of the HLP is a result of six months of intensive work, and includes the review of 40 existing grants with a conclusion that all current weaknesses are opportunities that can be strengthened and improved.  The Board of the Global Fund will meet on the 26^th September 2011, in Geneva, Switzerland to review and discuss the findings and recommendations, act on the most urgent issues and agree on a process to address and action the recommendations. 

The Communities Delegation is deeply concerned, however, on how some of the findings of the HLP can be misconstrued.  The Global Fund has committed US$ 22.4 billion in over 150 countries to support large-scale prevention, treatment, care and support programmes against the three diseases.  This in practical terms translates to putting 3.2 million people on HIV treatment, treating 8.2 million people infected with Tuberculosis (TB), and 190 million bed-nets distributed to avert malaria infections.  Millions of lives have been saved, because of the work of the Global Fund and its partners, and this needs to be put into perspective.

During times of a massive financial crisis and instability in the biggest world economies, major Global Fund contributors could translate the outcomes of the report into excuses not to meet funding commitments.  The Global Fund needs the current and new donors to increase their contributions and pledges expressed at the Third Voluntary Replenishment Conference from US$ 11 billion to more than US$20 billion to ensure that efforts and gains made in the last decade can be effectively sustained.  The Global Fund is thus far, the only mechanism in existence that could invest these resources needed in life-saving interventions.  The report states, "the failure of the Global Fund would be a global health catastrophe".

Currently, 15 million people living with HIV are in dire need to be on life-saving drugs; the case detection for TB globally is at 65%, with drug resistant TB spiralling faster; and malaria cases though contained might be at a risk of exploding if efforts are not preventive efforts are not sustained.  These are all emergencies that require immediate attention and extraordinary actions so as to benefit the very communities that we stand up for.

The Communities Delegation does not support the HLP suggestions to re-evaluate the Board decision on Round 11 funding, and proposals for new eligibility criteria.  The Board of the Global Fund needs to be able to discuss the impact, consequences and recommendations responsibly bearing in mind the tremendous ramifications these decision(s) will have on achieving MDGs 4, 5, and 6, and ultimately on the lives of communities.

Shared responsibility is at the core of partnerships, and the Global Fund is a unique funding mechanism and partnership with an oversight and governance structure that includes multi-stakeholder participation at both global and national level.  The report provides a timely opportunity for both implementers and donors to not only make the money work, but also to demonstrate how it works.

We are dismayed with some disparaging and opportunistic public statements related to the leadership at the Global Fund Secretariat after the release of the HLP report, and would like to point out that the recent reappointment of the Executive Director proves the trust and confidence of the Board in his work.  The Communities Delegation has confidence in the leadership of the Executive Director, and would like to express our most sincere gratitude to staff at the Global Fund Secretariat for their tireless commitment and dedication to ensuring that lives are being saved across the three diseases.

The Communities Delegation reiterates its position of zero tolerance to corruption and the commitment to transparency and accountability.  We bring to the Global Fund Board the voices and needs of millions of people living with and affected by the three diseases, and together with the Civil Society Constituencies on the Board of the Global Fund, we will remain vigilant to ensure that the most urgent changes in the structures, policies and processes of the Global Fund are implemented in order to continue saving lives.

We call for the responsible use of the public information released in the HLP report by media and governments and other partners, with a reminder that the challenges related to the three disease is an on-going emergency in many parts of the world.  We need to ensure that the recommendations of the Board, and its responses to these recommendations constantly place the lives of people at the centre of our discussions.

On behalf of the Communities Delegation,

Shaun Mellors

Board Member,

Communities Delegation

mellorsshaun@gmail.com

Lucy Chesire

Interim Alternate Board Member,

Communities Delegation

lucy@tbadvocacy.co.ke

Rachel Ong

Communications Focal Point,

Communities Delegation

rachel.ong.gfatm@gmail.com  

Vaccines Against Major Childhood Diseases to Reach 37 More Countries

GAVI Alliance

GAVI Alliance delivers on its promise to tackle diarrhoea and pneumonia

Geneva, 27 September 2011 - The GAVI Alliance today announced it will provide funding for 16 more developing countries to introduce rotavirus vaccines and 18 more countries to introduce pneumococcal vaccines -- a major step towards protecting children against severe diarrhoea and pneumonia -- the two leading child killers.

The roll out of rotavirus vaccines across the African continent has already begun in Sudan, and today's announcement confirms funding for 12 more African countries to follow suit.

"Thanks to our donors and partners, the GAVI Alliance is now delivering on its promise to protect more children across the developing world against rotavirus, pneumococcal disease and other life-threatening yet preventable diseases," said GAVI CEO Seth Berkley M.D..

"The death toll of rotavirus and pneumococcal infections in Africa is particularly devastating, and this is where these vaccines will make the most significant impact, not only in lives saved, but also in terms of healthy lives lived," he added. "Immunisation enables good health and healthy people are more productive and ultimately fuel economic growth."

An ever-increasing number of countries have applied for vaccine funding and yesterday (Monday) GAVI's Executive Committee approved applications from 37 countries - 16 for rotavirus vaccines, 18 for pneumococcal vaccines, five for pentavalent vaccine, and 12 for other types of vaccines (see annex for detailed list of approved countries - some countries have been approved for more than one vaccine). Out of the 37 countries, 24 are in Africa.

Rotavirus is the leading cause of severe diarrhoea in children under five years of age, killing more than half a million children each year worldwide and causing illness in several million more. Nearly 50% of all rotavirus deaths occur in Africa, where access to treatment for severe rotavirus diarrhoea is limited or unavailable.

Pneumococcal disease causes pneumonia, meningitis and sepsis and also takes the lives of more than half a million children each year worldwide, the vast majority of them in Africa and Asia. The funding of 18 more countries (including 12 in Africa) to introduce pneumococcal vaccines will take the total to 37 since the roll out of pneumococcal vaccines in GAVI-supported countries began in December 2010 in Nicaragua.

By 2015, GAVI and its partners plan to support more than 40 of the world's poorest countries to rollout rotavirus vaccines and immunise more than 50 million children. In addition to Sudan, Nicaragua, Bolivia, Guyana, and Honduras have already introduced rotavirus vaccines with GAVI's support.

"The high number of approved applications for funding for new vaccines in this latest round is yet another milestone in the fight to prevent child deaths from vaccine-preventable diseases," said Dr Margaret Chan, WHO Director-General. "As demand for new vaccines increases further, WHO will continue providing critical support to countries for decision-making on new vaccines, surveillance, and immunization programme planning, training, and evaluation."

"These new vaccines will prevent millions of children from dying of pneumonia and diarrhoea, the biggest killers of children under five," said UNICEF Executive Director Anthony Lake. "In rolling out these vaccines, we need to focus especially on reaching the children at greatest risk, for it is among the most vulnerable that these vaccines can make the biggest difference, especially if they are combined with better nutrition, sanitation and other critical interventions."

"Vaccines prevent disease and give children a healthy start to life - they represent one of the best investments in global health," said Dr. Rajeev Venkayya, Director of Vaccine Delivery at the Bill & Melinda Gates Foundation. "We must work together to ensure that all children have access to the right set of vaccines, in rich and poor countries alike."

Rotavirus vaccines have proven to be highly effective at reducing severe and fatal diarrhoea and have saved thousands of children's lives. Recent studies show the swift and significant impact of rotavirus vaccines to reduce child deaths and improve children's health.[1] For example, prior to the introduction of the vaccines in Mexico in 2006, 50% of deaths due to childhood diarrhoea were caused by rotavirus. The country has since seen a remarkable 46% reduction in the number of children under age five dying from diarrhoea.[2]

GAVI and its partners also plan to support more than 40 countries to introduce pneumococcal vaccines and immunise more than 90 million children against pneumococcal disease by 2015.

#          #          #

[1] http://journals.lww.com/pidj/toc/2011/01001

[2] http://www.nejm.org/doi/pdf/10.1056/NEJMc1100062

The GAVI Alliance is a public-private global health partnership committed to saving children's lives and protecting people's health by increasing access to immunisation in poor countries. The Alliance brings together developing country and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry in both industrialised and developing countries, research and technical agencies, civil society organizations, the Bill & Melinda Gates Foundation and other private philanthropists. Since it was launched at the World Economic Forum in 2000, GAVI has prevented more than five million future deaths and helped protect 288 million children with new and underused vaccines.

For more information, please visit: www.gavialliance.org

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Making Tuberculosis History: BRAC Releases New Book On Their TB Program

BRAC.net

Like many of BRAC's programs, its community-based model for TB has garnered much praise: it's been profiled in articles in the New York Times, documented in Harvard Business School case studies, received the Stop TB Partnership Kochon Prize, and hosted dozens of distinguished visitors. Some of its methods have brought them under fire, within conservative communities, with the public sector, and international donors-it was one of the first to treat patients with lay volunteers (called shasthya shebikas), all women, in the community. And while medications have always been provided for free by the government, BRAC requires patients to hand over a small deposit prior to beginning treatment that's returned only when the patient completes the six months of treatment (this can be paid by the community or waived when necessary). Shasthya shebikas watch the patients take their medications every day (a strategy now called directly observed therapy, short-course or DOTS) at their homes, receiving a small payment upon treatment completion.When pressured to change its delivery strategy, BRAC has refused, with one argument amply supported by program data and rigorous research studies: this model works. With adherence as an Achilles' heel for treating infectious and non-communicable disease alike, BRAC found a way to engage patients and motivate them to continue the full course of treatment, defended it, and then scaled up to one of the largest programs in the world. Now a critical member in a national partnership with the Government of Bangladesh, over 40 other non-governments organizations, BRAC treats close to 100,000 patients a year with a success rate of 92%, defying the assumed trade-off between quality and scale. These achievements reflect significant contributions from many, including technical expertise from the World Health Organization and the Japanese Anti-TB Association, and resource mobilization by the Country Coordinating Mechanism, and transcend national borders.Internationally, BRAC has begun to adapt the model to new contexts. BRAC Afghanistan has worked with the government to make community-based TB treatment options part of the standard package of health services offered nationally.

Since its first write-up in a scientific newsletter in 1991, BRAC has published several academic articles on its successes in tuberculosis. It has even written chapters on the program in Tuberculosis: an interdisciplinary perspective and more recently, in From One to Many, a collection of programmatic experiences in scale up edited by BRAC. Ian Smillie dedicates a chapter of his book on BRAC, Freedom from Want, to tuberculosis control. But a thorough, reflective documentation, one capturingthe broader elements of the history, collective insights, support systems, strategic thinking, and overall, the story of what had built the program, written by its veteran leaders and staff, was absent. Finally, in Making Tuberculosis History: Community-based Solutions for Millions, we have achieved just that. The book offers a complete account of the program: how it was conceived, piloted, refined, scaled, managed, and ultimately adapted for new contexts, including Bangladesh's rapidly growing citiesand Afghanistan's remote mountainous regions. Summarizing past successes and current dilemmas, the book's ultimate aim is to advance efforts to eliminate poverty and disease globally. The public health challenges facing the world today demonstrate the critical need for large-scale thinking; lessons from BRAC's TB program can inspire others to think creatively about health delivery and advancing towards health for all.

Urine test for TB shows promise

Testing urine samples for specific chemicals could serve as a quick and painless way to detect tuberculosis (TB), according to Indian researchers.

The urine test offers a less invasive diagnostic method for an infectious disease  that causes three million deaths and 10 million new cases worldwide each year. Developing countries account for 95 per cent of new infections and 98 per cent of deaths.

The Delhi-based International Centre for Genetic Engineering and Biotechnology (ICGEB) and the Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases, collaborated with the National University of Singapore to develop the test. 

The test measures five specific chemicals present in urine, the researchers reported last month (July) in Analytical Chemistry, published by the American Chemical Society.

TB diagnosis relies mainly on a test to detect Mycobacterium tuberculosis in blood or sputum samples taken from the lung and examined under a microscope.  

Diagnostic tests based on 'serum' - the clear liquid separated from clotted blood - are not sensitive, especially in people vaccinated against TB.

Drug-resistant cases need an expensive, sophisticated test that takes two weeks of culturing blood samples to detect the bacterium. 

Developing countries prefer a simple test requiring minimum resources and trained personnel, and one that gives quick and easily interpreted results, the Delhi scientists observed.

Their technique measures five 'volatile organic compounds' (VOCs) in urine that have a low boiling point and vaporise at room temperature.

The team tested the method in 117 fresh cases of TB and found significantly different levels of these chemicals in TB patients, compared with healthy people.

It found a distinct pattern - three VOCs showed higher levels and two lower levels - in TB patients, not seen in healthy persons or in patients with lung ailments such as lung cancer or asthma. 

The levels could also indicate the effect of treatment, the team said.

"A major advantage of the proposed method is the non-invasive nature of urine collection. Urine is a comparatively safer matrix as compared to sputum and painless in collection as compared to blood," it added.

ICGEB scientist Ranjan Nanda, one of the authors of the paper, explained toSciDev.Net that this was the first stage.

Nanda's team plans to validate the findings from multiple sites across India and involve a larger number of patients using improved data acquisition methods.

The team also plans to profile other VOCs in urine samples "to identify the maximum number of molecules," Nanda said.

Link to abstract in Analytical Chemistry 

Bayer Joins TB Battle

http://pharmtech.findpharma.com

Bayer Healthcare has pledged its support to a Tuberculosis (TB) partnership by providing 620,000 tablets of the antibiotic moxifloxacin to the World Health Organization (WHO), which will make the tablets available to China's national TB program. In particular, the medicine will be used to fight multidrug-resistant TB.

"We have decided to make moxifloxacin available to provide quick support to those patients in need," Jörg Reinhardt, chairman of the board of management of Bayer HealthCare, said in a statement. "We were happy to follow the request from WHO because we believe that this is the right step to address an increasing medical need in patients affected with this serious disease and for whom there are only very limited oral treatment options available."

According to Bayer, multidrug-resistant TB does not respond to standard TB drugs and can take two years or longer to cure. "Some countries, especially the former Soviet Union, China and India, have a high incidence of multidrug-resistant TB," explained Bayer. "According to WHO, an estimated 440,000 multidrug-resistant TB cases and 150,000 deaths occurred in 2008. Multidrug-resistant TB occurs almost everywhere in the world, the main focus being in Asia. Nearly half of multidrug-resistant TB cases are estimated to occur in China and India."

The medicine provided by Bayer, moxifloxacin, is a broad-spectrum antibiotic, but is not approved for the treatment of TB or multidrug-resistant TB. However, WHO has included the medicine in treatment group III of its guidelines as part of a second-line TB regimen in patients with confirmed multidrug-resistant TB. Moxifloxacin will be administered in China in a highly controlled manner, with close monitoring.

"Together with the Global Alliance for TB Drug Development, Bayer's pharmaceutical division is working on the development of moxifloxacin as a treatment for drug-susceptible pulmonary TB. It is the aim of ongoing studies to show that use of moxifloxacin could reduce the length of treatment for drug-susceptible TB from six to four months. Bayer HealthCare intends to apply for the approval of moxifloxacin for the treatment of pulmonary TB as soon as clinical trials have been completed," said Bayer.

The TB partnership, Stop TB, was formed by WHO in 2001, and comprises a network of international organizations, countries, donors from the public and private sectors, and governmental and nongovernmental organizations.

This is the second boost that China has had in recent weeks with regards to TB treatments. Last month, the Stop TB Partnership also announced that Aeras, a US-based product development organization and a member of the program's Working Group on New TB Vaccines, had signed a memorandum of understanding with the China National Biotech Group, with the aim of pursuing opportunities to jointly develop TB vaccines in China. Potential activities will cover the full spectrum of product development, including preclinical development, process development and manufacturing, and clinical development in TB.

According to Aeras, TB is a major public health priority in China where there are more than one million new TB cases every year. Globally, TB is reported to be responsible for 1.7 million deaths every year.

Shortage of Drug-Resistant TB Treatment Looms

http://www.plusnews.org

While countries are rolling out new tests that will enable them to diagnose more patients with drug-resistant tuberculosis (DR-TB), a worldwide shortage of the drugs to treat these patients is likely, Médecins Sans Frontières (MSF) warns. 

DR-TB can occur when TB patients do not complete their initial course of TB treatment. The only way to test for DR-TB is through cultures or via molecular testing - neither of which has been widely available in many high incident countries - until the advent of the GeneXpert, a two-hour molecular TB test released in 2010. 

South Africa, which has the world's fifth-largest burden of multi-drug resistant (MDR) TB cases, will replace all microscope-based TB diagnoses with faster, more sensitive GeneXpert testing within two years, making it the world's largest user of the machine, according to Norbert Ndjeka, director of DR-TB, TB and HIV at the South African National Department of Health. 

The GeneXpert machine - about the size of a milk crate - provides a fully automated nucleic acid amplification test (NAAT) that is effective in the early diagnosis of TB, MDR-TB, and TB patients co-infected with HIV, which is more difficult to diagnose. 

Speaking at a recent meeting co-hosted by South African AIDS lobby group, the Treatment Action Campaign, human rights organization SECTION27 and MSF, Ndjeka said that national use of the GeneXpert machine could double the number of MDR-TB cases diagnosed. 

But while more patients may get diagnosed, their access to treatment remains precarious as a limited number of approved drug producers keep many DR-TB prices high and supply uncertain, according to Dr Eric Goemaere, MSF's senior regional adviser. 

Higher prices 

The country cures about 42 percent of MDR-TB patients nationally, according to Ndjeka, but the national success rate masks provincial cure rates as low as 10 percent. 

Treating MDR-TB patients takes up about half South Africa's TB budget and this proportion is expected to rise as the country diagnoses more cases with technology like the GeneXpert. 

While DR-TB drugs remain expensive worldwide, South African activists have long complained that the country paid more than other countries that were able to access prices negotiated by the international procurement body, the Global Drug Facility. South Africa recently negotiated a US$33.8 million savings in TB drugs through its new TB drug tender, which also included DR-TB drugs such as capreomycin and moxifloxacin. 

MSF has estimated that without lower DR-TB costs, South Africa will be spending as much as $630 million on treatment by 2015. At present, para-aminosalicylic (PAS), one of the world's oldest TB drugs - which has been reintroduced to MDR-TB treatment due to a lack of alternatives - can account for as much as half of MDR-TB treatment costs generally. 

Ndjeka admitted that South Africa continues to pay higher-than-average prices for PAS as the drug has not been registered for use by South Africa's regulatory Medicines Control Council (MCC), which has been labouring for years under a backlog in drug registrations, including those of some fixed-dose antiretrovirals. The country now pays a private company to import the drug through a special application to the MCC. 

Behind the shortages 

The answer to why the prices of DR-TB drugs - even for an antiquated and highly toxic drug such as PAS - remain high is wrapped up in a range of market and regulatory dynamics that will likely mean a shortage, says Goemaere. 

A drug starts with the active pharmaceutical ingredient (API), but the number of API producers for DR-TB is extremely low, and for some drugs there is only one, says Goemaere. 

Many countries struggle to accurately forecast DR-TB drug needs, leaving API producers unable to forecast not only possible increases in demand but also the market: without an accurate idea of potential financial returns, would-be API producers have little reason to enter the DR-TB drug market. 

In addition, difficulties in obtaining regulatory approval are another disincentive. "Because of this, our experience in MSF with stock supply is that we go from stock failure to stock failure," Goemaere remarked. 

DR-TB drug capreomycin for example, has more than doubled in price in the past 10 years, according to a recent MSF report,DR-TB Drugs Under the Microscope. 

MSF has called for countries to avert the looming crisis by improving drug forecasting, negotiating better prices and accelerating national medicines registrations. 

Mapping a New Course to Defeat Tuberculosis

The story line is reliable, says Dr. Kevin Patterson.

"Granny starts coughing" and "losing weight" and then the "night sweats" start.

It sounds like a bad case of the flu and at first that's what it feels like. "It's not something that falls on you like a ton of bricks, like other infections might, it's usually a slow moving process," he says.

Granny doesn't like going to the doctor so she puts up with "the flu" for two months, until she's "lost 30 pounds."

When she starts coughing up blood, she finally gives in. By that time, the grandkids are coughing too.

"I don't know the death rate, but it certainly is regularly lethal," says Patterson. He's speaking of tuberculosis, a disease that most Canadians never encounter except perhaps in a storybook set long ago. Hasn't TB long been banished from developed countries like Canada?

No it hasn't. Canada's TB incidence rate was 4.8 cases for every 100,000 people in 2009, a bit better than Australia (6.4 per 100,000) and a bit worse than the U.S. (4.1 per 100,000).

But TB in some of Canada's First Nations communities is far more prevalent. The rate among Aboriginals living on reserves, in fact, is 31 times higher than among non-Aboriginal Canadians, while among the Inuit the rate is 185 times higher, according to evidence presented for a 2010 report by the House of Commons Standing Committee on Health.

And Patterson is all too correct that tuberculosis kills. One out of 25 First Nations TB cases ended in death in Canada between 1990 and 2000, according to Health Canada. Older Aboriginal people are particularly vulnerable; one in five with TB over the age of 75 died.

"Tuberculosis is fundamentally a flag for poverty" says Patterson, who knows first hand. Every year since 1995, he has spent a few weeks working in northern Inuit communities. Tuberculosis, he says, is "a barometer of social privilege and the fact that no TB exists in the south among Caucasians, for all intents and purposes, and that it's highly prevalent among the reservations and among the Inuit is just the most graphic evidence of the extent of the disparity."

Patterson says this as his sail boat, The Sea Mouse, heads out of the harbour on Salt Spring Island, beginning the first leg of a sailing trip to Desolation Sound. Patterson, who allowed a reporter to sail along with him for a day, lives on Salt Spring and works at the hospital in Nanaimo. He is a well-known author who has written a memoir of sailing from Vancouver Island to Tahiti. He also has written a novel, Consumption, about how life in northern Canada changed drastically in the latter half of the 20th century and the role played by tuberculosis, formerly called consumption, in advancing these changes.

If Patterson seems consumed with the persistent toll taken by TB, he explains why as his boat slowly makes headway. "It's a manifestation of poverty and crowding." Housing in many indigenous communities is "desperate," he says. "The fact of endemic tuberculosis really reflects that."

A new strategy

Many working in TB prevention and control are hopeful a favourable shift in the wind is about to occur.

The First Nations and Inuit Health Branch of Health Canada is releasing an updated version of its 1992 TB Elimination Strategy later this year. The new strategy, called the First Nations and Inuit Health Branch National Strategy Against TB, 2011 will "reflect current knowledge, best practices and lessons learned since the 1992 release," according to an email from a Health Canada spokesperson.

The strategy is meant to include national targets that will assist in evaluating TB programs. It is unclear whether the new strategy will also adequately address the social conditions that allow TB to run rampant in Aboriginal communities, an aspect that Patterson and others say is key to effective prevention and control.

In response to questions regarding the inclusion of social targets in the new strategy a Health Canada spokesperson replied, by email, that the strategy "encourages collaboration within Health Canada and among key partners" to address the poor social conditions. Key partners mentioned specifically included: the Assembly of First Nations, Inuit Tapiriit Kanatami, First Nation and Inuit communities, provincial governments and health authorities, Aboriginal Affairs and Northern Development Canada and the Public Health Agency of Canada."

The response also says that the government has made significant investments to address these social conditions but that "improved collaboration among partners is essential to further reducing the incidence and burden of diseases."

"TB is a medical diagnosis, but it's a social disease," says Gail Turner, chair of the Committee on Health for Inuit Tapariit Kanatami, a national Inuit advocacy organization. TB rates have increased among the Inuit over the past 10 years and her organization is creating its own TB strategy designed specifically for Inuit communities.

TB is caused by Mycobacterium tuberculosis, bacteria that usually affect the lungs. It is spread when someone with active TB coughs or sneezes, releasing the bacteria into the air. If a healthy person is exposed to active TB, the infection could remain latent, reactivating at a later time if that person's immune system is weakened.

Crowded housing has long been considered a key risk factor for the spread of TB and just like the disease itself, northern Canada suffers a disproportionate percentage of housing needs in Canada.

The Conference Board of Canada's Centre for the North reported last year that up to 25 per cent of homes in northern Canada are crowded, compared with up to nine per cent of homes in southern Canada.

According to Health Canada, "First Nations communities with higher average housing densities have higher TB rates."

Patterson prescribes more and better housing.

"I think you prepare a grid of the First Nations communities with the highest TB prevalence and incidence rates and you just go in and the first step of the response is medical, screening and contacts the next step is that summer you build 50 houses and keep doing it until the TB rate goes down. And it will. Every time there's a TB outbreak, that's just an argument for building 100 houses," he says.Turner cites another key factor in the fight to reduce TB: ready access to healthy food. Patterson agrees, based on what he's observed first hand.

"It's often people who are vulnerable for other medical reasons who develop tuberculosis which makes it doubly dangerous," he says. Consider, he says, the nutrition-sensitive illness of diabetes.

"Diabetes can be thought of as being to the indigenous people of North America what HIV is to Africa," he says. It "causes impaired immune function in anyone that has it, especially if blood sugars are poorly controlled."

According to Health Canada, "before, older people used to get diabetes, but now, Aboriginal people are getting it a lot younger because their traditional lifestyle has changed so fast." Eating healthy foods is the government's number one suggestion for avoiding diabetes, something that might be difficult for a community suffering from widespread food insecurity to do.

The exact interplay of TB and diabetes isn't clear yet, but Patterson says "anything that makes you sicker... increases your risk of TB."

Very clear is the link between TB and HIV.

According to the WHO, "the risk of developing tuberculosis (TB) is estimated to be between 20-37 times greater in people living with HIV than among those without HIV infection."

Patterson says HIV has not "gotten loose" among Aboriginal people in northern Canada to the same extent as on the West Coast, "but if that ever happens, TB will become a much more serious problem."

That much more serious problem may not be too far away.

"It appears that HIV rates have been steadily increasing in First Nations and Inuit populations. They are at increased risk for HIV infections for several reasons. Social, economic, and behavioural factors such as poverty, substance use, including injection drug use, sexually transmitted diseases, and limited access to health services, have increased their vulnerability," according to Health Canada.

The medical response

When tuberculosis takes hold in a place, says Dr. Pamela Orr, a professor of medicine at the University of Manitoba, the burden increases sharply on local health workers who already may be struggling with few resources in remote places.

Where "there's a very high rate of TB, they need a lot of local workers to deliver care and provide education to the community," says Orr. "They need more nurses."

Even a single TB diagnoses in a community can mean a lot of extra work for a community health nurse or worker, says Dr. Victoria Cook, the director of Tuberculosis Services for Aboriginal Communities, a department of the B.C. Centre for Disease Control.

Diagnosing someone with TB means starting him on treatment and making sure the treatment is going smoothly, says Cook, but "there's also the follow-up."

"TB is spread through the airborne route so it's something that can be spread from person to person," she says, and "there's a lot that goes into what we call contact tracing."

Contact tracing involves identifying people that may have been exposed to TB through contact with a patient, testing those contacts for TB and starting them on treatment if necessary. Potential contacts include family members, friends and health care workers. Effective contact tracing takes a lot of time says Cook. "It can be quite onerous."

According to Orr, technological resources are also in short supply in some areas.

For instance, "on the Labrador coast many of the communities don't have x-ray machines, so people have to be flown out if they have a cough," she says, "and their system of trying to get a sputum [sample] from a patient to a lab is difficult." Sputum is mucus that is coughed up from the lungs and is used to test for TB.

A spokesperson from Health Canada said in an email to The Tyee that "in 2011-2012, Health Canada is investing more than $9 million to support TB prevention, treatment and outbreak control for First Nations on-reserve across Canada and Inuit in Nunatsiavut."

Health Canada had not responded to a follow-up question asking how the $9 million would be allocated by posting time.

Targets and accountability

When the new First Nations and Inuit Health Branch National Strategy Against TB is released in the coming weeks, many on the front lines will be looking for benchmarks that can be used to hold authorities accountable for achieving progress.

Targets are crucial, says Orr, for understanding what's working and what's not in terms of TB programming. Right now, she says "there are no national performance targets that apply across the country for the general population or for sub-groups like the Aboriginals."

Cook, from the BC Center of Disease Control, says the new strategy should have ways of tracking how quickly and thoroughly First Nations are treated for TB. The plan could look at "what percentage of active cases of tuberculosis get started on treatment within the first 24 hours, what percentage of active cases of TB are treated with Directly Observed Therapy, what percentage of active cases of TB complete their treatment... how many people screened for tuberculosis actually get put on treatment for latent infection" and "looking at how many contacts are screened."

These "are absolutely reasonable targets to look at," Cook says "and are things that are useful to compare, not only internationally but actually from province to province."

"Part of the challenge has been... looking at accountability and outcome measurement," says Turner, of the Inuit Tapariit Kanatami's Inuit Committee on Health.

Turner says the best chance to eliminate TB in Inuit communities is with "an Inuit specific" strategy that is "designed by Inuit, delivered by Inuit." The ITK TB strategy is going through approval stages within ITK now.

In the meantime, those on the front lines against TB wait to find out how ambitious will be the new national strategy. Given that rates are highest among Aboriginals, The Tyee asked both the Public Health Agency of Canada and Health Canada to provide what, if any, specific targets related to Aboriginal communities will be included in the new strategy. PHAC's spokesperson sent an email with a target number for the general population instead, saying, "the strategy outlines a course of action to help reach the TB target incidence rate of 3.6 cases per 100,000 people by 2015 in Canada, in the spirit of the Global Plan to Stop TB." The Global Plan to Stop TB is a comprehensive plan for eliminating TB as a global public health issue.

Kevin Patterson is eager to see what new map the government is preparing to deal seriously with tuberculosis among the Aboriginal people he's come to know over the 16 years he has visited their communities and tended their sick.

"You can't have 15 people in a three bedroom house for about 100 different reasons, one of which is TB," he says. "And if the other 99 aren't good enough reasons, then we can use TB as a reason to improve the housing issues on reservations."

Patterson's boat chops through the waves as he considers Canada's response so far to TB and its social causes. He scans the horizon, and finds a word. "Shameful."

TB’s slow-motion Africa disaster

http://www.timescolonist.com

With the famine in Somalia a new threat to millions of lives, it might seem an unlikely time to call for increased spending on HIV/TB co-infection. But the disaster in the Horn of Africa has been years in the making, and due in no small part due to global neglect. Much could have been done, but wasn't, and now the world is responding after the fact, when lives have already been lost and aid much more difficult to provide.

As in Somalia, there is another longterm disaster stalking Africa that is the result of neglect. But unlike Somalia, it is absurdly simple to solve. It is estimated that less than five per cent of the millions of individuals being treated for HIV infection have been screened for TB, which is the primary killer for those living with HIV. This is despite the fact that screening is very simple. Eight questions are asked, and if the results are positive the patient is given a medical test. Treatment is less than $20 per year.

It is estimated that two million HIV survivors will die from preventable TB in the next three years.

We have a choice: We can bury the bodies after the fact, wasting millions of

dollars in the process, or we can be proactive and easily save lives. TB might be less dramatic than dust storms and packed refugee camps, but the results are the same.

New TB drug-resistance test shows promise but needs investment for those diagnosed to be cured

http://www.eurekalert.org

Two research studies in this week's PLoS Medicine suggest that a new automated DNA test for tuberculosis (Xpert MTB/RIF), which can detect TB within 2 hours and has been endorsed by the World Health Organization, can significantly increase TB detection rate compared to other tests, particularly in HIV positive patients who have a high risk of being infected with TB, including multidrug resistant TB. An accompanying Essay and Perspective highlight the economic challenges and implications of such diagnostic tests.

In the first study, led by Stephen Lawn from the Desmond Tutu HIV Centre at the University of Cape Town in South Africa, the authors collected sputum from HIV-infected adults with no current TB diagnosis who were enrolling at an HIV treatment clinic in a South African township. The authors then compared the diagnostic accuracy of Xpert MTB/RIF with several other tests, including liquid culture (the reference test).

Nearly a fifth of the patients had culture-positive TB and Xpert MTB/RIF identified three-quarters of these patients. Furthermore, the new test had a low false-positive rate and was able to detect all cases of smear-positive, culture-positive TB but only 43.4% of smear-negative, culture-positive cases from a single sputum sample. The new test also correctly identified rifampicin resistance, a marker for multidrug resistant TB, in all four patients who had this form of TB, but incorrectly identified resistance in three patients with drug-sensitive TB.

The authors say: "In this population of individuals at high risk of TB, intensive screening using the Xpert MTB/RIF assay increased case detection by 45% compared with smear microscopy, strongly supporting replacement of microscopy for this indication. " They continue: "However, despite the ability of the assay to rapidly detect rifampicin-resistant disease, the specificity for drug resistant TB was sub-optimal."

In a smaller study led by Lesley Scott from the University of the Witwatersrand in Johannesburg, South Africa, the authors compared the performance of Xpert MTB/RIF on a single sputum sample with that of smear microscopy, liquid culture and two other nucleic acid amplification tests (MTBDRplus and LightCycler MTB) in 311 adults suspected to have TB in Johannesburg, South Africa, a region where many adults are HIV-positive. Although these findings are likely to be affected by the study's small size, the results suggest that Xpert MTB/RIF may provide a more accurate rapid diagnosis of TB than smear microscopy and other currently available tests in regions where HIV and TB are endemic.

The authors conclude: "The Xpert MTB/RIF test has superior performance for rapid diagnosis of Mycobacterium tuberculosis over existing ... smear microscopy and other molecular methodologies in an HIV- and TB-endemic region. Its place in the clinical diagnostic algorithm in national health programs needs exploration."

In an Essay in the same issue, David Dowdy from the University of California in San Francisco, and colleagues discuss the challenges of economic analysis of diagnostic tests for tuberculosis, and argue that standard cost-effectiveness analyses may give misleading results when blindly applied to the scale-up of TB diagnostics.

To be useful to both policy-makers and decision-makers, the authors suggest that such analyses should establish society's valuation of false-positive tests relative to false-negative tests; evaluate the consequences of false-negative and false-positive diagnoses when new diagnostics are implemented in field settings; and set local cost-effectiveness thresholds for disease-specific interventions.

Furthermore, a Perspective by Carlton Evans from the Universidad Peruana Cayetano Heredia in Lima, Peru (not involved in any of the research studies here) stresses that although the new MTB/RIF-test has the capacity to be a "game-changer" in TB diagnosis, the new research in this week's PLoS Medicine raises important points of concern as the field progresses to implementation of this innovative technology. He emphasizes the shameful context that almost 2 million people die each year from TB, and very few of them would have been saved by any diagnostic test.

Evans says; "Specifically, these deaths occur in mainly HIV-negative people, almost all of whom die from drug-susceptible TB, principally because of the inadequacy of basic, inexpensive health care provision for this curable infectious disease."

Lack of awareness, facilities resulted in low TB detection rate

http://www.e-pao.net

The Tuberculosis(TB) detection rate is still low in Manipur comparing to the national detection level.

It's because of lack of awareness,facilities and poor communication due to geographical location.

This was disclosed by the State Tuberculosis Officer Dr O Manihar (Retd) on the sideline of the day long consultation meeting for recommendations on greater care and control of TB in Sadar hills under Manipur's Senapati district at Manipur Press Club today.

The consultation which was attended many representatives of the various NGOs and social organisations based in Senapati district was organized by Institute of Rural Development and Training Centre under the sponsorship of Global Health Advocates(GHA) .

The state has so far achieved an average of 60 percent TB detection rate against the 70 percent national detection rate since the launching of Revised National TB Control Programme(RNTCP) nine years ago,Dr Manihar added.

Dr Sapana Naveen and Christo Mathew of GHA which had organized similar consultation programmes in Thoubal district on July 5 last also spoke during the day's interaction session.

Interestingly Senapati,Tamenglong and Chandel have the low detection rate comparing to other remaining districts.

Tribals dominated Senapati has recorded only about 50 percent detection rate in the recent past.It has just 28 percent detection rate last year against state's average of around 64 per cent.

Information Education and Communication officer K Deben of State TB Cell who also attended the consultation meet speaking to this reporter informed that the multi-drug resistance (MDR)rate is also high in Senapati comparing to other districts of the state.

On the other hand Kuki-Chin-Zomi dominated Churachandpur district has the largest number of children having Tuberculosis cases comparing to other districts of the state.

"We're yet to ascertain the main cause of it",the official said.

"However we're providing necessary help and assistance to the needy people" .

So far more than 1000 TB patients have been given free medication under the state TB cell.

According to official records, as many as 31,471 TB patients were given proper treatment out of 37,420 cases detected in the year 2009.One thousand people die daily due to TB which is caused by bacilli called Mycobacterium Tuberculosis.

A Day in the Life of a TB Worker

http://www.talkgwinnett.net/

When Farhad Jameel, case manager at Gwinnett County's tuberculosis control clinic, arrives at work each morning, he collects his surgical mask and several large Zip-loc bags containing the individual medications for four to six homebound tuberculosis (TB) patients living in the county. He will spend the next three hours driving around the county to watch patients take their medications.

Each day Jameel sees a handful of patients who take medications only a few days per week and a few others who are taking medications every day, either because their TB was only recently diagnosed or because they cannot tolerate the larger doses required for skipping days.

As a case manager, it is not in Jameel's job description to watch homebound patients take their medication, a measure required by state law in order to ensure medications are taken properly and that multi-drug-resistant TB doesn't develop. This is the responsibility of a TB outreach worker, but since the East Metro district's funding for an outreach worker ran out in December of 2010, Jameel and his colleagues have been doing double duty in a region whose TB rates are among the highest in the state.

In 2010, the East Metro district of the Georgia Department of Community Health, which covers Gwinnett, Newton and Rockdale counties, saw 65 new cases of TB. Fifty-six of those were in Gwinnett County, making the county second in the state for new TB cases between DeKalb's 86 cases and Fulton's 51. These three most populous counties in the state alternate among the top three spots each year.

"With construction and the housing boom, there were suddenly a lot more people in Gwinnett and fast," said Donna Burel, LPN at the tuberculosis control clinic. Since 2001, 70 percent or more of new TB patients have been foreign-born residents of the county. The October 2008 Georgia Epidemiology Report cited Gwinnett's booming population and high concentration of immigrants from countries in which TB is endemic as the major hurdles to eliminating the infection in the county.

Highly contagious, TB must be tightly controlled by state and local public health authorities.

So Jameel can spend half his day doing outreach, his maximum case load was cut from 15 to seven, while his colleagues, who are especially bombarded with new cases in the spring and summer months, absorb Jameel's load.

As the district's only outreach worker, Jameel feels the burden. "I think each county needs two to three outreach workers just to do DOT [direct observe therapy]," Jameel says. In fact, according to CDC recommendations, counties with TB rates like Gwinnett's need 4.3 full-time outreach workers to administer medications and conduct contact investigations. Jameel's half-days spent on the road mean Gwinnett has half an outreach worker. For Gwinnett's caseload, the CDC recommends a total of 13 full-time dedicated TB staff. Gwinnett has 10.3, including one who is on loan from the district office and could be taken away at any time.

"Funding and staffing depend on how many patients you have in your county, but with the recent economic crisis, we are not meeting those funding and staff requirements," says Jameel.

Conversely, if TB rates go down in a given county, the state will assume the county can do with less funding for prevention and control. Michael Redmond, RN, the East-Metro district's tuberculosis control program manager, says that when this happened in New York in the 1980s, there was an immediate upswing in TB cases.

TB disease is the result of infection with the tuberculosis bacteria. Most infections become the non-contagious and asymptomatic latent TB (LTBI). One in ten cases of LTBI converts to the contagious, symptomatic active TB disease. Stress, poor nutrition, an immune system compromised by other illnesses, or a number of other risk factors can cause the conversion to active TB. So LTBI must be indentified and treated in order to prevent this conversion and the further spread of disease. Typically affecting the lungs, TB can infect any part of the body, such as the spine, the joints, the eye or the brain. Passed through the air, via coughing, sneezing or otherwise transmitting infected saliva into the air, pulmonary TB is the most contagious form, but all forms, if untreated, can be fatal.

According to state law, when a patient is diagnosed with TB or suspected of having TB, his or her health care provider must report it to the health department in the patient's county. The health department then takes over the case, administering medication in person daily, monitoring the patient monthly for up to 12 months, and investigating the patient's contacts to identify any other cases of TB or LTBI.

"For active TB patients, every dose every day must be observed by a TB worker," Jameel says. Children under the age of five, whether they have active disease or latent infection, must also take their medication in front of a health professional each day.

This means most of the county's active TB patients, 27 as of the end of June, report to the health department daily or several times a week to take up to five drugs needed to treat the disease, while children may take medications under the supervision of a school nurse. But, in part because the poor and the elderly are particularly susceptible to TB, some TB patients are homebound.

Jameel has driven more than 10,000 miles in a quarter on his DOT route. Stopping at houses in Lawrenceville, Snellville, Norcross and other areas, he dons a surgical mask before knocking on the doors of contagious patients, typically those within the first two to four weeks of treatment. At some homes, he is in and out in a just a few minutes. At others, he stays to answer questions about symptoms or side effects the patient may be experiencing. In some homes, spouses, siblings or children of the patient may be undergoing treatment for LTBI themselves.

Some of Jameel's time -- and that of other TB workers - is spent conducting contact investigations, during which a TB worker tries to reach and screen anyone who had contact with a TB patient during active infection.

"We need staff and time to conduct contact investigations and go out and screen people, but if case loads go up, we'll have just enough time to address active patients," said Redmond.

Each time a new case is identified, case managers initiate contact investigations to discover who may be at risk of having contracted the disease from the new patient. Contact investigations could be limited to just the immediate family or they could include all of a patient's co-workers, classmates or fellow church members. The extent of the investigation depends on the patient's lifestyle. More complicated investigations can take months to complete. Contact investigations are crucial to containing the infection.

In June, 11 investigations were underway: 10 for patients in the district and one for a patient elsewhere. Gwinnett County may contribute to investigations in other districts or even other states if the patient is suspected to have had contacts in the county while contagious.

Once he's back at the clinic, Jameel gets back to his cases. Case managers are responsible for all active cases of TB. A case can remain active for up to twelve months after diagnosis. Clinic nurses handle the latent TB patients who continue to come to the clinic for monthly evaluations until they are free of infection.

As of June, in addition to its 27 active patients, the clinic was seeing 118 latent patients, and one multi-drug-resistant patient.

Regardless of whether a patient has a private doctor, case managers follow active TB patients from the time their disease is reported to the health department until they no longer have active TB.

"One of the hugest obstacles is to help a new patient understand that directly observed therapy is something that works for you, not something that's being imposed on you. It's not just because there is a trust issue but to make sure these pills are doing what they are supposed to do for you," said April Garcia, one of the clinic's four case managers.

When patients start treatment, they will take four drugs until lab work - coordinated by the case manager and conducted on site - determines to which medications the patient is responding. This typically takes about two months. At this point, the patient is taken off two of the drugs.

TB drugs can also have serious side effects, including liver damage. Patients' liver function is monitored in the on-site lab at the Gwinnett clinic. If a patient's liver reacts to the drugs, the patient is taken off all drugs until the liver normalizes then each drug is gradually reintroduced or second-line drugs are used. This extends the treatment time and, thus, the time the patient is considered active.

In addition to monitoring patients' sensitivity to the drugs, case managers follow the patient's weight to make sure the involuntary weight loss associated with TB has stopped. Regular sputum tests conducted at the clinic determine if the patient is still contagious.

Garcia says the role also extends beyond clinical functions. She's helped patients find housing, and she's helped them find the fastest, most affordable taxi when they were without transportation to the clinic.

"It's a lot of social work," she says.

Georgia's regulations for the treatment and control of TB are similar to those in other states and in accordance with CDC recommendations. Without strict monitoring of treatment, the risk is too great for the spread of TB and the development of multi-drug-resistant strains, which can be spread as well.

"A contagious infectious disease is a public issue," Jameel says. "When you have a contagious disease, it's not just the problem of the patient himself; it also becomes the problem of the people around him."

President Arthur quarantines immigrants, July 18, 1884

politico.com

President Chester Arthur issued a proclamation giving the federal government the power to quarantine persons entering the United States to avoid the spread of "pestilence." The proclamation did not mention the name of the disease from which Arthur was seeking to protect the public: tuberculosis.

Two years earlier, the bacillus that causes tuberculosis had first been identified by Robert Koch, a German physician. Koch received the 1905 Nobel Prize in medicine for the discovery.

Prior to 1890, individual states, rather than Washington, regulated immigration into the United States. While several states maintained their own quarantine rules, Arthur saw a need to broaden the federal government's powers to intervene in order to avert a potential health crisis. Moreover, Arthur served as president during a depression, when increasing numbers of Americans opposed allowing people to emigrate from European and Asian nations, where tuberculosis was rampant.

Arthur advised states and cities with ports of entry to "resist the power of the disease and to mitigate its severity." He effectively authorized people to report to the federal government any persons suspected of carrying highly contagious diseases.

It is now "relatively uncommon," according to Neil Schluger, a professor at Columbia University's Mailman School of Public Health, for persons to enter the U.S. with an active case of tuberculosis.

"Most of those persons don't come legally," Schluger said. "If you try to legally immigrate, ... you actually have to be screened for tuberculosis in your home country, so if you're coming here on a residence visa, ... you have to have an X-ray in your home country and it's got to show that you don't have contagious TB before you can come in."

Capreomycin shortage: symptom of a bigger problem in multidrug-resistant tuberculosis

PLoS Medicine (http://blogs.plos.org)

There is currently a worldwide shortage of quality-assured capreomycin, a key drug in any regime to treat multidrug resistant (MDR) TB. This shortage has occurred because Akorn-a US manufacturer and the only supplier of capreomycin to the Global Drug Facility-has had a problem with the supply of the active pharmaceutical ingredient. This situation is not unique to capreomycin: in 2010 there was a global shortage of kanamycin, similarly as a result of having only a single manufacturer producing quality-assured injections and a problem with the active pharmaceutical ingredient.

The current shortage of capreomycin could result at a country level in MDR-TB patients not completing the required length of treatment or delay patients starting treatment, with the associated increase in morbidity and mortality.

Of the 9.4 million new tuberculosis (TB) cases diagnosed each year, approximately 5% are multidrug resistant (MDR). MDR-TB treatment is demanding for patients, requiring a complex treatment course lasting 18-24 months, and using a minimum of five different antibiotics that often add up to more than 20 tablets a day.

One of the group of drugs required are injectable antibiotics that must be given for a minimum of 8 months. These drugs-kanamycin, amikacin, and capreomycin-are key to any treatment regimen for MDR-TB. There are a limited number of manufacturers globally who produce quality-assured formulations of these drugs, and changes in the producers in the MDR-TB market has resulted in single manufacturers supplying the global demands. The MDR-TB treatment regimen has been plagued with drug shortages for many years due to this situation .

MSF currently supports TB care for over 25,000 patients in 29 countries, and is providing treatment to over 1000 patients with MDR-TB in 15 countries. The number of patients enrolling in MDR-TB programmes is increasing each year. MSF is using its emergency stock to bridge the shortfall and are advising their projects on ways to prevent patients' treatment being compromised by the low stock levels.

Prior to the increase in the rate of MDR-TB, the use of some of these antibiotics was declining, so their production capacity decreased accordingly. This has led to the limited availability and high cost of quality assured second line medicines to treat MDF-TB.

There are manufacturers in China, India, South Africa and the former Soviet Union who provude injectable antibiotics for MDR-TB treatment but their compliance with World Health Organization (WHO) quality assurance standards is unknown. All manufacturers of these drugs need to meet internationally recognised quality standards to ensure efficacious treatment and prevention of further resistance.

One mechanism to ensure the quality of drugs is the WHO Prequalification Programme, which evaluates both the product and manufacturer. Today, there are two main mechanisms that are internationally recognised to ensure the quality assurance of a medicine: WHO prequalification and the approval of a stringent regulatory authority.

The lack of quality-assured manufacturers involved in MDR-TB drug production, combined with growing demand, has contributed to the increased price of these drugs. The average price of treating a patient with MDR-TB is approximately US$9000, compared with $19 for drug-sensitive TB. Capreomycin significantly contributes to this increase in cost (as well as moxifloxacin, para-aminosalycilic acid, and cycloserine). The price of capreomycin has risen from $4 to $8 a unit, after manufacturer Eli Lilly, which had been subsidising the cost, ceased production. The new quality-assured manufacturer for capreomycin was not able to offer the same prices, although they are still offering some subsidies. The other major injectable agent, amikacin, has increased in price by 991% since 2001.³ This and other cost increases could be attributed to monopoly situations for some drugs and manufacturers who were subsidising the supply of certain drugs leaving the TB market.

WHO and other partners created the Green Light Committee (GLC) in 2000 to respond to the need for affordable second-line drugs. It has been largely unsuccessful in providing a large market force to drive down prices. The GLC is currently undergoing a restructuring to try and increase access to quality-assured products and encourage the scale up of DR-TB programmes. Some countries and projects not currently in GLC programmes are purchasing these important drugs from either pharmaceutical companies with non-approved products or at increased cost from approved companies, and in some cases not starting MDR-TB patients on the appropriate treatment. MSF has recently published, in collaboration with the Treatment Action Group (TAG) and Partners in Health (PIH), a report into these global initiatives and the extent of certain countries' scale up of MDR-TB programmes (http://www.msfaccess.org/fileadmin/user_upload/diseases/tuberculosis/TB_report_TreatmentScaleUp_ENG_2011_01.pdf).

With the improvements in TB diagnostics, especially with the new Xpert MTB/RIF test, MDR-TB is becoming faster and easier to diagnose, and the numbers requiring treatment is expected to grow exponentially as a result. Even without this expected increase in diagnosis, only 10% of the current estimated MDR-TB cases in the high burden MDR-TB countries, and 11% globally, have been started on treatment.² This could mean that there are, at least, more than half a million potential patients needing second-line treatment now, even before the expected increase with new diagnostics.

The current stock rupture of capreomycin should be seen as a wake-up call to everyone involved in the management of MDR-TB. There is an urgent need to develop novel funding mechanisms to incentivise new manufacturers to enter, and to retain current manufacturers' engagement, in the global TB market, to ensure uninterrupted supply of quality assured medicines. While this key debate is left unaddressed, we will continue to see severe shortages of critical MDR-TB drugs, and with a likely greater frequency as the demand increases. This will have devastating implications for both the individual and the public health of the community.

Chehera: The Human Face of TB

Brought to us by our partners at GHA India, they recently attended an art exhibit that harnessed the power of art and imagery to spread the message of tuberculosis (TB) to the masses who still are unfamiliar with this deadly disease. Read further to download a PDF containing the powerful images from the exhibit. We must extend special thanks to "Art for Change, the vibrant group of socially conscious artists who made this happen.

Chehera: The Human Face of TB

New Report Shows Global Response to MDR-TB Has Been Slow

www.globalhealth.kff.org

A new report released recently and compiled by the Treatment Action Group, Medecins Sans Frontieres and Partners In Health says that international efforts aimed at scaling up treatment of multi-drug resistant tuberculosis (MDR-TB) have been slow due to weak government action, low funding and a "sluggish response by international support mechanisms," BMJ News reports.

The report is based on data from India, Russia and South Africa. "The countries reviewed had insufficient access to quality assured laboratory diagnostic capacity, resulting in delays in diagnosis and an enduring burden of undiagnosed patients. Quality care was also jeopardized by limited access to quality assured drugs and unpredictable and expensive drug supplies," BMJ News writes. "WHO fully shares the report's conclusion that governments need to tackle the issue much more vigorously than most have so far. Tackling TB is difficult; tackling MDR-TB, as this report makes clear, is even more challenging," Mario Raviglione, director of the WHO's Stop TB Department, said.

Read full report here

Rapid TB Test Reliable in Kids

medpagetoday.com

A rapid automated test for tuberculosis -- already recommended by the World Health Organization for disease detection in adults -- proved more effective than smear microscopy for identifying Mycobacterium tuberculosis infection in children, a large prospective study found.

Using two induced sputum samples from children whose median age was 19.4 months, the Xpert MTB/RIF test detected 75.9% (95% CI 64.5 to 87.2) of cases of tuberculosis, according to Mark P. Nicol, PhD, of the University of Cape Town in South Africa, and colleagues.

In contrast, smear microscopy only detected 37.9% (95% CI 25.1 to 50.8), the researchers reported online in The Lancet.

Diagnosis of tuberculosis -- particularly in the lower-income parts of the world where the disease flourishes -- typically has relied on smear microscopy.

However, smear microscopy is less sensitive than culture, such that the results in children often are negative even when cultures subsequently confirm the infection.

But cultures can take up to six weeks, and quicker decisions are needed for optimal treatment outcomes.

The worldwide increase in drug resistance to anti-tuberculosis agents has further heightened the need for a rapid, highly sensitive and specific test for both diagnosis and for identification of drug sensitivity.

The Xpert MTB/RIF utilizes nucleic acid amplification to detect both the organism and its sensitivity to rifampin, one of the first-line drugs to treat tuberculosis. In adults, a single test detected 98.2% of cases of tuberculosis that were smear-positive and 72.5% of those that were smear-negative.

Accordingly, the World Health Organization endorsed the test for adults at risk for drug-resistant disease or who were HIV-infected.

But the test had not been evaluated for use in children, so Nicol and colleagues enrolled 542 children ages 15 and younger who were admitted to the hospital for suspected pulmonary tuberculosis.

All children had at least one sputum induction procedure, and a second was done in 385.

Specimens were tested by both smear microscopy and with automated MTB/RIF testing, and positive specimens were then cultured.

Among children for whom at least one induced sputum sample was tested with MTB/RIF, 16% had definite tuberculosis, 48% had possible tuberculosis, and 37% did not have the disease, the researchers found.

They also found at least one positive MTB/RIF test in 74.3% of the children classified as having definite tuberculosis, in 2.8% of those with possible tuberculosis, and in none of those who did not have tuberculosis.

In children with at least one test, the overall sensitivity was 58.7%, specificity was 99.4%, positive predictive value was 94.4%, and negative predictive value was 93.1%.

Among children who were HIV positive -- about one-quarter of the total population -- the sensitivity of the MTB/RIF test was higher than in HIV-negative children (100% versus 85.4%, P=0.042).

For children with two induced sputum results, the specificity of the test was 98.8% (95% CI 97.6 to 99.9).

And for HIV-positive children with two induced sputum tests, the specificity was 100% (95% CI 95.5 to 100).

The MTB/RIF test also detected 100% of cases that were positive on smear microscopy, as well as 61% of cases that were negative on smear microscopy.

With a second test, the sensitivity in smear-negative cases increased by 27.8%, the researchers reported.

In addition, a per-sample analysis found that the MTB/RIF test identified all of the 70 cases that were rifampin-susceptible as well as two that were resistant.

Although the test was not as sensitive in cases where smear microscopy was negative, the yield still was twice that of the conventional rapid test.

The MTB/RIF test "is widely anticipated to replace smear microscopy in resource-poor settings where HIV coinfection or drug-resistant tuberculosis are common, and our results suggest that its use is a major improvement over use of smear microscopy," stated Nicol and colleagues.

And although the WHO recommendation for adults is for a single MTB/RIF test, the findings of this study suggest that children whose initial results are negative should have a second test.

This could increase the cost, however.

The researchers noted that for this type of testing to be widely implemented, local clinics will need to provide facilities suitable for sputum induction, with training of staff and measures to prevent transmission.

Limitations of the study included enrollment only from specialized facilities, where patients may have had more severe disease, and small numbers of resistant cases.

In a comment accompanying the study, Eduardo Gotuzzo, MD, of Universidad Peruana Cayetano Heredia in Lima, Peru, called for urgent additional research into this approach to testing.

"Unless fast, cheap, point-of-care tests that can also detect multidrug-resistant tuberculosis are researched, efforts to control tuberculosis will not succeed because while patients await diagnosis and adequate treatment, disease transmission will continue," Gotuzzo warned.

RESULTS Educational Fund Executive Director Joanne Carter Makes Statement on GAVI U.S. Pledge

"Today the United States made a strong commitment to a global plan to save 4 million lives by vaccinating 250 million children by 2015, pledging $450 million over three years to the GAVI Alliance. We congratulate the Obama Administration on this decision and pledge our support to ensure this funding is delivered. We also welcome USAID Administrator's Rajiv Shah's commitment to host a high-level conference on GAVI next year, which will be an important moment to assess our progress and hold donors accountable for their commitments.

"New vaccines to help prevent the biggest killers of children - pneumonia and diarrhea - will accelerate our progress on stopping needless disease and death. These new vaccines are game changers, and it is heartening that even in a challenging budget environment, the U.S. can seize new opportunities presented by medical innovation. With foreign aid currently accounting for less that 1 percent of the federal budget, our leadership on global health and our commitment to the poorest people on the planet must not fall victim to senseless budget cuts.

"The GAVI Alliance is an innovative and effective global partnership, which helps deliver new and underutilized vaccines in poor countries, and its efforts have already saved more than five million lives. With significant new funding commitments from the U.K., Australia, Japan, France, and many other donors, this is truly a shared global effort.

"It will ultimately be up to Congress to fulfill this U.S. commitment to help turn the tide against the leading childhood killers. We look forward to working with members of Congress to ensure that this pledge is fully met, and other funding for global health and poverty alleviation remains a top priority."

United Nations General Assembly Adopts A New Political Declaration On HIV/AIDS

ACTION

ACTION (Advocacy to Control TB Internationally) Director Kolleen Bouchane issued the following statement in response to the United Nations General Assembly's adoption today of a new political declaration on HIV/AIDS.

"This morning at the United Nations High Level Meeting (HLM) on HIV/AIDS, the UN General Assembly adopted an ambitious new declaration demonstrating a serious commitment to intensify the global response to the AIDS epidemic, including by addressing TB as the leading killer of people with HIV. The declaration comes 30 years after the illness that came to be known as AIDS was first described, 10 years since the first UN Declaration of Commitment on HIV/AIDS, and five years after the 2006 UN Political Declaration on HIV/AIDS.

"As the declaration acknowledges, the world has made substantial progress against AIDS. Less than a decade ago, virtually no one living with HIV/AIDS in low-income countries was receiving antiretroviral therapy (ART) - now 6.6 million people have access to these life saving drugs. The rate of new infections has declined by more than 25 percent in over 30 countries, and HIV deaths have declined more than 20 percent in the last five years.

"Recent research shows that providing early ART can reduce transmission by 96 percent. Building upon this knowledge, the declaration represents another milestone in the fight against AIDS by setting a target of reaching 15 million individuals with ART access by 2015. Now, governments, the private sector, communities, and civil society must act to fulfill this target, and doing so will go a long way to preventing new infections.

"ACTION is grateful for work of many including the Brazil and Thailand country delegations, who proved to be instrumental in moving this declaration forward, as well as the powerful voices coming from the Treatment Action Campaign, Health GAP, Treatment Action Group and Medicins Sans Frontieres, among others who were able to secure this strong commitment.

"We commend UN member states for recognizing the vital importance of the Global Fund to Fight AIDS, Tuberculosis and Malaria to the global AIDS response, and for calling on donor governments to provide the highest level of financing to meet its resource needs. We call for an emphasis on tuberculosis and TB/HIV in the next round of programs to be approved in order save an additional million lives from TB/HIV by 2015.

"We also commend the member states for committing to investing in accelerated research for new diagnostics to treat TB in people living with HIV - a critical step to stop the leading killer of people with HIV.

"Despite these considerable commitments, we remain alarmed by the weakening of key language from earlier drafts aimed at addressing TB, the leading killer of people living with HIV/AIDS. The dilution of previously considered commitments is unfortunate, especially given new scientific modeling unveiled at the UN this week by the Stop TB Partnership in collaboration with the World Health Organization and UNAIDS showing that one million additional lives could be saved by 2015 by more aggressively treating and preventing TB disease in people living with HIV.

"Previous drafts of the declaration included explicit commitments to fully implement the Global Plan to Stop TB 2011-2015, including $9.6 billion committed for research and development of new TB tools appropriate for use among people living with AIDS - an essential component of the AIDS response. We are disappointed that the United States delegation moved to strike these commitments from the declaration shortly before the text was made final.

"Despite the shortfalls, ACTION celebrates the achievements in this new declaration and remains committed to a more ambitious target on TB and TB-HIV. We urge global leaders to fight TB-HIV as a single disease with scaled-up and focused funding through direct aid and the Global Fund to Fight AIDS, Tuberculosis and Malaria. By doing so, leaders will have the opportunity to cut TB-HIV deaths by 80 percent and save an additional million lives by 2015."

See also:

Joanne Carter, executive director, RESULTS Educational Fund, on Huffington Post
http://www.huffingtonpost.com/joanne-carter/tb-hiv-_b_873848.html

Kolleen Bouchane, director, ACTION, on Huffington Post
http://www.huffingtonpost.com/kolleen-bouchane/aids-one-million-_b_872936.html

Mandy Slutsker, research associate, ACTION, on One.org
http://www.one.org/blog/2011/06/10/stop-aids-treat-tuberculosis/

ACTION Blog
http://www.action.org/blog/

Full text of the declaration
http://www.un.org/ga/search/view_doc.asp?symbol=A/65/L.77

Find out how to save a million lives!

ONE.org: Stop AIDS. Treat Tuberculosis.

ACTION Project Director Kolleen Bouchane: We Can Save a Million More Lives

Global leaders urged to take action and save an additional million lives

ACTION

By: Jove Oliver

New York, NY - Advocates urged global leaders to act in response to new scientific modeling released today by the Stop TB Partnership, showing that between 2011 and 2015 it is feasible to avert over one million deaths caused by a dual infection of HIV and tuberculosis (TB). The modeling was released on the eve of the United Nations High Level Meeting on HIV/AIDS in New York City.

"The world's most devastating viral epidemic and the world's most devastating bacterial epidemic have merged together, with each one fueling the other," said Kolleen Bouchane, director of ACTION. "We will hear soaring speeches from world leaders on AIDS this week, and they're important. More important, however, is that once the speeches are over, leaders return home and deliver the basic services that will save the lives of people in their countries."

The modeling, conducted by epidemiologists at the Stop TB Partnership and the World Health Organization, describes the anticipated result of more effectively diagnosing and treating people with TB and improving access to TB preventive therapy among people living with HIV. The model demonstrates that it is feasible to reduce deaths from TB-HIV disease by 80 percent between 2011 and 2015. The cumulative impact would be to save one million lives by 2015.

"This modeling shows that we can save a million people from an untimely death, and we can do it with technology and knowledge we already have," said Bouchane. "We've made historic progress against AIDS over the last 30 years, but the epidemic is evolving. We need to get serious about addressing HIV and TB as a single disease or we are going to lose both fights and millions more lives."

The modeling is released on the heels of a game-changing new AIDS study, which not only demonstrates that early antiretroviral HIV therapy (ART) reduces the spread of HIV by 96 percent, but it also dramatically reduces the risk of developing TB. Paradoxically, this new evidence comes at a time when governments have begun scaling back AIDS funding.

"U.S. global health investments must continue to follow where the evidence leads. We have the treatment and diagnostics, and now we have the evidence and modeling that demonstrates we can stop TB-HIV in its tracks." said John Fawcett, legislative director of RESULTS Educational Fund, host of the ACTION Secretariat. "Proposed cuts in Congress to global health funding are irrelevant to the deficit and would roll back the progress we've already made by allowing the dual epidemics to continue spreading."

Particularly in sub-Saharan Africa, the AIDS virus has teamed up with Mycobacterium tuberculosis - the bacterium that causes TB - to spawn a dual epidemic. One out of every three people worldwide carries a dormant TB infection, which awakens into contagious and often lethal TB disease when HIV weakens the immune system. Even though ART has made HIV/AIDS a manageable chronic illness for millions, one in four people living with HIV ultimately dies of tuberculosis.

TB vaccines: getting them out of the lab

http://www.trust.org/

International tuberculosis (TB) experts are gathering today — World TB Day — in France to discuss advances in research into vaccines.

But the reason there is no effective vaccine to prevent the roughly ten million new cases and two million deaths from TB each year has little to do with the science. There are already 11 vaccines in clinical trials whose progress has slowed or stalled because the funding has dried up.

That is why the TuBerculosis Vaccine Initiative (TBVI), an independent organisation that promotes the development of TB vaccines, is launching a new funding model today.

Joris Vandeputte, senior vice-president of advocacy and resource mobilisation at TBVI, tells SciDev.Net that US$1.5 billion is urgently needed to translate basic research into market-ready vaccines over the next decade. A single TB vaccine can cost up to US$300 million to develop.

Funding gap

Basic research has been adequately funded, he says, resulting in around 40 candidate vaccines because of a huge research effort over the past decade. In addition to the 11 in the faltering trials, a further 30 are languishing in laboratories, some of them in developing countries, waiting to be tested.

But the "second chunk" of funding, needed to get the candidate vaccines through clinical trials, is missing — so vaccine development has effectively stopped, he says.

Under the new funding model, the European Union would provide loans to fill the gaps, possibly through the European Investment Bank. The loans would be administered by the TBVI and paid back once the vaccines start making money.

The model takes into account various logistical difficulties facing the researchers, such as the bottleneck caused by the lack of capacity in clinical trials, by calculating in the costs needed to tackle such issues.

"We will have to look to the east — China, India, Russia — to do more clinical trials," he says, in an attempt to overcome this bottleneck. But he maintains that once there is a new vaccine, it will attract a huge market.

Around 90 per cent of countries currently vaccinate their children against TB with the Bacillus Calmette-Guérin (BCG) vaccine, using 100 million doses each year. BCG protects children from severe forms of TB but does not protect adults from pulmonary TB — the most common and infectious form of the disease.

A more effective vaccine would save huge amounts on treatment, which costs European countries alone about US$3 billion a year.

Low take-up

But even if the money for trials becomes available and an effective vaccine emerges, further problems may await. Data to be published later this year in a special vaccines issue of the journal Tuberculosis show that some developing countries may be reluctant to accept new TB vaccines.

Several factors seem to determine whether countries are prepared to shoulder the costs of a new vaccine campaign, including whether the vaccine has been tested in their own country.

The study's authors conducted 86 structured interviews with public health clinicians, politicians and senior civil servants from health and finance ministries in countries with the highest burden of the disease: Brazil, Cambodia, China, India, South Africa, Mozambique, Romania and Russia.

Lew Barker, senior medical advisor at the Aeras Global TB Vaccine Foundation in the United States, says their study sought to gauge the opinions of people in high-burden countries who are likely to be involved in making decisions about whether to adopt TB vaccines when they become available.

"None of the respondents, when asked about the most important public health issues and needs of their country, spontaneously mentioned TB," Barker says. Instead, primary, rural and mother-and-child healthcare, as well as HIV/AIDS, were identified as the most pressing issues.

"However, when TB was mentioned [by the interviewer], they uniformly said this is a very serious problem and, by and large, they said it's also a neglected problem that needs and deserves more attention then it gets," Barker adds.

Respondents in the survey welcomed the development of better TB vaccines, but around 20 per cent said it was unlikely that such vaccines would be taken up in their countries, and many more were undecided. In most of the vaccine roll-out scenarios presented, less than half said they were willing to commit to a new vaccine and provide funding. One of the main reasons was that they wanted to see strong efficacy data from clinical trials in their own country.

Barker concludes that robust data showing efficacy of 90 per cent, rather than a more realistic 60 per cent, and from studies in the countries concerned, are likely to be needed for the introduction of new TB vaccines.

Opokua Ofori-Anyinam, senior clinical development manager at GSK Biologicals, a vaccine manufacturer, said researchers should engage with policymakers to make sure that, after spending millions of dollars on trials and testing vaccines in thousands of individuals, they end up with vaccines that policymakers will want to deploy.

"These are the things we have to think about ahead of time," Ofori-Anyinam tells SciDev.Net.

Vandeputte says the TB research community must engage with the media and policymakers to put TB onto national political agendas.

But he points out that Aeras' market research, presented by Barker, found a mixed response and that the proportion of decision-makers who would go for a new vaccine is bigger than those who would not. Engagement and advocacy before a new vaccine reaches the market may also help convince the undecided.

But he adds that although studies are needed to address uptake issues and pave the way for the future deployment of TB vaccines, the priority should be on designing and testing vaccines rather than worrying about their subsequent uptake.

Helen McShane, a TB vaccine researcher at the University of Oxford, United Kingdom, whose vaccine MVA85A is currently in phase IIb clinical trials, told SciDev.Net: "The more effective a vaccine is, the more likely that it will be taken on. It will also depend on cost — I think if you have a very effective vaccine at affordable prices for the developing areas of the world then it will be taken on."

She adds: "There may be certain countries where you have to do some studies in that country to get some safety data but, although those are all important factors, I don't see them as the biggest challenge — the biggest challenge is that we need to get a vaccine that works."

Face Masks Can Help Cut TB Transmission

http://www.medindia.net

Simple face masks worn by patients infected with tuberculosis may significantly reduce the transmission rates to non-infected patients, suggests study.

The study was conducted in a specialized airborne infections research facility in South Africa, which was designed to allow study of methods to control the spread of TB. Transmission rates were measured using healthy guinea pigs exposed to infected patients."We found that when infectious patients with multidrug resistant tuberculosis (MDR-TB) wore face masks while they were hospitalized, the face masks helped decrease the transmission of tuberculosis by 50 percent compared to when the patients did not wear face masks," said study author Ashwin Dharmadhikari, associate physician at Harvard Medical School's Brigham and Women's Hospital.

The masks may represent a simple way to reduce TB transmissions in areas with limited resources and widespread TB. "This is especially important when one thinks about the importance of protecting health care workers and other patients from getting TB when these vulnerable individuals might be in the same room as a TB patient," said Dharmadhikari.

The study will be presented at the ATS 2011 International Conference in Denver.

Private sector TB treatment in Asia: a lot of it, but often sub-optimal

http://www.aidsmap.com/page/1789145/

Private sector markets for tuberculosis drugs in some Asian countries are providing enough drugs to treat every new TB case each year - but in many cases patients appear to be receiving drug regimens that are not recommended in international guidelines, according to a major survey published in the journal PLoS One.

Although tuberculosis treatment is largely provided through the public sector in the majority of countries with a high burden of tuberculosis (TB), the coexistence of public and private medical sectors in many Asian countries has led to large-scale dispensing of medicines with very loose regulation.

Until recently public sector TB control programmes were underdeveloped in many Asian countries, leading to large-scale use of private sector diagnosis and treatment.

As governments seek to scale up public sector TB responses with the support of donors it has become clear that greater consistency in treatment approaches between public and private sectors will be an important part of limiting the emergence of multi-drug resistant TB.

For example, public sector programmes have been working towards the adoption of a number of measures designed to limit the emergence of drug resistance, including directly observed treatment during the intensive phase of TB treatment, usually known as DOTS, the use of fixed-dose combinations to improve adherence, and prescription of a very limited number of different drugs based on recent information about drug resistance patterns in each country.

In each case, promoting adoption of these practices in the private sector has proved challenging.

In India one study found that 100 private sector doctors managed to prescribe 80 different TB regimens to their patients, while in the Philippines another study found that 89% of TB prescriptions by private sector providers didn't match national guidelines.

However, there is little information about the size of private sector TB treatment markets and the drugs prescribed within them that would help national programmes begin to push for changes.

To help in mapping the role of the private sector in TB treatment the Global Alliance for TB Drug Development carried out an international survey of private sector providers with IMS Health, a healthcare market research company, in 10 countries representing 60% of the global TB burden (Bangladesh, China, India, Indonesia, Pakistan, Philippines, Russian Federation, South Africa, Thailand, and Viet Nam).

The most significant finding was the sheer volume of drugs being prescribed in the private sector, and the extent to which total national prescribing in both public and private sectors appeared to exceed the national burden of TB, in some cases by 60 to 80%.

In India, for example, the total volume of TB drugs prescribed for first-line treatment by the private sector in India would treat 117% of the incident TB cases reported in 2008-2009. In Indonesia the volume of prescriptions was equivalent to 116% of incident TB cases, in the Philippines 86% and in Pakistan 65%.

Where did all these drugs go? The researchers suggest that many patients who present for care to public facilities may already have received treatment in the private sector; indeed they note that in India, 86% of patients in one study had first sought care in the private sector.

It is also possible that a large number of cases of TB never get reported properly, despite drug prescription.

However, two other practices may also be contributing to the large volume of prescribing: the tendency of private sector physicians to prescribe TB drugs for longer than recommended in international guidelines, and the use of TB drugs to treat pneumonia.

The study also found that at least one-third of all private sector dosages of first-line TB drugs fall outside of national and international treatment recommendations. No less than 111 different first-line TB drug dosages and combinations were being prescribed in the private sector across ten countries, compared to the 14 deemed necessary by the Stop TB Partnership's Global Drug Facility.

Although a large proportion of first-line TB treatment is being prescribed by the private sector, very few patients with multi-drug resistant TB receive treatment in the private sector, and where MDR-TB treatment is being prescribed, the low volumes of many oral drugs recorded in the survey suggests that it is sub-optimal.

International and national guidelines favour the use of fixed-dose combinations for TB treatment because it helps adherence to medication and ensures that the right doses of drugs are dispensed. While India, Pakistan, Philippines, Bangladesh and South Africa had relatively high volumes of fixed-dose combination prescription in the private sector, greater than 90% of first-line TB prescriptions in the remaining countries still come in the form of loose TB drugs.

Furthermore, some countries appeared to have high levels of prescription of first-line TB drugs at non-standard dosages, which carries a clear risk of either inadequate drugs levels in the case of too-low dosages (most common in China) or side-effects leading to treatment discontinuation in the case of too-high dosages (most common in India). Thirty-five per cent of all first-line TB drugs prescribed across the ten countries were non-standard dosages.

Patients receiving private sector treatment were also paying high prices for TB drugs; on average, almost twice the price at which drugs were supplied to the public sector. An average course of first-line TB treatment in most countries was at least $50, suggesting another reason why so many patients either failed to complete a course of TB treatment, or present to public sector TB clinics after a period of private TB treatment.

"Most countries covered in this study have public-private mix (PPM) programmes for TB care," said Mario Raviglione, Director of the Stop TB Department at the World Health Organization.

"Based on country experiences, these programmes have shown good results in optimising TB management by private care providers. However, the size of the response is not commensurate with the size of the challenge; there is enormous scope to expand these programmes urgently."

He recommends that private providers following best practices should be supported through accreditation and access to free TB drugs from the public sector, while those not doing so should be regulated.

"Greater government and international support is needed for these efforts and also for improved regulatory oversight and quality assurance of TB drugs. A dual track approach of collaboration and regulation is the logical way forward. We ought to make private providers responsible partners of the public sector in controlling TB and MDR-TB".

Australian experts fear clinic closure will fuel TB threat

The chairman of the Torres Straight Regional Authority in far north Queensland says the decision to close down the region's tuberculosis (TB) clinics could put Australians at risk.

The Queensland Health-operated clinics, which have been treating Papua New Guinean nationals for a drug-resistant form of TB, are set to close at the end of June.

Authority chairman Toshi Kris says the clinics act as border protection point for Australia and the closure could result in a national outbreak.

"Within these health centres, although they are under-resourced, they have really kept it away from becoming an epidemic," he said.

"It's not just the Torres Straight and Torres Straight Islanders, it's the whole nation of Australia.

"It's very high value to both countries and we really need to work with the state and the Commonwealth, with the Torres Straight Aboriginal Authority and the local government to look at how we can better work with this issue.

"Not just coming up with a bandaid solution by closing the clinic, because we're not going to stop these people coming across."

Venezuelan prisoners hold 22 officials hostage to protest against TB outbreak

http://www.guardian.co.uk

Troops in Venezuela surrounded a jail where inmates were holding 22 hostages, including the prison director, to protest against an alleged tuberculosis outbreak.

National guard units with helmets and shields blocked access to the Rodeo II prison in Guatire, just outside the capital Caracas, as officials attempted to negotiate a peaceful end to the two-day siege.

Prisoners seized the director, Luis Aranguren, and 21 other officials on Wednesday after an inmate with tuberculosis-type symptoms was taken to another jail for medical tests.

They demanded a medical inspection of the facility, which holds 1,200 inmates in cramped cells, and complained that their warnings of a possible epidemic over the past four months had been ignored even after the disease allegedly killed an inmate.

The deputy interior minister, Edwin Rojas, was due to visit the jail to talk to the hostages and try to broker an end to the stand-off without bowing to what authorities called kidnap pressure.

Holding hostages was "not the most adequate way" to make grievances known, said Rojas. The prisoner who was removed for medical tests had pneumonia, not tuberculosis, and a medical team was on stand-by to enter the jail once hostages were freed, the minister added.

"We believe in peaceful dialogue, in peaceful coexistence and the respect of human rights, not only of the prisoners but also of those who work in the prison system."

The prisoners, in messages sent via their families, said they feared reprisals and wanted guarantees for their safety. Relatives were due to read on TV a letter from prisoner leaders elaborating on demands and grievances.

The government has promised to build new, humane prisons but most of Venezuela's 48,000 inmates languish in old, degraded facilities. Humberto Prado, head of the Prisons Observatory watchdog, said the system was designed to hold only 12,500. Conditions are primitive and violence is rife, with hundreds killed every year.

In a tacit pact with authorities some gangs had started strangling rivals, rather than shooting or stabbing them, so the deaths could be registered as suicide, Prado wrote in the newspaper Tal Cual.

Carlos Nieto, head of another watchdog group, A Window for Freedom, said the fact a mass hostage taking could last for days showed that prisoners rather than authorities controlled jails.

Pakistan ranks 6th among high burden TB affected countries

http://app.com.pk

Pakistan ranks sixth among the 22 high tuberculosis affected countries, and has 43 per cent share of its patients in the Eastern-Mediterranean region of World Health Organization (WHO).According to available data, the incidence of TB per 100,000 population in Pakistan is 181, case notification per 100,000 per year is 150 while the treatment success rate is 85 per cent.An estimated one-third of the world's population is currently infected with TB. The WHO is working on a plan to reduce TB prevalence rate and deaths by half by 2015.

An official of the National TB Control Programme said that over 700,000 TB patients have been treated free of cost and 100 per cent latest treatment methodology of DOTS coverage has been achieved in the country.

He said training and health education material has been developed and all health care providers concerned have been trained. He said 982 microscopy centres have been set up from public resources for free of cost diagnosis of TB.

He said external quality assurance for sputum microscopy has been implemented in 40 districts of the country while five reference laboratories have also been established, including one at federal level and one each at provincial levels.

Dr Wasim Khawaja from Pakistan Institute of Medical Sciences (PIMS) said that TB is an infectious bacterial disease caused by mycobacterium tuberculosis, which most commonly affects the lungs.

He added that the disease is transmitted from person to person via droplets from throat and lungs of people with the active respiratory disease. In healthy people, infection with mycobacterium tuberculosis often causes no symptoms,because their immune system acts to wall off the bacteria.

He said the symptoms of active TB of the lung are coughing, sometimes with sputum or blood, chest pains, weakness, weight loss, fever and night sweats. He added tuberculosis is treatable with a six-month course of antibiotics.

‘TB disclosure cost me my job’

http://www.timeslive.co.za

Wiseman Molefe claims that the municipality's chief professional nurse, Khalek Ahmed, disclosed his condition to municipal management without his consent.

He has also taken the municipality to court in the hope of being re-employed, as he claims he was promised, and wants compensation for damages and future losses.

Molefe, who has since recovered from TB, said in an affidavit that he was discriminated against after his condition was revealed. He said he was promised a permanent position as a driver in the Durban metro police but this did not materialise after his TB status was disclosed.

"Furthermore, I applied internally for a position. I was selected and short-listed," Molefe said.

But, he said, he was told by a human resources manager that he had been "mistakenly selected".

In responding court papers, the municipality's attorney, Eshana Baijnath, said that Molefe had told his supervisor that he had a communicable disease . But Ahmed did not disclose Molefe's condition to the metro police.

Molefe was also told that his managers needed to be informed of his condition, which posed a risk to his fellow employees.

Baijnath said Molefe had no objection to disclosing his condition to his manager or supervisor.

She said that Molefe did apply for an advertised position at the municipality but denied that he had been short-listed.

United Kingdom TB Screening Misses 70% of Latent Cases in Immigrants

http://topnews.us/

The Lancet published a study that showed 1/5 of new immigrants to the United Kingdom from the Indian subcontinent carried latent TB, along with 1/3 of the immigrants from sub-Saharan Africa.

Right now, the UK screens people entering their country for TB if they come from places with a TB incidence of more than 40 per 100,000, but it only checks for the latent version of the disease in a division of these individuals.

Between the years of 1998 and 2009, the number of TB cases in the UK went up by 50%, and the amount of cases from immigrants went up by 98%. According to The Guardian, the current process for TB screening misses 70% of latent cases that can later lead to full-fledged TB.

A study done by a team of researchers at the Imperial College London along with other TB services in the country found that a positive IGRA test, along with a positive tuberculin skin test in people under the age of 35 is a good way to screen for latent TB.

A study on cost effectiveness between 2008 and 2010 for a blood test (IGRA) to screen for TB instead of the standard chest x-ray examined 1,229 immigrants to the UK that came in through Leeds, Blackburn and Westminster. However, only those 35 or younger were included in the results.

TB discovery could lead to new treatments

http://www3.imperial.ac.uk/

TB is caused by the bacterium Mycobacterium tuberculosis. The infection destroys patients’ lung tissue, causing them to cough up the bacteria, which then spread through the air and can be inhaled by others. The mechanism behind this lung damage is poorly understood, and no treatments currently used prevent it from occurring. Patients require at least six months of antibiotic treatment, but drug-resistant strains of the bacterium are becoming increasingly common.

The new research shows that in patients with TB, there is an increase in levels of an enzyme called MMP-1 in their lungs. When the researchers infected human immune cells with TB in the lab, they found that the cells greatly increased production of this enzyme.

Since the mouse version of MMP-1 is not expressed in the lung, the researchers developed a transgenic mouse with human MMP-1 to investigate whether the enzyme causes lung damage in TB. When these mice were infected with TB, MMP-1 levels increased significantly and the infection led to lung damage similar to that seen in humans with TB.

The scientists also found that a drug proven to be safe in humans was effective at suppressing MMP-1 activity driven by TB infection in human cells. The findings suggest that similar drugs might prevent lung damage in TB patients and help limit the spread of the disease.

The study was done by researchers at Imperial College London with collaborators at Columbia University in New York and the University of East Anglia, and it was supported by the National Institute for Health Research (who funded the work on human cells), the Scadding Morriston Davies Travel Fellowship and the US National Institutes of Health.

Dr Paul Elkington, from the Department of Infectious Diseases and Immunity at Imperial College London, said:

“A third of the world’s population is infected with tuberculosis, and almost 2 million people die from the disease every year.

“Standard TB treatment has remained unchanged for 35 years, and no current treatments prevent the lung destruction that TB causes. These findings suggest that drugs available now might be able to reduce deaths from TB.”

Many MMP inhibitor drugs were developed in the 1990s because they showed initial promise for treating cancer. The researchers now plan to carry out further studies to see whether these drugs can prevent lung destruction in patients with TB.

Professor Jon Friedland, senior author of the study from the Department of Infectious Diseases and Immunity at Imperial College London, said:

“Until now, we haven’t had a convincing explanation of how lung destruction is caused by TB. We hypothesised that protease enzymes must be involved, since nothing else could break down the strong collagen fibres that make up the scaffold of the lung. The results of this study provide strong evidence to support that idea.”

Dr Elkington and his colleagues first put forward their hypothesis that MMP enzymes play a key role in TB in a review article published earlier this year in the journal Science Translational Medicine.

Effectiveness of Four-Drug TB Treatment Confirmed

http://www.voanews.com/

One of the biggest challenges in fighting tuberculosis comes from new drug-resistant strains of the disease. And one of the main reason those strains have developed is that TB patients often don't take their standard, 14-pill, course of medication as instructed. Now, a new study finds that a simpler approach - combining four TB drugs into one pill - is just as effective in treating this global killer.

For about a decade now the World Health Organization has recommended treating tuberculosis by using a four-drug, fixed-dose combination of medication - which has the same amount of pharmaceutical ingredients as the 14 pills that have traditionally been used.

But the logic of fewer pills - a simpler routine for sick patients - has not yet sunk in among many doctors.

For a variety of reasons, health professionals treating TB have resisted prescribing fewer pills.

But a new study in the high-TB-incidence areas of Africa, Asia, and Latin America confirms that the four-drug combination of pills is just as effective as the 14-pill regimen.Dr. Christian Lienhardt conducted the the research in several countries comparing the new and old treatment regimens.

"It is true everywhere in the world patients, don't like to take too many pills and if you have to take 14 pills every day for 6 months - you have the choice for four, then I will prefer 4 and lot of people will prefer 4," said Dr. Lienhardt.

But Lienhardt says the four-pill treatment has been resisted because many care providers intuitively doubt it would be as effective.

"There is a type of a common sense and mainly among the health staff that when you take the older drugs that you know each one of them had a very, very good activity and when you combine maybe there is a way to lose that activity," he said. "That is a type of common sense that might unfortunately take place mainly among the care providers rather than the patients."

Tuberculosis is an aggressive bacterial disease that attacks the lungs and spreads rapidly among people with weakened immune systems. It kills nearly two million people worldwide every year . Experts say it's treatable if medication is taken as prescribed.

In the classical treatment, TB patients are usually prescribed 12 to 20 pills daily depending on their weight. Having the combination drug would improve the chances that patients would finish taking their entire dose.

In the 11-country study by Leinhardt and his colleagues, patients were divided into two groups. One got the combination pills and the other took the same drugs in individual pills, clinical trial found the combination pills to be equally effective.

"We need to really make this case very strongly that using these types of drugs is having the same efficacy as the normal drugs," said said Dr. Lienhardt. "But again it is a very good tool to avoid the emergence of drug resistance."

More powerful medicines are needed for drug-resistant strains, and some are even hard to treat with any drugs.

Dr. Lee Reichman has worked to control TB for 40 years.

"Multi-drug resistant TB and extensively drug resistant TB are failures of the system," said Dr. Reichman. 'TB is treatable and preventable. And if we find TB properly and treat TB properly, a: they are cured, and b: they don't develop drug resistant TB, whether it be multi-drug or extensive drug."

Researchers aim to popularize the four-drug fixed-dose combination pills among international public health officials, policy makers, and patient's organizations as part of the continuing campaign to eradicate TB.

The Phillipines on USAID priority list in anti-TB drive

http://globalnation.inquirer.net

The Philippines has been named one of the 20 priority countries of the United States Agency for International Development (USAID) in the Washington, D.C.-based agency's worldwide campaign against tuberculosis (TB).

Gloria D. Steele, the Filipino-American USAID mission director, has confirmed to the Philippine Daily Inquirer the inclusion of the Philippines on the agency's anti-TB campaign list of "Tier 1 countries."

Also on the list are Afghanistan, Bangladesh, Brazil, Cambodia, Congo, Ethiopia, India, Indonesia, Kenya, Mozambique, Nigeria, Pakistan, Russia, South Africa, Tanzania, Uganda, Ukraine, Zambia, and Zimbabwe.

USAID, which is celebrating its 50th year of active involvement in the Philippines, also supports anti-TB programs in the following countries: Angola, Armenia, Azerbaijan, Belarus, Bolivia, Djibouti, Dominican Republic, Georgia, Ghana, Haiti, Kazakhstan, Kyrgyzstan, Malawi, Mexico, Namibia, Peru, Senegal, Southern Sudan, Tajikistan, Turkmenistan, and Uzbekistan.

Priority countries are "selected to receive bilateral support for TB based on the prevalence of the disease, potential for anti-TB drug resistance, and case detection and treatment success rates," said a USAID report.

Political commitment

"Political commitment and technical and managerial feasibility are also considered in country selections," said the same report.

Steele said USAID was strengthening its TB monitoring and evaluation system in the Philippines "with the country's Millennium Development Goals in mind."

"Everything we do is in coordination with the Department of Health," she noted.

The Philippines has the ninth highest TB burden in the world. With over 105 Filipinos dying of TB every day, it has become the country's sixth leading cause of death and illness.

The majority of TB cases here are "found in those between the ages of 15 and 54, impacting not only the health of the person infected but the economic stability of his or her family and community," said USAID.

TB is a bacterial infection caused by mycobacterium tuberculosis.

The disease usually affects the lungs but can spread to other parts of the body in serious cases. An individual can become infected with TB when another person who has active TB coughs, sneezes or spits.

However, not all people who become infected with TB will develop symptoms. Those who do not become ill are referred to as having latent TB and cannot spread the disease to others.

Tuberculosis: Unchecked Killer of Women

Monday Developments

Mandy Slutsker, Research Associate with the ACTION campaign, has just been published in Monday Developments! The article is a small peek into her work researching the links between Tuberculosis and women in our ongoing efforts to not only to highlight the profile of Tuberculosis but to have TB legitimately recognized as a womens issue as well. Click here to read the full article.

Monday Developments magazine provides in-depth news and commentary on global trends that affect relief, refugee and development work. To find out more about them, click here.

Tuberculosis remains a major challenge for Bay Area public health departments

http://www.insidebayarea.com

"The TB case rate in the Santa Clara-San Jose-Sunnyvale area is routinely, if not the highest, at least in the top three in the U.S. every year," said Julie Higashi, deputy health officer for Santa Clara County.

And while TB cases have been decreasing in other parts of California and the United States, Santa Clara County's rate has remained nearly the same for the past three years.

With a troubled economy and cuts to public health, officials say eradicating TB may get even tougher.

"California's financial situation could affect TB control programs, which would be unfortunate," said Lee Riley, a professor of Epidemiology and Infectious Diseases at UC Berkeley's School of Public Health.

Cutbacks to New York City's TB programs led to an explosion in TB cases in the 1990s, he said. TB cases increased from fewer than 1,500 cases in 1980 to a peak of 3,700 in 1992, according to figures from the New York City Department of Health and Mental Hygiene. By 1995, the epidemic had cost the city more than $1 billion.

"It ultimately cost them a lot more money," Riley said. "California should be made aware of that."

Although the disease can be cured, the treatment is long and expensive. Latent TB infections cost the county roughly $250 to $300 per patient, while the active, contagious form can cost from $10,000 to more than $30,000, Higashi said. Patients need to take several pills a day for six to 12 months to get rid of the disease.

Incomplete treatment not only fails to cure TB but can cause the bacteria to become drug-resistant. And each drug-resistant case costs hundreds of thousands of dollars to treat.

The county "plays an extremely important role in managing patients," said Alex Studemeister, an infectious diseases specialist with the San Jose Medical Group.

Each case is monitored by an assigned public health nurse. These nurses are essential to making sure patients complete their treatment regimen, he said. "It's not just a condition where you take pills, go home and you're well," he said.

Budget cuts have meant fewer county public health nurses, but the county says it's coping. The county now has a specialized team of nurses that work only on TB, Higashi said.

"We struggle with resources, but we're continually trying to find ways to meet those needs for public safety," Higashi said. That's particularly important in the Bay Area, with its high rate of TB cases.

One reason why the Bay Area has such high TB rates is "because we're so international," said Masae Kawamura, director of San Francisco Public Health TB Control. More than a third of Santa Clara County's residents are foreign-born, and they contributed 90 percent of active TB cases in 2010, according to county statistics. People catch the disease when visiting countries where it is endemic, or may have been infected before they came to the U.S. Seventy percent have lived in the U.S. for more than five years when they fall sick with TB.

The TB bacteria can infect a person decades earlier, and "can stay living in your body as a time-bomb," Kawamura said. "You never know if it's gonna wake up or not, or when it's gonna wake up."

That why controlling TB means going beyond just people with the active disease.

"Screening would make a difference in identifying and treating the people who have latent TB," Riley said. "But it takes a lot of effort and manpower."

The county requires every new and transfer school student to be tested for TB. To add to the costs, the public health department also has to track down and test every person with whom a TB patient came in contact.

"It's intense, but you can't scrimp on any of it," Kawamura said. Otherwise, the disease is transmitted in the community, she said.

Buoyed by a decrease in San Francisco's TB cases, which fell below 100 for the first time in 2010, Kawamura is confident that rates will go down. New diagnostic technologies should help. These include a blood test that is more accurate than the traditional skin test, and a new sputum test that can identify the TB bacterium within hours rather than two to three weeks, she said. Kawamura said she also hoped for new and better drugs with a shorter treatment regimen.

Until that time, treating TB is going to be costly and a lot of work, she said.

"I don't think I'll ever be out of a job," Kawamura said, "but we're trying really hard to achieve that."

Sequella, Maxwell sign pact to develop, commercialize TB drug

http://contractservices.pharmaceutical-business-review.com/

Sequella and Maxwell Biotech Venture Fund have entered into a pact for completing clinical development and commercialization of SQ109 as a treatment for tuberculosis (TB).

Jointly discovered by scientists at Sequella and the National Institute of Allergy and Infectious Diseases (NIAID), SQ109 is currently being investigated in Phase 2 efficacy studies in TB patients in Africa.

Sequella has licensed the drug to Biotech Venture Fund in Russian Federation and neighboring Commonwealth of Independent States (CIS) countries, including Armenia, Azerbaijan, Belorussia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Turkmenistan, and Ukraine.

The financial terms of the agreement include an equity investment, clinical trial supply purchase, milestones, and royalty payments that, contingent upon successful development and commercialization, could be worth up to $50m to Sequella over the duration of the license.

Maxwell Biotech Venture managing partner Alexander Polinsky said this molecule, if successful, has the potential to benefit significantly all patients with TB.

"By investing in our subsidiary, Maxwell Biotech Venture Fund is fulfilling its strategic objective of making novel innovative drugs available to Russian patients," Polinsky said.

Applied Visual Sciences Launches “TBDxV” TB Diagnostic Aid in India

Signature Mapping Medical Sciences, the healthcare subsidiary of Applied Visual Sciences, Inc. (OTCBB: APVS), has begun TBDxV^TM product sales and marketing initiatives through its subsidiary and agents in India. TBDxV, a fully automated tuberculosis (TB) visualization technology to aid in the diagnosis of TB, addresses the approximately 52 million diagnostic slides analyzed by clinical lab technicians each year.

TBDxV provides automated computer-aided analysis for a clinician; specifically displaying acid-fast TB bacteria using Signature Mapping's advanced computer vision and pattern recognition technologies. Its high-throughput 200-slide capacity automatically and continuously scans stained sputum slides from four removable slide magazines, providing quick display of the results and digitized images for diagnostic review. Additionally, the application provides a patient report that features patient information, TB load, and severity statistics.

TBDxV is targeted to government and private institutions that screen tuberculosis patients. It is the precursor to TBDx, a TB diagnostics system currently nearing completion of Phase II clinical trials in South Africa that features automatic TB detect ion capabilities.

"India processes more TB diagnostic slides than anywhere in the world and the workload has overwhelmed the country's laboratory resources," said Bill Donovan, Applied Visual Sciences President & COO, "TBDxV will greatly enhance the productivity of India's TB sputum microscopy technicians by helping them more quickly locate and identify TB bacilli in slides. Our TB visualization system streamlines this tedious task and helps overcome the wide variations in slide quality and TB bacilli to enable technicians to improve diagnostic accuracy."

Donovan added, "We are working closely with the Indian government regarding our TBDx diagnostic system and hope that we can further enhance their TB diagnostics productivity after clinical trials and other government clearances are received."

How TBDxV works:
Signature Mapping TBDxV^TM software integrates APVS's patented visualization algorithms and processes with existing analog bright-field microscopes to highlight tuberculosis bacilli in sputum slides. The 200-slide capacity "auto-loader" delivers individual slides to a microscope slide stage. A digital camera is attached to the microscope and it captures and digitizes images of the Ziehl-Neelsen-stained sputum slide samples. These images are treated as digital "fields of view (FOV)." The images are then displayed on the workstation monitor. For each FOV, the technician will input the count of bacilli, establishing a "load" count for each specimen; accumulate and tally the data; and output a report on the findings including the current severity.

TBDxV features:

• Real-time image processing and a FOV Slide Manager to compensate for variations.
• Patient work list and identifiers.
• Digitizes (into DICOM) each slide by FOV and processes with Signature Mapping^TM visualization software.
• Displays slide images, and presents visualizations of suspected areas of tuberculosis.
• Magnifies and manipulates slide images, and provides areas where the lab technician can annotate individual images, navigate, and manipulate digital slide images.
• Generates World Health Organization standard report results with manual data entry capabilities.
• Microsoft Windows based SQL Server Database for image storage using standard DICOM file-based storage mechanisms.

TBDxV provides several clinical workflow advantages:
1. Does not require oil immersion for TBDxV to operate effectively and efficiently;
2. Minimizes human error associated with slide preparation;
3. Improves detection accuracy and patient outcome;
4. Reduces human fatigue and improves staff productivity and,
5. Minimizes error associated with stain variation.

Experts warn about increase in drug-resistant tuberculosis in Australia

http://www.virtualmedicalcentre.com/

A recent tuberculosis scare at Liverpool Hospital has made many people realise Australia is not a tuberculosis-free nation, with more than 1,100 cases of TB reported in Australia.

TB experts at the Centenary Institute, a research institute affiliated with the University of Sydney, warn that the greatest threat to tuberculosis control is the steady rise in Australia and around the world in multi-drug resistant super strains of tuberculosis known as MDR-TB.

In 2007 there were 24 cases of MDR-TB, but this jumped by 30 per cent in just two years with 31 cases of MDR-TB detected in 2009. This is a significant increase on just eight cases reported in 2000.

Centenary Institute senior tuberculosis researcher Dr Bernadette Saunders said: "Although the number infected might seem small, the emergence of super strains of TB poses a serious and costly threat to controlling the disease in Australia."

One person who knows the personal effects of MDR-TB is 28-year-old Sydneysider Christiaan van Vuuren. He shot to fame when his YouTube comedic rap videos, parodying his life in quarantine for the disease, caused an online sensation that has clocked up over 2.3 million views. Christiaan (aka "The Fully Sick Rapper") joined with the Centenary Institute this year for World TB Day to help raise awareness about TB and drug-resistant TB.

Dr Saunders said: "10 years ago Australia would only have about one case of MDR-TB per state each year. However, there has been a steady increase in the number of MDR-TB cases across Australia. We've even had a reported case of extensively-drug resistant tuberculosis (XDR-TB). These new super strains of tuberculosis are very difficult to treat with the current drugs, which are over 50 years old.

Christiaan added: "This time last year I was four months into almost seven months of quarantine in a Sydney hospital to treat multi-drug resistant TB. I became infected with TB while travelling overseas. It was a challenge to go through the treatment, but I felt really fortunate that I had access to the right drugs.

"I've now been out of quarantine for a while now, and I'm doing some awesome stuff that I would never have dreamed of doing before my time in hospital. I was really lucky though. Sadly, two billion people in the world are infected with TB and each year almost two million people die from TB. And about 440,000 people will be diagnosed with MDR-TB each year. We need to develop new ways, tests, vaccines and drugs to control TB, especially these new forms of TB that are resistant to the current drugs."

Drug resistance occurs when microorganisms such as bacteria, viruses, fungi and parasites change in ways that render medications ineffective in treating the infections. When the microorganisms become resistant to most drugs they are often referred to as superbugs. This is a major concern because drug-resistant infections become difficult and sometimes impossible to treat. It can lead to increases in new cases, treatment costs and sometimes deaths.

Dr Saunders said: "The Centenary Institute is working on a number of projects to improve the fight against the spread of TB and drug-resistant tuberculosis. The Centenary Institute is involved in research to develop new tests, vaccines and drugs to diagnose, treat and prevent TB, especially drug-resistant strains of TB bacteria."

150,000 Indonesians Die Each Year For Misusing Antibiotics On TB

World Health Organisation (WHO) data show that 150,000 people out of 440,000 tuberculosis sufferers in Indonesia died each year for misusing antibiotics, Health Minister Endang Rahayu Sedyaningsih said here on Thursday.

Speaking at a seminar on the Use of Antibiotics Appropriately to Prevent Bacterial Immunity, the minister said in 2009 Indonesia was eighth among countries with Multi Drug Resistance (MDR) cases caused by the misuse of antibiotics.

Of this number, 6,395 new TB cases had been predicted to appear in Indonesia every year, she was reported as saying by Antara news agency.

However, the minister said that misuse of antibiotic also happened in other countries and that WHO had announced the slogan Use Antibiotics Rationally as the theme of this year's World Health Day.

Endang said antibiotics must be used appropriately to prevent body resistance against drugs since it would cause negative effects (especially to those with contagious diseases) such as longer period of infection or bad clinical condition.

To reduce the number of antibiotic misuse in Indonesia, Endang said her ministry had published a General Guidance Book for Antibiotic Use expected to be useful in giving health care services in Indonesia.

The minister also urged people to use antibiotics wisely and follow doctor's prescriptions.

New substance to tackle drug resistant tuberculosis

The project NM4TB, which gathers 18 research teams from 13 countries, discovered a novel class of substances, called benzothiazinones (BTZ), that could be used in the treatment of tuberculosis and drug resistant tuberculosis. These substances act by preventing the bacteria that cause tuberculosis from constructing their cell wall. This discovery represents an important breakthrough in the battle against tuberculosis as the most advanced compound of this new class, BTZ043, is also effective against extensively drug resistant tuberculosis (XDR-TB).

Overuse of antibiotics leads to the rise of drug-resistant TB in China

http://www.todayonline.com

Drug-resistant forms of diseases such as tuberculosis are on the rise in China because of the overuse of antibiotics and urgent action is needed to reverse the problem, China's Health Ministry and the World Health Organisation (WHO) warned yesterday.

The WHO said the antibiotic-resistant infections or superbugs have reached unprecedented levels and threatens to return the world to a pre-Penicillin era where even the smallest infection could be deadly.

Each year, about 440,000 new cases of multidrug-resistant tuberculosis emerge around the world, causing at least 150,000 deaths.

In China, about 6.8 per cent of tuberculosis cases are multiple-drug resistant, far higher than the 2 per cent rate in most developed countries, according to Dr Michael O'Leary, the WHO's representative in China.

"Infections caused by resistant micro-organisms often fail to respond to conventional treatment, resulting in prolonged illness and greater risk of death," Dr O'Leary added.

China's vice-health minister Ma Xiaowei said at a ceremony to mark World Health Day that he hoped hospitals would push for antibiotics to be used in "scientific and rational" ways.

The overuse of antibiotics is common in China, often because it is a way for hospitals to boost revenue.

The WHO said the abuse of antibiotics for humans and the use of the drug in animals was threatening to take the world to an era before the discovery of penicillin in the 1920s.

In Europe alone, 25,000 people die each year from superbugs.

"We need to raise the alert that we are at a critical point where antibiotic resistance is reaching unprecedented levels and new antibiotics are not going to arrive quickly enough," said Ms Zsuzsanna Jakab, WHO regional director for Europe.

There are few new antibiotics in the pharmaceutical pipeline because they prove hard to discover and are not lucrative investments for drug companies. AGENCIES

Canada pledges further support for TB care in Afghanistan

The Canadian International Development Agency (CIDA) has announced a grant of CAD$ 1.79 million to support Afghanistan's fight against tuberculosis (TB).

The grant follows the 2010 Berlin Declaration to stop TB and improve women's health in Afghanistan, and adds to the CAD$ 6 million that CIDA has already provided to the country's efforts against TB.

The funding will support research into why more women than men become ill with TB in Afghanistan. It also aims to help cured patients promote better TB care, strengthen civil society's role in mobilizing communities and support the work of women's committees in remote areas of the country.

The grant is a sign of confidence in the Stop TB Partnership Afghanistan, which leads the government's TB care and control activities and represents public and private sector healthcare providers, bilateral and multilateral organizations, the media, academia and civil society groups.

TB is a major public health and development challenge in Afghanistan. The country is one of 22 TB high-burden countries in the world. The World Health Organization estimates that every year in Afghanistan, more than 42 000 new cases of TB occur and more than 8000 people die because of this curable disease. Women, already a vulnerable group in Afghanistan, account for 68% of cases.

Afghanistan has been successfully expanding TB care in the past decade, despite economic, social and security challenges. Since the introduction of Directly Observed Treatment Short Course (DOTS), 180 373 TB patients have been provided with care.

Risking TB in Kenya’s gold mines

http://www.plusnews.org

Timothy Omuya spends most days chipping away at stones in search of gold and inhaling fine particles of dust without protective gear in western Kenya's mines. It was not a huge surprise, therefore, when he tested positive for tuberculosis.

His local hospital put him on TB medication, but his long working hours meant he did not stick to the schedule.

"At times I fail to take them because I don't go in good time to take new ones from the hospital when I finish the ones I have," he told IRIN/PlusNews. "Here at the mines, we work both day and night, so the time you are supposed to go and take your medicine, you are deep down in the mine."

What Omuya did not realize was the risk to his family; his wife and youngest child are now both infected. His wife Peres says she and the child adhere to their medications strictly, but fears that if Omuya continues to miss doses of his medication, he may re-infect them.

Fatalism

According to Ruth Muga, a senior nursing officer at the Nyatike District Hospital, many miners have a fatalistic attitude towards death because of the dangerous nature of their work.

"We counsel many of them who come here and they tell us the reason they default is because they are busy; also many of them cite the dangerous nature of the mines as the reason they don't take drugs," she said. "They will simply tell you that the mines can collapse and kill them any time. To them, death is always lingering somewhere."

Julius Owino, another gold miner in Nyatike, is HIV-positive and knows that he risks death every day in the mines, but says mining is the only way he knows how to feed his family.

"We risk our lives to earn a living and we must earn it until we no longer live; I think we are careless with our lives," he added. "Many of us are very sick and do not seek treatment... at times I ask myself why we are so busy chasing money until it kills us."

On top of widespread TB, Nyatike, where most residents earn less than US$1 a day, also has one of the country's highest levels of HIV; it is located in Nyanza Province, with an HIV prevalence of over 15 percent. Sex work is prevalent around the mines.
High risk

Joseph Sitienei, head of Kenya's National Leprosy and Tuberculosis Control Programme, says miners and their families are considered a high-risk group for TB.

"The dusty conditions there increase chances of getting tuberculosis amongst miners and the crowded nature of mines and poor ventilation provide a perfect ground for the spread of TB; remember, these people go back home and interact with others and therefore they can very easily spread the disease in big communities."

According to a 2010 study published in the American Journal of Public Health, mining for gold was associated with considerably higher TB incidence than other mining.

"The implication for policy is not to close mines but to reduce levels of risk," said the authors, who recommended that healthcare programmes for miners facilitate earlier diagnosis and improve working conditions to reduce the risk of incident infection, for example by reducing poor working conditions, cramped hostel living quarters, or exposure to silica dust.

Sitienei noted that the government was working to build awareness of TB in high-risk communities, to encourage people to visit health centres for screening and to ensure those who began treatment adhered to it.

"When people don't get full treatment, they risk developing drug resistant tuberculosis and even those who are on medication can be re-infected by those who default on treatment," he said.

Kenya ranks 13th on the list of 22 high-burden TB countries in the world and has the fifth-highest burden in Africa.

World Bank pledges 41 Mil US to Fight TB, HIV in Swaziland

http://www.observer.org.sz

He said the programme was based on the challenges faced by the health sector. The programme has three components being; strengthening the capacity of the health sector, facility - level support to improve access as well as quality and efficient services. Under strengthening the capacity of the health sector, the ministry will support interventions to strengthen the health care system at different levels. This will be especially in the areas of governance, management planning and coordination. Xaba said: "The facility -level support to improve access quality and efficiency of services seeks to provide support to clinics, health centres and hospitals to improve access to quality of health services and support training institutions to expand midwifery."

Swaziland, South Africa, Lesotho form ‘A Team'

Swaziland, Lesotho and South Africa have joined forces to fight new infections and the spread of tuberculosis. The team intends to devise strategies and ways of ensuring that the TB is not spread to many people. The three countries' ministers of health attended a ‘Stop TB' partnership recently, where they told delegates that tuberculosis needed to be a thing of the past. The ministers; Xaba - Swaziland, Aaron Motsoaledi - South Africa and Ramatlapeng from Lesotho recently came back for the stop TB meeting in Washington DC. A newspaper in Washington is quoted as saying :"The ministers of Lesotho, Swaziland and South Africa are rolling up their sleeves to tackle the alarming spread and increasing resistance of tuberculosis."

He praises PEPFAR

Xaba also praised PEFPFAR for being the greatest supporters of the Prevention of Mother to Child Transmittion, thus he said PEPFAR has been giving money to Swaziland supporting the programme and and saving thousands of babies' lives. He further reported to the meeting that apart from all the prevention strategies, Swaziland has embarked on Medical Male circumcision after having realised it was one of the most innovative aspects of the fight against HIV and AIDS. He stated that ‘Soka Unqobe' which means "circumcise and conquer" campaign targeting 152 000 men aged 15-49 years will link men to HIV prevention, care and treatment services while utilising MC as the entry point to create these other linkages. "We are expecting a positive impact with regards to HIV reduction. It is estimated that if the 80 percent is met, almost 90 000 new infections could be prevented over the next 15 years translating into a 75% drop in new infections at a treatment cost savings of US 650 million dollars." He said these HIV prevention intervention would have not been possible without both the technical and financial support of PEPFAR.

ART and Counseling

In the past year more than 155 000 people have been reached for HIV and AIDS counselling and testing services. Just about 25 000 mothers have been provided with health care services for the prevention of mother to child transmission of HIV and AIDS. The minister said: "In fact Swaziland is poised to be one of the first countries in Africa to virtually eliminate maternal to child transmission of HIV. Our national PMTCT programme is well on its way to bring services to women beyond the clinic walls and ensuring that they and their families are supported through out the whole process. We look forward to the day when all children in Swaziland are born HIV free so that they can achieve greatest potential."

TB machine coming

TB Reach organisation from the US has pledged to donate a TB detecting machine to Swaziland as over 10 000 people are suffering from the disease in the country. The ministry of Health has since sent two people to Geneva to learn how to use the new machine which detects TB in less than five minutes. Minister Xaba said: "This machine would be of great help because we would be able to diagnosis cases of TB fast." He said it would also help fast track screening of the multi drug resistant TB faster than the usual three months which was taken after sending specimen to the laboratory.

Swaziland needs about E861million

Swaziland needs about E861 million (USD123m) to fight tuberculosis as stated by the Minister of Health Benedict Xaba in his speech when he addressed delegates in New York in the Stop TB meeting which lasted for a week.

75 Pinoys die of TB every day

http://www.philstar.com

Seventy-five Filipinos die of tuberculosis (TB) every day, making the disease still the number one threat to human health in the country, the Philippine Business for Social Progress (PBSP) said.

PBSP media relations officer Mitchel Confesor said at least 90 people worldwide died of TB every day or an average of nine million people each year, 10 to 15 percent of whom are children.

The PBSP said the Philippines has ranked ninth among 22 high-burden nations for TB all over the world.

Representatives of the Department of Health, the Philippine Coalition Against Tuberculosis (PhilCAT), the Pediatric Infectious Disease Society of the Philippines Inc., the Armed Forces of the Philippines (AFP) Medical Center, and the World Health Organization (WHO) disclosed these data during the recent observance of World TB Day in Metro Manila and Cebu late last month, capping this year's commemoration of the event started in 1997.

Through the corporate-led PBSP as the principal recipient for its TB program, the international public-private partnership Global Fund to Fight AIDS (Acquired Immune Deficiency Syndrome), Tuberculosis and Malaria has aimed to sustain TB control and ensure access to comprehensive quality TB health care in the country.

In a forum in Cebu City, the PBSP said the project aims to reduce the prevalence, incidence, and mortality of TB beyond 50 percent after 2010 from a baseline established in 2000 to support the Millennium Development Goals for poverty alleviation.

TB & The 18th Century Canadian Fur Trade

http://www.physorg.com

In one such study, published in the Proceedings of the National Academy of Sciences, Pepperell and her colleagues studied one unique strain of the disease as it traveled with French fur traders from Europe to the Canadian province of Quebec where the indigenous peoples became infected. But it wasn't until the buffalo ran out and those indigenous peoples were put on reservations that TB began killing massive amounts of people.

To follow the strain, the researchers analyzed the genetic makeup of the bacterium from inhabitants of both the mostly European ancestral people in and around Quebec and those from mostly indigenous population areas. Then using statistical analysis and mathematical modeling, they were able to trace the path of the disease as it spread across parts of Canada. It was then that they were able to clearly see how the disease remained mostly latent (asymptomatic) in the early years after its spread, but then, as populations grew and people were put under stress, most notably by being forced onto reservations, they began to progress to the active disease, which can kill as many as half of those infected.

Pepperell notes in the paper that the key part of the research; the part that people should pay attention to, is the fact that TB can persist for very long periods of time (in the Canadian study for 100 years) without causing much harm, but can suddenly become more active when those infected people are exposed to hardships such as physical or emotional stress, malnutrition or even overcrowding.

Sharing Bong Might Lead to TB Contraction

http://topnews.net.nz/

Trying to establish a link between active TB cases and shared bongs, Australian medical researchers presented the findings of a study at the Thoracic Society of Australia and New Zealand conference in Perth.

The study suggested that sharing water pipes to smoke marijuana might lead to the contraction of pulmonary tuberculosis.

Dr. Michael Hayes and Dr. Susan Miles from the Department of General Medicine at Calvary Mater Hospital in Newcastle conducted this research on three recent TB patients in the Hunter-New England who were regular users of pot.

After examining these patients closely, researchers found positive results for 30 people who were in close contact with the patients.

This study holds a lot of importance as about 1000 people are infected with TB each year, while globally an estimated 1.7 million people die from the disease every year.

Dr. Hayes, who is also a specialist in the respiratory and sleep unit at the John Hunter Hospital in NSW, said, "Smoking marijuana is a cough-provoking activity and it is usually conducted in a confined environment that is conducive to the spread of the organism".

Experts believe that this issue is needed to be explored more to reach to more substantial conclusions.

Muhammadiyah Appoints Actress to Spread Word on Tuberculosis Danger

http://ibnlive.in.com/

As tuberculosis remains a serious problem across the country, a prominent Muslim organization has appointed an ambassador to begin raising awareness of the debilitating disease.

Aisyiyah, the women's wing of Muhammadiyah, the second-largest Muslim organization in the country, recently chose actress Mediana Hutomo to inform the public about the dangers of tuberculosis.

Mediana, who was appointed tuberculosis ambassador on Thursday, will spend three months traveling across the archipelago to spread the message about the deadly respiratory disease.

The campaign, which is set to begin late this month, will visit 35 cities and districts in 16 provinces, Aisyiyah chairwoman Noor Rochmah said.

"The reason that we are really concerned about TB [tuberculosis] is because the number of TB cases in Indonesia is quite high," Noor said on Sunday.

"According to the minister of health, TB causes 346 deaths in Indonesia every day. Therefore, it is very important to raise the awareness among Indonesian society because they do not realize that they may have TB."

Indonesia has in recent years taken steps to reduce the prevalence of the disease. In December, the Health Ministry said it was optimistic the country could reach the UN Millennium Development Goal on halting and beginning to reverse the incidence of tuberculosis by the 2015 target date.

According to the World Health Organization's Global Tuberculosis Control data, Indonesia is ranked fifth worldwide in total tuberculosis cases with 429,730. India tops the list, followed by China, South Africa and Nigeria.

That is still a significant improvement from the 2007 figures, when Indonesia's 528,000 tuberculosis cases placed it third, behind India and China.

Noor said that although Mediana was appointed as Muhammadiyah's tuberculosis ambassador, she would work with Christian and Buddhist groups to get the word out.

"The main thing here is how society can raise their awareness about TB because so many people sometimes do not recognize TB symptoms, which often appear as an ordinary flu and coughing," Noor said.

"But as times goes by, the coughing will become coughing blood, the patient will lose weight and it then kills them without being recognized that the coughing was the indication of TB."

Noor said that after Mediana's initial three-month tour concludes, the campaign will expand to cover an additional 75 cities and districts starting in July.

TB awareness gets a new “pitch”

http://timesofindia.indiatimes.com/

Some NGOs working towards creating awareness about tuberculosis (a disease that kills more than three million people every year in India) have found an innovative way to educate children about the disease. They are distributing CDs of computer games, based on cricket, to educate children about the disease.

In 'Stop TB Cricket' (the most popular game) there are two teams — Safety XI and TB Germs XI. One has to bat and chase a set score after choosing his or her team. "After every shot, a dialogue box containing facts about the disease or information countering popular myths and misconceptions associated with it is displayed. When a player scores runs, information on how to prevent TB get displayed on the screen. When a player loses a wicket, information on how TB is transmitted and its cure is flashed," said Hilmi Quraishi, head of the NGO which has developed the game.

More than 2,000 CDs of the game have been distributed among children of government and public schools in Delhi, Kolkata and Hyderabad, said Quraishi. "The interactive games are endorsed by the Revised National Tuberculosis Control Programme (RNTCP) of the Central government."

Dr R P Vashisht, Delhi state TB control officer, said the CDs were available at DOTs centres and the games could be downloaded from the website as well. "Our website has become quite popular. In the last six months, the website has received more than five lakh hits," he said.

Some schools are also organizing competitions based on these games. The other games included in the CDs are 'Stop TB Quiz' that has been developed on the lines of the popular TV show, Kaun Banega Crorepati.

Health experts say approximately 40% of India's population is infected with the TB bacteria. What is worrying is that about 70% of TB patients are aged between 15 and 54 years.

UC Denver student isolated after being diagnosed with TB

www.denverpost.com

A student at the University of Colorado Denver's Auraria campus has been diagnosed with an active case of tuberculosis.

The student has been isolated and is receiving treatment, spokeswoman Jacque Montgomery said.

"Our focus right now is educating the handful of students and staff who may have been exposed," Montgomery said.

The infection is airborne, but transmission usually requires more than 100 hours of continued indoor exposure, said Dr. Randall Reves, spokesman for the Denver Public Health Department.

"It's not like the flu that spreads rapidly," said Reves, who worked on the UCD investigation.

A few students who may have been exposed are being tested for the infection.

While tuberculosis is rare in the U.S., isolated cases do occur at several college campuses every year.

Most college cases are among students who have worked or studied in countries where tuberculosis is common, particularly countries in Asia and Africa, or among students who grew up in a foreign country and carry a dormant form of the infection.

Reves would not say whether the student had traveled recently or grew up in another country.

The bacteria that cause the infection by attacking the lungs are detected by a skin or blood test.

Following standard treatment, the student will be isolated until he or she is no longer considered contagious and will remain on various medications for six to nine months.

India: As the middle class rises, so does tuberculosis

www.globalpost.com

When Fatima's doctor told her that she wasn't suffering from ordinary Delhi belly - her stomach cramps and diarrhea were caused by tuberculosis - her biggest fear wasn't the dreaded disease. With her marriage still impending, the 29-year-old, middle-class resident of Kolkata was afraid that her secret would get out, said Dr. Raja Dhar, a physician at the West Bengal city's posh Fortis Hospital.

"The first thing she told me was never to tell anyone that she had TB," said Dhar, who explained that the young IT professional feared her impending marriage would be scuttled if people came to know of her infection - even though she was eventually cured.

Despite her shame, Fatima - whose name was changed for this article to preserve her anonymity - is in good company.

Although tuberculosis is still associated with poverty, malnutrition and crowded living conditions in India, the disease is endemic among rich and poor, Dhar said. Among the affluent, it has simply been lying in wait, only to emerge when the immune systems of the new rich are compromised by the same stress factors that are causing an increases in "lifestyle related" problems like type 2 diabetes and heart disease.

"In a country where tuberculosis is more or less endemic, you have latent TB present in the body that does not manifest because you have a good immune system," Dhar said. "But if the immune system goes down, the time is ripe for the TB to actually flare up."

According to the World Health Organization, the total number of TB sufferers has steadily declined in South and Southeast Asia over the past decade, but the region still accounts for a third of the world's total TB patients - with more than 3 million cases added every year, mostly from India. And just as the disease made a resurgence in America in the 1990s, thanks to immune system complications associated with HIV/AIDS, in at least one respect the problem is getting worse.

Working at an upscale, private Indian hospital for the past two years, Dhar said that around 70 percent of his TB patients are middle-class or affluent professionals - many of whom react with anger or disbelief when they hear his diagnosis. And looking back at hospital records and discussing the rate of incidence with doctors in other cities, he estimates that the number of wealthy people contracting TB has risen about 20 percent in recent years, even as the number of poor patients has dropped. Meanwhile, local press reports say the number of TB patients from higher income families have doubled in the last three years in Delhi hospitals.

Though TB is better known as the debilitating lung ailment, once called consumption, which affected writers like the Romantic era poet John Keats, India's affluent sufferers are mainly falling victim to lesser known versions of the disease that strike the stomach, heart or even bone. That makes sufferers even less likely to think they have TB, and also makes it harder for doctors to make the right diagnosis.

"More than the rate actually going up in affluent people, I think it may be just that people are realizing that TB is affecting everyone, not just the really poor," said Dr. Madhukar Pai, a McGill University-based researcher who works with WHO's Stop TB Partnership program. "Awareness about TB may be higher, especially with rumors about Bollywood celebrities being affected."

But even if TB has scaled the society columns, it still carries a powerful stigma. Not long ago, film star Amitabh Bachchan was compelled to issue a public denial when press reports circulated claiming that his daughter-in-law, Bollywood's Aishwarya Rai, was suffering from the same type of TB that Fatima hid from her parents and fiance.

That, too, makes a disease that should be easily cured more difficult to treat, according to Dhar. Most TB cases can be cured easily if the victim seeks medical treatment early in the disease's progression, and their doctors get the diagnosis right and prescribe the right treatment. But the more fear and shame associated with TB, the less likely that is to happen.

"There is a far greater taboo about people in the affluent class saying that they have TB," Dhar said. "It's like having leprosy years ago."

In that respect, some high-profile Bollywood victims - if any are willing to rise above ignorant perceptions about the disease - could be a huge boon, said McGill's Dr. Pai. Just as Hollywood stars and professional athletes helped reduce the fear and stigma surrounding HIV, a few rich and famous Indian TB patients could revolutionize the fight as new, drug-resistant strains of TB increase fear of the illness worldwide.

With a new molecular diagnostic test, called Xpert, available, India could eliminate its persistent problem with erroneous false-positives, provided it could roll out the new test to thousands of laboratories that today report as many as 1.5 million inaccurate results every year. And four new vaccines are in late-stage trials, setting the stage for a massive eradication campaign - if somebody will step up to the plate.

"Rich Indians have done almost nothing for TB in India," Pai said. "No major philanthropic groups or donors or industries have taken on the TB challenge in India. Politicians and Bollywood stars and cricket celebrities have largely ignored the TB problem."

Over 30 percent of TB cases going undetected in Myanmar

irinnews.org

According to the most recent national tuberculosis (TB) prevalence survey in Myanmar conducted from 2009-2010 and still undergoing analysis, preliminary data show a large proportion of TB cases are going undetected.

In 2010, the World Health Organization (WHO) - working from 2009 estimates not yet confirmed by the latest survey data - estimated 300,000 TB cases out of a total population of 53 million, but that only 64 percent of new cases were being detected.

The latest survey by the government's national TB programme of 51,367 people in 70 geographical areas confirmed the 2009 estimates.

Of the estimated 597 in every 100,000 people nationwide who have TB (316,410 out of 53 million), most are male living in urban areas. The number infected in urban areas is twice as high as in rural areas, as has been the case for years.

"Of the found TB cases in the [2009-2010] national prevalence survey, the majority had not sought health care for TB," said Eva Nathanson, the TB technical officer in Myanmar's WHO office.

It may be that patients are ignoring symptoms of their illness, are unaware about TB, live far from health care facilities, are not having their TB detected by health workers, or are being misdiagnosed, she added.

Of those who do start treatment, many abandon it before completion, making them candidates for multi-drug resistant TB, said a government clinic doctor in Mgway Division in central Myanmar who preferred anonymity.

"Many patients do not understand their TB could be resistant if they do not take drugs regularly. It is hard to convince them why they must take their drugs on a regular basis... Some patients stop taking their drugs when their health is getting better. They just come back [to treatment] when their health is bad again."

MDR-TB

The 2009-2010 survey did not examine multi-drug resistant TB (MDR-TB) - when patients no longer respond to the first line of TB treatment because they are infected with a drug-resistant form of the disease, or they did not follow through with the entire course of treatment, thereby rendering treatment ineffective.

Based on earlier surveys, heath experts estimated there were 9,000 people with this more difficult-to-treat form of TB in Myanmar in 2008.

The next nationwide drug resistance survey is expected to be conducted in 2011.

TB results in an estimated 1.7 million deaths each year, with the global number of new cases in 2009 (more than nine million, with 55 percent occurring in Asia) higher than at any other time in history, according to WHO.

In a study published in the British medical journal, the Lancet, for World TB Day on 24 March, the authors concluded: "Increasing rates of drug-resistant TB in eastern Europe, Asia, and sub-Saharan Africa now threaten to undermine the gains made by worldwide tuberculosis control programmes."

Classified by WHO as a high-burden TB country, Myanmar has one of the world's highest TB prevalence rates.

Over 1,000 People Test Positive for TB in Jinja, Uganda

allafrica.com

A total of 1,287 people in Jinja District have been diagnosed with tuberculosis. The district tuberculosis/leprosy control supervisor, Mr Bernard Mugabi, last Thursday told the media that the number of patients puts the case detection rate for TB in Jinja at 82 per cent which is higher than the 70 per cent national figure.

Mr Mugabi said the men are the most affected with 724 of them having TB compared to 563 female according to the latest survey conducted at Jinja Referral Hospital.

He said lack of information about the availability of TB drugs and refusal by some people to go to hospital for testing is the major cause of the big number of TB patients in the district.

The high prevalence is also associated with oversmoking and heavy consumption of alcohol. "TB drugs are available at health centre IIIs and IVs but people do not utilise them. Some people completely refuse to go to hospitals for testing even when they have persistent cough which is always associated with TB," Mr Mugabi said.

He said the district has embarked on the registration of all TB patients and offering homecare treatment to those infected as a way of intensifying the fight against the scourge.

He called for proper use of drugs, testing for TB in health centres and residing in well ventilated houses as part of the solution to reduce the infection.

Tuberculosis cases at an all-time low in the U.S., the CDC says

The number of tuberculosis cases in the United States reached an all-time low last year, with only 11,181 cases reported to public health authorities, according to the Centers for Disease Control and Prevention. That represented a 3.9% drop in the number of cases from the preceding year, but was a disappointment on two counts: the number of cases had dropped by 11.9% in 2009, and authorities had hoped a major decline would continue; and in 1989, health officials had set a goal of eradicating TB in the U.S. by 2010, a roadmark that was clearly not met.

The agency reported in its Morbidity and Mortality Weekly Report that nearly 40% of the cases, 4,378, were in people born in the United States. The remaining 6,707 cases were in people who were born abroad. More than half of those cases were among people born in four countries: Mexico (23%), the Philippines (11%), India (8.6%) and Vietnam (7.7%). Overall, foreign-born people were 11 times as likely to have TB as those born in this country.

Four states -- California, Texas, New York and Florida -- accounted for 49.2% of the TB cases, a total of 5,503 cases. More cases were reported among Hispanics than any other ethnic group, but Asians had the highest case rate. TB rates among Hispanics, blacks and Asians were seven, eight and 25 times as high as among Caucasians, respectively.

Tuberculosis is caused by a bacterium called Mycobacterium tuberculosis. It can be cured with antibiotics, but a full course of treatment requires six to nine months to fully eradicate the microorganism. Many people do not finish the full treatment, which leads to the development of drug-resistant strains of the bacterium. According to the CDC, nearly 94% of those who began treatment in 2007 completed their regimen.

The survey of TB cases detected 113 cases of so-called multidrug-resistant TB, which is caused by a bacterium that is resistant to at least two different antibiotics. The researchers found only one case of extensively drug-resistant TB, which is caused by a strain that is resistant to virtually all the antibiotics used to treat TB. Both forms of the disease are growing problems around the world because they are spreading rapidly and are extremely difficult to treat. The World Health Organization on Wednesday called for more funds for research and treatment of drug-resistant TB.

45 % Ghanaians ignorant of TB

http://news.myjoyonline.com/

As Ghana joins the world to celebrate World Tuberculosis Day, Program Coordinator for the National Tuberculosis Control Programme, Frank Bonsu has disclosed that Ghanaians are still ignorant about the existence of the disease.

World Tuberculosis Day, which falls on March 24 each year, has been designed to raise public awareness about the global epidemic of tuberculosis and efforts to eliminate the disease.

Tuberculosis causes the deaths of about 1.7 million people worldwide each year, mostly in the third world countries according to World Health Organization (WHO) report for 2010.

It is against this background that the National TB Control Programme has chosen to celebrate the day at Sunyani in the Brong Ahafo region in order to intensify awareness of the disease.

Mr. Bonsu told Adom News that "Sunyani is far behind national percentage of TB cure of 82 percent so we are taking it there to intensify campaign and bring them at par with the rest of the country."

He said the National Tuberculosis Control Programme had not relented in its efforts to fight the disease. He stated that about 86 percent of cases reported are treated but 25 percent of the patients die of the disease because they do not report the disease early enough.

He lauded government's efforts in providing free medication and feeding over the past ten years, for the patients who report the disease at health centres.

He noted that government had also recruited trained health assistants who move into various villages and hinterlands to spread awareness of the disease and sometimes help in administering medication.

World TB Day Media Call

Today, March 24th, 2011, ACTION held a media call to discuss the important issues and developments happening around World TB Day. Click here to listen to the full audio!

Cabinet approves scaling up services of management of drug resistant tuberculosis

The Cabinet Committee on Economic Affairs on Thursday approved the proposal of Union Health and Family Welfare Ministry for scaling up services for diagnosis, care and management of drug resistant tuberculosis under Revised National Tuberculosis Control Programme (RNTCP) with assistance from Global Fund at an estimated cost of Rs.649.02 crore.

The upgradation envisages procurement of second line drugs, scaling up of laboratory services and provision of technical assistance.

With the scaling up of diagnosis, care and management services for Multi Drug Resistant TB (MDR-TB), the RNTCP shall establish 43 state of the art laboratories using latest diagnostic technologies throughout the country.

The project shall also scale up care and management of MDR-TB in the country resulting in the initiation of treatment of 55,000 cases.

The project shall continue till September 2015.

Better health comes in shipping containers

http://www.allheadlinenews.com

New technologies are helping Zambia make the most of its scarce health workers and laboratories in the fight against tuberculosis (TB), and showing that there may be more to a shipping container than meets the eye.
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The Zambia Aids-Related TB Project (ZAMBART), a local NGO that provides testing and treatment, has introduced easy-to-use digital chest x-rays and relatively cheap made-to-order laboratories to help close gaps in stepping up the fight against TB and HIV, which are common co-infections.

In a country where about 39,000 new cases of TB are reported annually, these innovations could help combat the high level of undiagnosed infectious TB, the recent Zambia-South Africa TB and AIDS Reduction (ZAMSTAR) study noted.

According to UNAIDS, about 14 percent of Zambians are HIV-positive, which greatly increases their vulnerability to TB. ZAMBART estimates that about 70 percent of TB patients are co-infected with HIV, making them harder to diagnose and more likely to die from TB, the leading killer of HIV-positive people worldwide.

Technology meets task shifting

The ZAMSTAR study also found that while many patients with a chronic cough - a symptom of TB - did not seek medical attention, those who did were often poorly investigated.

After routine screening for TB, clinic staff asked TB suspects for a sputum sample. In HIV/TB co-infected patients these samples were more likely to result in a false positive result, so health workers used chest X-rays to confirm test results.

Gideon Phiri, a ZAMBART research associate based at Kanyama Clinic in the Zambian capital, Lusaka, said the facility served an estimated 14,000 households.

Housed in a small container, KanyamaÂ's new x-ray machine is easy to secure, and a shortage of health workers has been overcome because the machine is so easy to use that local students like Timothy Manja, now in his a third year of study at the nearby Evelyn Hone College, learnt to operate it in a day and can use the experience towards his practical training requirement.

Shortages of medical personnel, such as x-ray operators and lab technicians, have also prompted ZAMBART and Zambia's Ministry of Health to pilot the use of high school graduates to collect and analyse sputum samples at Kanyama.

The X-rays Manja takes also form part of a database being used by the machine's manufacturers, Delft Diagnostic Imaging, to develop a system for TB detection, in which a computer would compare a patient's chest x-ray to a database of images so as to flag possible TB cases. This would facilitate early detection, and also reduce the heavy caseload of health professionals.

Nurse Foster Chileshe said the onsite machine decreased the time patients had to wait for x-rays, and there were fewer follow-up losses.

Good things come in containers

The new TB lab at the national reference laboratory in Lusaka, housed in a slightly larger container, is making a big difference. Barry Kosloff, of the London School of Hygiene and Tropical Medicine, ZAMSTA's mini-lab project manager and designer of the lab, said while the concept was not new, container-based labs had never been this sophisticated.

Labs are internationally graded according to their biosafety level, or the level of precautions taken to isolate dangerous diseases like TB.

Zambia's first container lab ranks at 3 on a scale of 1 to 4, with 4 being the level used to control highly contagious biological agents such as hemorrhagic diseases.

"In Africa there's a great need to expand diagnostic services, [but] up until this lab was done, if you ever wanted to get a biosafety level-3 lab, you'd have to spend three times as much money - around half a million dollars," Kosloff told IRIN/PlusNews. His container-based labs cost about US$130,000.

In some of AfricaÂ's national reference laboratories, staff battle funding constraints, aging infrastructure and technology, and poor infection controls that leave them frustrated and make it dangerous to test TB cultures like those grown in KosloffÂ's lab.

TB cultures are particularly important in diagnosing TB in HIV-positive patients, and to determine whether patients have successfully completed treatment. Additional lab capacity would speed up diagnosis and test results, and increase the number of patients referred for treatment.

Container labs are produced, in part, by a South African manufacturer, and can be on the ground about three months after being ordered.

Despite what Kosloff called "container stigma" - because governments seemed to look down on non-permanent structures - countries like Haiti, Peru and Kenya have all expressed interest.

Because each lab is built to order, Kosloff said, it could be adapted to country-specific needs, including water tanks or generators for areas with interrupted water and power supplies.

"Some people see containers as something less than a real lab - that because it's a container it must be poor quality - but inside it;s a beautiful lab," he said. "It's about people getting the best lab for the least amount of money."

AstraZeneca joins fight against tuberculosis

AstraZeneca has joined a consortium to fight tuberculosis around the world with French rival Sanofi-aventis and the universities of Cambridge and Lausanne.

The More Medicines for Tuberculosis (MM4TB) consortium intends to develop new drugs for successful and shorter treatment for TB. The universities of Pavia in Italy, and Uppsala in Sweden, along with 19 other research groups from a total of 13 countries, are also involved. The consortium will be funded by a €16m (£13.5m) EU grant and led by TB expert Professor Stewart Cole, of the École Polytechnique Fédérale de Lausanne.

He said: "This is one of the strongest consortiums ever put together. It is led by academia but with the drug discovery knowhow of big pharma and biotechs."

Every year, 1.8 million people die from TB around the world. The drugs used to treat it are nearly 50 years old and must usually be taken for six to nine months, or up to two years for drug-resistant strains of the disease. This can prove too much for many patients and erratic treatment can lead to drug resistance and death. Cole said new drugs could reduce the treatment to a few months.

AstraZeneca is sharing its compounds and expertise. Research will be carried out at London hospitals and the John Innes Centre in the capital, as well as in Russia, India and South Africa. The aim is to have 10 to 20 compounds in the pipeline to develop two or three successful TB drugs that will be given to the patient as a cocktail.

A previous consortium came up with a promising product that is now being developed by Germany's Alere. "We're confident we can replicate that and come up with two candidates [drugs]," said Cole. It will take eight to 12 years to develop a medicine, test it and have it approved by regulators.
AstraZeneca said the current treatment for TB, directly observed short-course chemotherapy, was old, slow and inefficient by today's standards. Multidrug-resistant strains have appeared during the past 15 years.

Meanwhile the Global Fund, a public-private partnership set up in 2002 to raise money to fight tuberculosis, HIV/Aids and malaria, is preparing to launch an exchange-traded fund (ETF) with Deutsche Bank in London next Tuesday. The fund invests in shares of 50 companies that support the Global Fund, including HSBC, ExxonMobil, Vodafone, BHP Billiton, Apple, Novartis, Total, Royal Dutch Shell, Toyota and Siemens. About 2% of the 2.5% annual fee charged by the ETF will go directly to the Global Fund's fight against HIV, TB and malaria.

Robert Fillip, head of innovative financing at the Global Fund, said: "With more and more people depending on continuity in their treatments and health programmes, we urgently need financing models that generate long-term revenues. Our partners are some of the biggest names in industry. We are interested in projects that are both good for business and good for saving lives."

The ETF has already been launched in Germany and could provide the Global Fund, which is mainly funded by governments, with a steady income stream. Although it is small at present ($5m), the aim is to get it up to $300m and to launch similar funds in future. The Global Fund has provided $21.7bn for more than 600 programmes fighting Aids, TB and malaria in 150 countries.

New antibody therapy to tackle tuberculosis

http://www.wellcome.ac.uk

Researchers from the University of Dundee, King's College London and St George's Hospital Medical School have developed a monoclonal antibody that was found to offer protection against tuberculosis (TB) infection in experimental models when combined with interferon, a modulator of the immune system.

TB remains a recognised global emergency, claiming around two million lives across the world each year, and 2010 saw the largest number of new cases of TB in the UK for more than a decade.

Approximately one-third of the world's population is infected with Mycobacterium tuberculosis, the bacterium responsible for this huge public health problem. Unfortunately, the BCG vaccine used in some countries does not protect against disease in all adults, and drugs need to be delivered for several months.

The problem has been compounded by a dramatic rise in TB strains displaying multiple drug resistance. As a result, new ways to prevent and control tuberculosis are urgently required, and the strategy developed by the teams in London and Dundee paves the way toward a previously unexplored form of treatment.

The human monoclonal antibody produced by the team is of the IgA type and can specifically recognise Mycobacterium tuberculosis. IgA antibodies are proteins normally used by the immune system to identify and neutralise foreign microbes like bacteria and viruses within the lungs and intestinal tract.

The antibody works by attaching to the bacterial cells and triggering immune processes that prevent bacterial growth. Although human monoclonal antibodies are widely used to treat various forms of cancer and inflammatory disorders, this is the first demonstration that they might have applicability against TB.

Dr Jenny Woof, who led the research at Dundee, explained the need to develop new treatments and vaccines for TB and the potential to develop this research further. "The number of cases of TB remains very high, and so this is clearly a major problem," she said. "Across the world, there are millions of people falling victim to infectious diseases such as TB, so the implications of this research could be considerable.

"Antibodies exist as five different types in humans, with those of the IgG type already being used in some clinical treatments. Antibodies of the IgA type are slightly different. They possess properties that we believe may be important in governing how this IgA antibody works against TB infection."

The study was the result of a productive collaboration, with each team bringing a different sphere of expertise. Professor Juraj Ivanyi at King's is an international expert in tuberculosis research, while Dr Woof's team in Dundee brought experience in human IgA antibodies. Dr Rajko Reljic at St George's has expertise and special facilities for experimental models of infection.

Professor Ivanyi is based at the Dental Institute at King's College London, which has a long history of pioneering research into mucosal immunology and vaccines. He said: "This study brings us much closer to finding new ways to treat tuberculosis, although further research is needed before we can begin to trial this approach in patients. I am excited about where this project can lead us in terms of potential new treatments for this devastating disease."

The findings are published in the most recent edition of 'Journal of Immunology'.

Delegates From European Parliament Express Support For Rapid Development Of New TB Vaccine

Emergent BioSolutions Inc. (NYSE:EBS) announced that a joint delegation of Members of the European Parliament (MEPs) and representatives from the Oxford-Emergent Tuberculosis Consortium (OETC) visited the trial site where MVA85A, the world's most clinically advanced tuberculosis (TB) vaccine candidate in development, is being studied in a Phase IIb infant efficacy clinical trial. This clinical trial in Worcester, South Africa is being conducted by the University of Cape Town's South African Tuberculosis Vaccine Initiative (SATVI), in partnership with OETC and Aeras.

"I am very anxious to see a new TB vaccine licensed and I am delighted that this trial of this promising new vaccine candidate is taking place," said MEP Michael Cashman, Chairman of the South Africa Delegation of the European Parliament. "It is vital for South Africa that a new vaccine is developed as soon as possible, especially for infants and those with HIV. If this trial is successful, South Africa will benefit and so will the rest of the world. Too many lives are lost to tuberculosis and I am pleased to see so many public and private bodies coming together to deliver what could be the first new TB vaccine in 90 years."

"Emergent BioSolutions is proud to be part of OETC, a joint venture established with the University of Oxford in 2008, to further develop the most clinically advanced investigational TB vaccine," said Allen Shofe, OETC Board Member and Senior Vice President Corporate Affairs of Emergent BioSolutions. "This collaboration is an integral part of a multi-pronged approach to alleviating the global burden of tuberculosis. Through our involvement in OETC, Emergent is given an opportunity to touch the lives of many in fulfillment of our company mission - to protect life."

The MEPs learned firsthand about the TB vaccine candidate and progress of the clinical trial from lead scientist and developer Dr. Helen McShane from the University of Oxford. "We are extremely pleased with the progress of the trial," said Dr. McShane. "We anticipate that the trial, which involves administering MVA85A as a booster to the BCG vaccine, will reach the enrollment target of 2,784 infants by the end of April 2011. The follow-up period and study results are expected to be completed in 2012."

The delegation also observed the vaccination of infants as part of the trial and visited the hospital facilities with Dr. Hassan Mahomed, SATVI's Principal Investigator on the study.

Tuberculosis rates in Birmingham reach Third World levels

The Government is being urged to reconsider its policy on vaccinating all schoolchildren for tuberculosis (TB) as rates in Birmingham reach Third World levels.

The city's Health Scrutiny Committee is writing to Health Secretary Andrew Lansley asking if the city can bring back jabs for all children and vulnerable adults.

It comes after thousands of residents signed three petitions circulating across the city backing the reinstatement of a mass vaccination programme for schoolchildren, which was abandoned by the Government in 2005.

The disease has killed at least 68 people in the city in the past five years including 15-year-old pupil Alina Sarag, from Golden Hillock School in Sparkhill, who died in January.

Coun Deirdre Alden, chairman of Birmingham Health Scrutiny Committee, said: "There's a lot of concern in Birmingham over TB and a lot of people have signed these petitions so need to send a message to the Government.

"Birmingham is one of the TB hotspots, maybe they don't need everyone to be vaccinated in leafy Surrey, but we have very much higher rates.

"Heart of Birmingham Primary Care Trust (PCT) is a hot-spot but children mix freely. The levels are so high that we think maybe we need to do the rest of the population in Birmingham."

TB rates for Heart of Birmingham PCT, which includes Ladywood, Aston, Nechells and Sparkbrook, has reported 99 cases per 100,000 of population.

That is comparable to rates in Africa and India and more than double the 40 cases per 100,000 point at which Department of Health advice suggests the disease is running out of control.

In Lozells and East Handsworth, the rate is 140 cases per 100,000 and in Aston it is 145.

Jim McManus, Birmingham's joint director of public health said: "The Government has directed its policy because of scientific evidence at the time, but public opinion in Birmingham is saying we are not sure that is right and need a review of the science in Birmingham."

Immunitor Presents Positive TB Treatment Data at African Conference

http://www.globenewswire.com/

Immunitor will present latest results from its imm01 clinical trial in tuberculosis patients in Abuja, Nigeria at the 18th Union TB and Lung Diseases Conference of the African Region, 2nd to 5th March, 2011.

Clinical evidence indicates that Immunitor's V5:

* Clears TB bacteria from patient sputum in one month
* Clears symptoms of TB such as fever and inflammation
* Helps underweight patients re-gain lost weight
* Is effective for drug resistant TB, as well as TB with HIV co-infection
* Reduces adverse side effects of conventional drugs
* Is safe and free of adverse effects even in severely ill patients

About 2,000 participants are expected at the African conference, which will deliberate on problems and solutions for tuberculosis, asthma, pneumonia, lung cancer, TB and HIV, funding for TB research, and new preventive, diagnostic and curative methods to fight TB. In addition, the conference will raise awareness of new developments in the area of equipment and treatment (for further information see: http://afrouniontbconf2011.org/en/welcome.html).

The Immunitor presentation will summarize data from the 120-patient imm01 phase II trial in Ukraine. Preliminary interim results were published in two peer reviewed journals earlier this year (see http://www.ncbi.nlm.nih.gov/pubmed/21182457 and http://www.ncbi.nlm.nih.gov/pubmed/21244690 ). The study, conducted by internationally recognized experts in TB immunotherapy, compared V5 immunotherapy to placebo among treatment refractory tuberculosis cases including re-treated TB, multi-drug resistant (MDR-TB) and TB with HIV co-infection. After one month, 44/50 patients (88%) became sputum smear negative in the V5 group, whereas only 7/38 (18.4%) in placebo group had converted. The high conversion rate in V5-receiving subjects was similar regardless whether TB was drug-sensitive or drug-resistant or with HIV co-infection. V5 also down-regulated TB-associated inflammation as shown by normalization of mean elevated leukocyte counts and decreased erythrocyte sedimentation rate. V5 was also associated with improvement in weight gain, another important endpoint in TB treatment. No adverse side effects or reactivation of TB attributable to V5 were seen at any time. The investigators concluded that V5 was safe and effective as an immune adjunct to chemotherapeutic management of TB and can shorten substantially the duration of treatment.

After AIDS, tuberculosis is the second most common cause of death from an infectious disease, with approximately 2 million people dying each year. Current treatments are not fully effective, particularly against multi-drug resistant TB (MDR-TB) and HIV-TB, and strenuous treatment regimens lasting for up to 2 years are required.

"Immunitor's products, some of which are approved for sale in African countries, including Nigeria, offer effective and safe treatment solutions. Nigeria ranks 4th among high burden countries where TB is rampant. V5 is inexpensive, easy to administer, stable at tropical temperature, and is made from readily available sources, which suits ideally developing countries," said Vichai Jirathitikal, co-founder and co-inventor of the Immunitor oral vaccine platform. For additional information about Immunitor company, please visit http://www.immunitor.com.

TB Control Programme to be launched in rural areas

http://www.dailytimes.com.pk

Health care facilities under the National TB Control Programme would be provided at the 3 rural health centers of Islamabad while other rural health centers are to be upgraded shortly under 1st phase of the programme, said Deputy Commissioner (DC) Islamabad Amer Ali Ahmed on Tuesday.

He reviewed the arrangements related to the provision of health care facilities under the National TB Control Programme in rural areas of the federal capital in a meeting chaired by him. The DHO ICT Dr. Amirzada Khan and officials from the National TB Control Programme attended the meeting.

The health care facilities would be launched at the 3 rural health centers ie Tarlai, Sihala and Bhara Kau under the 1st phase of the programme and thereafter, National TB Control Programme would be launched at the other 14 Basic Health Units in the rural areas of Islamabad. Amer Ali Ahmed said that overall health care facilities including provision of mother and child health care facilities, family planning services were also being up-graded in the rural areas. The health department Islamabad would provide laboratory test facilities and provision of medicines under the National TB Control Programme. Deputy Commissioner Islamabad told that purpose of launching the National TB Control programme is to diagnose and control TB at the early stage and to provide treatment facilities in order to ensure best public health. The meeting also discussed provision of manpower and medicines for the health facilities in the rural areas.

Congo gets 17b from World Fund against HIV/AIDS, TB, malaria

http://www.afriquejet.com

The financing, over a period of five years, will help the National Council of Fight against HIV/AIDS (CNLS) and the French Red Cross to reinforce prevention in illiterate young people, who are more at risk and the management of children with HIV/AIDS, the committee added.

'This funding will, among other things, facilitate access to counselling and screening of 267,520 adults, aged between 15 and 49; increase management to cover 100 per cent of children identified with HIV/AIDS and reinforce the treatment of infected children,' the committee said in a communique.

Under the programme, more than 50 per cent of women will have access to counselling and voluntary screening in the mobile voluntary screening centres and 4,480 children with HIV/AIDS will benefit from a medical, psychological and nutritional management.

New Diagnostic Tool for Quick Identification of TB

Scientists have developed a new diagnostic tool to identify active tuberculosis more quickly and effectively. Tuberculosis (TB) remains one of the most pressing public health priorities for the 21st century, with over one third of the world population infected.

Active TB disease is a major issue both for the patients who require specific treatment and at a population level, since these patients are contagious. Diagnosis of active TB disease (from latent asymptomatic infection) requires several clinical, radiological, histo-pathological, bacteriological and molecular parameters.

The new diagnostic tool developed by Pr. G. Pantaleo and Dr. A. Harari allows sensitive and highly specific identification of patients with active TB disease. The study, initially designed to identify parameters of the immune response correlated to protection against TB, led to the observation that functional signatures of immune responses, i.e. the cytokines involved such as TNF-1, IL-2 and IFN, were indeed correlated to the different stages of tuberculosis disease.

The originality of this flow cytometry-based assay is that the read-out is focused on the immune response and not on microbiological parameters, thus explaining its reliability and quickness. "This assay and the functional signatures of TB-specific immune responses are not only relevant for discriminating between active TB disease and latent infection but may be also instrumental in monitoring the response to TB therapy", says Prof. Pantaleo. "The flow cytometry-based assay requires specific equipment and skillful laboratory personnel. However, further technological development is already under way to make the assay widely accessible", says Dr Harari.

Notre Dame researchers discover dual-action compound for potential treatment of TB and malaria

http://www.southbendtribune.com

Marvin Miller, the George and Winifred Clark Chair in Chemistry, and Michael Ferdig, associate professor of biological sciences at the University of Notre Dame, are co-authors of a study recently published in the Journal of the American Chemical Society on a potential breakthrough in the fight against tuberculosis and malaria - global diseases that each kill some 2 million people a year.

In an interdisciplinary project, the researchers synthesized an iron transport molecule attached to an antibiotic that the tuberculosis bacterium would gladly ingest as a "Trojan horse," a method that has proven to be successful for the Miller lab in other studies. The peroxide drug, artemisinin, is a leading antimalarial agent but is not effective alone against TB, whose cell membrane is difficult to penetrate. Chemistry triggered by the cell's efforts to use the iron in the transporter enables the drug to destroy the bacterium.

"It's all about delivery," Miller says, "and getting the lethal agent into the bacterium. Our study suggests that it works against TB by the same method that would work to kill malaria, which is pretty exciting."

About one-third of the world's population is infected with the bacterium that causes TB, and 40 percent of the world is affected by malaria. The standard regimen for TB treatment involves multiple drugs taken for six to eight months. Highly drug-resistant strains of the TB bacterium have evolved while no new effective antibiotics have been introduced for decades.

The research demonstrates the utility of "Trojan horse" drug design and how it could be used to target both malaria and TB. The molecule, while effective, may be too complex for commercial medicinal use, but researchers are already pursuing ways to make simplified versions. Garrett Moraski, a research assistant in Miller's lab, has identified some elements of the molecule that by themselves are equally effective against TB.

The article, "Design, Synthesis, and Study of a Mycobactin-Artemisinin Conjugate that has Selective and Potent Activity against Tuberculosis and Malaria=," was published Feb. 17. Collaborators include researchers from Duke University, the National Institutes of Health and the Liebniz Institute for National Product Research and Infection Biology in Germany, as well as graduate students, postdoctoral fellows and laboratory assistants at Notre Dame.

A Century of Fighting TB

World TB Day will be marked March 24 in various ways by the World Health Organization, national public health agencies, the Stop TB Partnership, and allied groups. A symposium that day presented by the partnership and other organizations has the title "World TB Day: The fight against tuberculosis: what's new in research?" and one has to wonder what Dr. Robert Koch would say if he presented a paper during the event.

World TB Day commemorates Koch's announcement on March 24, 1882, that he had discovered the TB bacillus that causes the disease. WHO says TB was raging in Europe and the Americas at that time, causing the deaths of one in every seven people, and Koch's discovery "opened the way towards diagnosing and curing TB."

Koch, a German, died in 1910. But TB has not been eradicated in the century since he accepted the Nobel Prize in Physiology or Medicine in 1905 for his discovery. In his Nobel Prize lecture, delivered on Dec. 12, 1905, Koch observed that most countries around the world by that time had begun campaigns to treat TB patients and combat the disease, and he said he expected these efforts would succeed. "We should not close our eyes to the fact that the fight against tuberculosis needs quite considerable financial resources. Basically it is only a question of money," Koch said.

Today, TB remains an epidemic in much of the world, kills millions of people annually, and has infected about one-third of the world's entire population, according to WHO, which is working to halve TB prevalence rates and deaths by 2015. WHO says 9.4 million people became sick with TB and 1.7 million died of it in 2009 alone.

Dr. Lucica Ditiu, 42, a former WHO medical officer for TB in eastern Europe, became executive secretary of the Stop TB Partnership on Jan. 19, 2011. The partnership, which is hosted by WHO in Geneva, consists of more than 1,200 international organizations, countries, donors from the public and private sectors, and nongovernmental and governmental organizations that are cooperating to eliminate TB by 2050.

Two months ago, WHO endorsed a new, rapid test for TB that it hopes will be especially useful in developing countries hit hard by the disease. It can provide an accurate diagnosis in about 100 minutes, far faster than current tests, where the patient's results may take as long as three months.

"This new test represents a major milestone for global TB diagnosis and care. It also represents new hope for the millions of people who are at the highest risk of TB and drug-resistant disease," said Dr. Mario Raviglione, director of the WHO Stop TB Department. "We have the scientific evidence, we have defined the policy, and now we aim to support implementation for impact in countries." The test is an automated nucleic acid amplification test that has been field-tested for effectiveness in the early diagnosis of TB, multidrug-resistant TB, and TB complicated by HIV infection, which are more difficult to diagnose.

Fighting tuberculosis in the North

Of all the health threats facing Canadians, tuberculosis is not high on the list. Although the disease kills an estimated two million people a year worldwide, it isn't a big problem in Canada.

Perhaps we should rephrase that: Tuberculosis isn't a big problem in most of Canada. But as an editorial in the Canadian Medical Association Journal details, its incidence has reached epidemic levels in the North, and in particular, in Nunavut. Indeed, while the number of new active cases in Canada has been steadily dropping, and is now fewer than five per 100,000 people, Nunavut has seen a dramatic increase in its incidence rate, which last year stood at more than 300 cases per 100,000 people.

That's because 2010 saw at least 100 new active documented cases, compared with 59 in 2009. And that means that the rate of TB in Nunavut is an astonishing 62 times the national average. Even worse, many of the new cases have been found in adolescents and young adults, which suggests active community transmission.

There are a variety of reasons for Nunavut's epidemic levels of TB, but many of them can be traced directly to the actions of the federal government over the last century. While northern Canadians first contracted TB from whalers in the 19th century, the disease gained strength when the government settled the originally nomadic Inuit into communities. The Inuit were typically housed in one-room dwellings with poor air circulation and no bathrooms, which practically ensured that an infectious disease like TB would spread.

In the 1950s, members of the Inuit who tested positive for TB were forcibly moved to the south to be treated, and many never returned. This created among the Inuit a distrust of physicians and public health authorities, a distrust that continues to this day.

The CMAJ editorial also notes that many current conditions help the spread of the disease: Nunavut communities tend to be small and isolated, residents face high levels of poverty and unemployment, and substandard housing and community infrastructures continue to plague the territory. These are difficult challenges to overcome, but they are not insurmountable, particularly in a country as wealthy and knowledgeable as Canada. And since the federal government played a large role in the initial spread of TB in the North, its responsibility to solve the problem is amplified.

The CMAJ notes that Nunavut schoolchildren are routinely screened for TB, but many other people have little contact with the health care system, in part because of their lack of trust. Consequently, the journal argues that the federal and territorial governments must work together to develop culturally sensitive community engagement and public education programs and to improve screening programs, diagnostic testing and treatment.

However, even if these programs are improved, the disease will continue to spread as long as Nunavut residents continue to live in substandard housing. Economic investments to improve the quality of housing and to decrease poverty are therefore essential.

Ottawa recently announced that it had earmarked $800,000 for Taima TB (Stop TB), a program that will provide door-to-door TB testing. That's a good start, but it must be part of a broader program designed not only to test people for TB, but to reduce their chances of becoming infected in the first place.

Efficacy Of Tuberculosis Vaccine Enhanced By VIB Scientists

http://www.medicalnewstoday.com

Nele Festjens and Nico Callewaert of VIB and Ghent University have improved the efficacy of the vaccine for tuberculosis. The new vaccine affords - as already proven in mice - better protection against the disease. The development of a new tuberculosis vaccine is a priority in the fight against the disease which claims the lives of 1.7 million people each year. The current vaccine provides only partial protection.

Nico Callewaert: "Our vaccine is more effective because it is more quickly recognized by the immune system of the vaccinated person. We have, as it were, undressed the existing vaccine by removing its protective shield."

Tuberculosis: a worldwide problem

One third of the world population is infected with the Mycobacterium tuberculosis bacterium which causes tuberculosis (TB). TB, AIDS and malaria are the three infectious diseases claiming the largest number of fatalities worldwide. The World Health Organization (WHO) estimates that each year 8 to 10 million people become infected. TB is in particular a disease of the poor and mainly affects young adults in their most productive years. Most TB fatalities are in the developing countries, more than half of them in Asia. In almost all of these countries, multidrug-resistant TB is becoming increasingly frequent. This form of TB is very hard to treat.

Prevention is better than cure

TB treatments are expensive and also very difficult because of multidrug-resistant TB. There has therefore been a strong focus on vaccination in the fight against TB. The only vaccine on the market is Bacillus Calmette-Guérin (BCG). It is produced from attenuated live bovine tuberculosis bacterium, Mycobacterium bovis, which has lost its virulence in humans. In children, the vaccine prevents only half of cases of tuberculosis and in adolescents and adults the degree of protection is much lower still.

In recent years, several other candidate vaccines have been developed and some of these have been tested on humans. Only a few have led to a moderate improvement in protection compared with the BCG vaccine. The search for a more efficient vaccine is therefore still on.

Removing the bacterium's defense shield

The bacterium from which the BCG vaccine is derived hides as it were from the immune system of the organism in which it ends up. This may well be the reason why the vaccine is not very effective. The fact is that a vaccine is meant to trigger an immune reaction in order to be able to afford good protection. Nele Festjens and Nico Callewaert have discovered that the bacterium hides behind the SapM enzyme that acts as a kind of shield.

They have used this knowledge to develop a new vaccine. They adapted Mycobacterium bovis BCG in such a way that it was no longer able to generate SapM and could therefore no longer hide from the immune system. Testing the new vaccine on mice has shown that it affords better protection than the present BCG vaccine.

A different mechanism

The researchers also demonstrated that their vaccine works in a way different from the other vaccines currently being tested. In fact, it acquires its extra protective value by emitting signals that provoke inflammation and in this way activate the right cells of the immune system. Festjens and Callewaert are convinced that applying their strategy - removing the protective shield - in the new vaccines that are somewhat better than the vaccine currently being marketed should lead to a vaccine that affords genuine protection against TB.

Mutated immune gene increases TB risk for African Americans

http://www.bcm.edu

A mutated immune system gene increases the risk of developing tuberculosis in African Americans who carry the TB bacteria, said researchers led by those from Baylor College of Medicine and the Methodist Hospital Research Institute in a report in the open-access journal PLoS One.

Only one in 10 people infected with the bacteria that cause tuberculosis actually go on to develop the disease, said Dr. Katherine Y. King, an instructor in the department of pediatrics - infectious diseases at BCM.

"We spend a lot of energy screening for tuberculosis and treating the people who test positive," she said. "It would be better to know who among those who test positive are most at risk of developing the disease. Then we could focus more attention on that group."

Tuberculosis caused by Mycobacterium tuberculosis is the second deadliest single infectious disease worldwide, causing 1.8 million deaths each year.

Mutation in IRGM1 gene

King and her colleagues determined the genotype (the genetic sequence) for the IRGMI1 gene and the nearby area of the genome for 370 African-Americans and 177 Caucasians with tuberculosis and compared them to the genotypes of 180 African Americans and 110 Caucasians who did not have the disease.

They found that the African Americans with tuberculosis were more likely to carry a specific mutation in the IRGM1 gene. The gene had single nucleotide polymorphisms or single letter changes in the genetic code in two places along with a deletion of genetic material in an area near the gene.

That mean the mutations in the gene increased the risk of developing tuberculosis for the African Americans who carry.

"We still do not know how the protein associated with this gene works in humans," said King. "Some studies indicate it might be important in the engulfment of bacteria by macrophages." Macrophages are immune system cells that engulf and degrade or digest bacteria and other foreign invaders.

Focusing on those who need care the most

Treatment for people who carry the TB bacteria but do not have the disease can last as long as nine months. Finding out who is at greatest risk can reduce such treatment and enable health care workers to focus their attention on people who most need such care.

Studies such as the one done by King and her colleagues can also improve understanding about immunity to TB and may lead to new approaches to treatment, she said.

In addition, this mutation in the IRGM1 is also associated with the development of Crohn's disease and this new study strengthens the possibility that that gastrointestinal disorder could have an infectious beginning that includes a misdirected immune response. (Crohn's disease is an inflammatory bowel disorder characterized by pain and severe diarrhea.)

Others who took part in this work include Dr. Margaret A. Goodell of BCM, Justin D. Lew, Ngan P. Ha, Xin Ma and Edward A. Graviss of Methodist Hospital Research Institute in Houston and Jeffery S. Lin of the University of California, Berkeley.

Funding for this work came from the Simmons Foundation Collaborative Research Fund.

Elephants Blamed For TB Outbreak In Tennessee

http://www.huffingtonpost.com/

A tuberculosis outbreak among workers at a Tennessee elephant sanctuary in 2009 is being blamed on one of the pachyderms, even though some of the employees didn't have close contact with the animal.

Elephants can carry TB, and there have been reports of them spreading it to people who touch them. In this instance, TB spread to eight employees, though three of them didn't work directly with the elephant, according to a report released Wednesday by the Centers for Disease Control and Prevention.

The three worked in an administrative building next to an elephant barn at the refuge in Hohenwald, about 85 miles southwest of Nashville. The 2,700-acre Elephant Sanctuary was founded in 1995 as a place for old, sick and rescued elephants.

One elephant in the barn - a female Asian elephant named Liz - had been diagnosed with tuberculosis. Investigators believe the TB bacteria spread through the air when the elephant sneezed, or through pressure washing or dust from sweeping the barn of the elephant's waste.

The eight employees tested positive on a skin test and received treatment, but are not sick or hazardous to others, sanctuary officials said in a statement Wednesday.

Liz the elephant received treatment and is still alive, said Dr. William Schaffner, the sanctuary's president. According to the refuge's website, Liz was a circus elephant for many years, has been at the sanctuary since 2006 and is about 54 years old.

Shaffner, a nationally known expert on infectious diseases at Vanderbilt University, is also one of the authors of the new report in the CDC journal Emerging Infectious Diseases. Other researchers are from the CDC and the Tennessee Department of Health. The authors called for better methods for diagnosing TB in elephants and more measures to protect employees from infection.

Shaffner said the sanctuary has made several changes, including increased use of breathing devices. He said he hopes the refuge becomes a center for studying TB in elephants and how it spreads.

This week, the sanctuary filed court papers claiming its co-founder and former CEO, Carol Buckley, created a hostile work environment and was lax about workers' health at the site.

Sanctuary officials claimed Buckley failed to implement infection controls for elephant caregivers as regulators suggested before the workers tested positive for TB.

The claim was in response to a lawsuit filed by Buckley in October. Buckley - who was fired last year - is seeking $500,000 in damages and visitation rights to one of the sanctuary's elephants.

Japan grants $350,000 for local drive on TB

The Japanese government has released a grant worth $350,000 to help support the Philippine government's fight against tuberculosis or TB, one of the most life threatening diseases infecting millions of people globally.

In a statement, the Japanese Embassy in Manila revealed that around 530,000 urban low-income residents of Payatas in Quezon City and Tondo, Manila will benefit from this project.

The grant covers three phases of the tuberculosis control project in socio-economically underprivileged urban areas in Metro Manila dubbed "Stop TB para sa Lahat."

Alarming TB death rate among Toronto homeless

http://www.torontosun.com/

The death rate from tuberculosis in homeless people in Toronto is "alarmingly high", an infectious disease expert warns.

A 10-year study looking into the homeless in Toronto found that one in five homeless people with tuberculosis died within a year of their diagnosis.

"Homeless people diagnosed with tuberculosis in Toronto have an alarmingly high mortality rate of 20%. That's three to four times higher than someone would expect to see in the normal population," said lead author Dr. Kamran Khan, an infectious disease physician and scientist at St. Michael's Hospital.

Khan says Toronto's homeless shelters have been lucky because a drug resistant strain of TB has not entered the shelter system. But, Khan warned if a multi-drug resistant TB strain did, it could set off an outbreak that would become very difficult to control.

Khan said it's imperative to set up ventilation systems within the shelter system to manage the potential for the disease to spread.

Khan says more work needs to be done to provide appropriate care to people infected by the disease.

One of the recommendations which resulted from an inquest where a homeless man died of TB, was to develop a centralized clinic system. Today, several health care providers care for people diagnosed with TB, but these health care providers have limited exposure with TB.

Khan said the second major finding of the study is the face of the tuberculosis population is changing and has become more diverse with 40% being immigrants. He says this raises the risk that dangerous drug resistant strains of tuberculosis could enter the shelter system.

Khan said the treatment of tuberculosis is often complicated by inadequate housing, substance dependence, language barriers, mental health problems, and the enormous stigma that comes with the disease.

The study is published in the Emerging Infectious Diseases journal.

No space for TB patients in PMC-run hospital

http://www.indianexpress.com/

The TB ward of PMC-run Dr Naidu Infectious Diseases Hospital, one of the swine flu screening centres with arrangements for H1N1 patients, has been shut for almost two years and TB patients are being turned away. They are either referred to the state-run Sassoon General hospital or the Aundh General Hospital.

PMC health authorities are awaiting the swine flu-free tag from the state government to start the TB ward. PMC chief medical officer Dr R R Pardeshi said there was not a single H1N1 case in the city . "However, while daily efforts of screening and testing patients with symptoms of cough and cold are still on at Naidu quarantine ward, throat swabs sent to National Institute of Virology (NIV) have not tested positive. We had to refer TB patients to Sassoon or Aundh, as TB patients had to be isolated from H1N1 patients," he said.

Naidu doctors said some 30 patients are screened daily and samples from 10-12 suspected H1N1 cases are sent for examination. According to Pardeshi, the Rs 7-crore, 180-bed hospital has been set up for a year now. Isolation wards had to be demolished for a sewage treatment plant. So far, 1,690 patients of diarrhoea, cholera, malaria, dengue, chikungunya, rabies, tetanus, influenza and other fevers had been admitted and treated, Dr Pardeshi said. He admitted that TB patients were sent to Sassoon or Aundh hospitals. The hospital used to admit 10-12 TB patients every month. "We will soon re-start the TB ward," Pardeshi said. In contrast, the Pimpri-Chinchwad Municipal Corporation (PCMC) has been admitting TB patients without segregating or isolating them. PCMC medical director Dr R R Iyer said 70 per cent of TB patients can be treated by the Directly Observed Treatment Short Course (DOTS) programme. "For admission we have made arrangements for seriously ill TB patients at the 30- bed ward of YCMH or the 10-bed ward for TB at Talera Hospital. Every month some 20 beds are occupied by TB patients and the PCMC does not require to shift them to the state-run Aundh hospital." Last year, 1,988 new patients were diagnosed in PCMC area while the PMC health authorities diagnosed 3,699 new TB cases. The city TB control unit diagnosed a 3,729 new cases in 2009 and 3,853 in 2008. The PMC has six TB units in the city and private public partnership has involved several general practitioners who function as DOTS providers.

Canada fails Nunavut in fighting TB: journal

Canada's efforts to fight tuberculosis in Nunavut, where infection rates hit a record high last year, has been called a "century of failure" by a leading medical journal.

In an editorial released Monday, the Canadian Medical Journal Association says last year's tuberculosis outbreak in Nunavut - the worst since the territory was created in 1999 - is a problem for all of Canada.

"We are a rich, developed nation that has the resources to solve the problem in Nunavut if we choose to employ them," said Dr. Matthew Stanbrook, a respirologist at Toronto Western Hospital.

"The fact that we have failed to do so, not just once but over a century, should be an embarrassment to every Canadian."

The editorial reports that Nunavut had 100 new and active cases of TB in 2010. That's the highest number in the territory's history and represents an infection rate 62 times the Canadian average.

Meanwhile, 14 new tuberculosis cases have emerged so far in 2011. Nunavut health officials told CBC News they could use more help to screen and track new infections.

Similar to developing world

Stanbrook and the editorial's other authors say most of the new TB cases in 2010 occurred in younger patients, suggesting the disease is being actively spread.

"This is happening at rates we see in the developing world," Stanbrook told CBC News on Monday.

"As the people of Nunavut are Canadians too, they deserve the same degree of effort that we have successfully exerted in the rest of Canada."

Tuberculosis is a germ-borne infection that most commonly attacks the lungs. It can cause shortness of breath, coughing, fever and death.

It has been largely eliminated in the south - although it is present in some aboriginal communities - but it has never left the North since it arrived with whaling crews in the 19th century.

Sociologists say the disease took firm root among the Inuit after the Second World War, when they were moved from hunting camps on the land into communities.

Government-provided, one-room houses with no bathrooms, or cramped shacks cobbled together from construction debris, provided ideal conditions for the disease to spread.

TB legacy remains

Records show that between 1953 and 1961, a total of 5,240 Inuit were sent south to be treated. The entire population of the Eastern Arctic at the time was about 11,500.

Many of those never returned or lost contact with their families, a memory that makes treating the current outbreak even harder, Stanbrook said.

"That legacy persists in the minds of the community in Nunavut today, especially among the elder generation who are the people who are most likely to reactivate the tuberculosis disease.... If you don't trust the public health officials, you're not going to disclose symptoms that seem like TB," he said.

"That really has frustrated efforts to address this epidemic."

The editorial notes that Nunavummiut add to the problem with unhealthy behaviours. More than half of them smoke at least once a day.

But the editorial says governments should do what they can to alleviate the problem. It calls for more emphasis on early diagnosis, testing and screening as well as for education programs to rebuild public trust. Overcrowded, substandard homes must go, it adds.

Aglukkaq defends Ottawa's response

But federal Health Minister Leona Aglukkaq insisted that her government is dealing with Nunavut's TB problem, having spent money to fight the outbreak itself and build more houses in Canada's North.

"I would say we have reacted, we have responded. We have invested in Nunavut alone, $100 million to construct 1,000 units. We know TB is a direct result of overcrowding," Aglukkaq told CBC News.

Last month, Aglukkaq announced $800,000 for Taima TB, a new program in which teams will go door-to-door in Nunavut communities to test people for signs of latent tuberculosis infection.

Stanbrook said Ottawa needs to do even better if it wants to lead the fight against tuberculosis, no matter what it costs.

"When we have the wealth that this country has, there's no excuse for not using all our resources to cure a curable epidemic disease," he said.

Stanbrook added that it's not good enough to accept poorer health in the North simply because the region is far away and thinly populated.

County TB program recognized for investigative techniques

http://www.themonitor.com/

Through brick wall after brick wall, Gloria Salinas and her staff kept searching for Patient Zero.

In cracking a tuberculosis outbreak that most health professionals thought impossible to solve, Salinas proved that a diagnostic practice previously confined to the laboratory setting could be applied in the time-intensive investigations that are her clinic's forte.

Salinas, the TB program manager for the Hidalgo County Health and Human Services Department, has spent the last 14 years handling TB prevention and treatment in a county notorious for its massive tuberculosis investigations. She's worked TB outbreaks in households, workplaces or in schools, where the legwork usually involves testing anywhere from 30 to 200 of the patient's "contacts" for TB.

The paperwork detailing a single tuberculosis case is enough to fill a filing cabinet drawer.

Patient confidentiality prevents Salinas from discussing specific details of the 10-month investigation.

But she said her pulmonary clinic honed the use of a genotyping database in a way that hadn't been done before in the state. The genotyping database catalogs specific strains of the TB bacteria and identifies the patients who contracted each strain.

In essence, Salinas showed that public health officials could trace a specific tuberculosis outbreak back to its source using a nationwide database of TB specimens. It's an approach similar to law enforcement's groundbreaking use of DNA to solve crimes.

"(The investigation) took quite a bit of time, manpower and brainstorming when we hit a lot of brick walls. But we used the genotyping to help find the initial culprit," said Salinas, who will present the techniques she used to crack the case at a Centers for Disease Control and Prevention meeting next month. "Finding the source helped save a lot of people's lives because we found out what type of TB germ it was and what appropriate medication we needed to give the other contacts."

CRACKING A CASE

The 16 employees who work in Hidalgo County's pulmonary clinic worked an average of 80 confirmed tuberculosis cases in each of the past six years.

On its face, the clinic's caseload appears light. But a single TB case can involve hundreds of hours of legwork in treating a patient and preventing the spread of tuberculosis, a disease caused by bacteria that are spread through the air from one person to another by coughing, sneezing or talking.

To fight the spread of TB, public health departments adopt two basic techniques:

>> direct observation of TB patients for six to nine months to ensure they complete their medication;

>> and contact investigations to determine whether the disease spread to family members, coworkers or others in close contact with the patient.

Dr. Brian Smith, the director for the Texas Department of State Health Services region that oversees the Rio Grande Valley, said ensuring that treatment is completed prevents the development of drug-resistant TB, which increases treatment costs from an average of about $15,000 a case to nearly $250,000.

But public health workers also are confronted with the task of testing people who came in contact with the patient. It's a task complicated by the stigma of the disease and by the sheer numbers of potential contacts; Hidalgo County once had 700 in a single outbreak.

But Smith said contact investigations are critical to curbing the spread of TB.

"It may be difficult to trace it to someone else because that connection may be distant. Very commonly, you have TB contacts that the patient hasn't identified," he said. "It's every bit as much of an investigation as an FBI investigation."

WORKING BACKWARD

The investigations are sometimes an open-and-shut case.

A person with TB symptoms is directed to the clinic, where they're put on a series of medications and their contacts vetted for the disease. But what happens if you don't know the source - the Patient Zero? That's the quandary that confronted Salinas last year when, rather than working an investigation outward from the source, she had to work backward to find the source and prevent further spread of the disease.

In a case that initially puzzled public health officials, a group of Hidalgo County residents were testing positive through a skin test for a latent, or dormant, TB infection. Although patients with latent TB don't show symptoms of the disease, about 5 percent to 10 percent of those people eventually develop the active form if they aren't put on preventive medications.

But the best way to determine what cocktail of medications to give the person - especially if they have extensively drug-resistant TB - is to trace their infection back to the source.

The state established procedures nine months ago to genotype the strains of the TB bacterium to determine the appropriate treatment method and trace the source of an outbreak, said Charles Wallace, the manager of the tuberculosis services branch for the Texas Department of State Health Services. Because the same strain of TB produces matching genotypes regardless of whom it infects, samples from two or more TB patients with the same genotypes proves they got the disease from each other.

That comes in handy in situations where TB patients are unwilling or unable to name all the people and places for potential contact. Universal genotyping will allow the state to quickly link even obscure connections between patients to identify other potential patients and get them treated as well.

He said genotyping could help identify connections between a Webb County case and an Hidalgo County case, for example, allowing case workers to more deftly identify missing links and ensure no one else is infected.

"The link for us is always the contact investigation. We need the patient to be forthcoming about their contacts," Wallace said. "It takes a lot of skill and finesse to get people to talk about their TB."

CLOSING THE LOOP

Those are skills the pulmonary clinic's staff has developed over years of working TB cases in a hotbed like Hidalgo County, said Eddie Olivarez, health and human services director. Although he couldn't discuss the case specifically, he said Salinas and her staff merged old-school techniques - like interviews with patients - with new-school techniques - like genotyping - to pinpoint the origin of the TB outbreak.

"There was not a leaf that was not turned over to track this particular Patient Zero," said Olivarez, who joined county commissioners in presenting Salinas with a plaque in recognition of her clinic's work. "It was just her tenaciousness in solving a tough case."

Salinas said her investigation showed that the database of genotypes could be used as a tool in a conventional contact investigation when no one knows the source of a TB outbreak. Salinas, who used genotyping to find Patient Zero and determine his or her connection with the rest, said finding the source without access to genotyping would have been about as easy as finding a needle in a haystack.

But she said she was determined to track the source until she reached a positive outcome.

"Finding the source can save lives," she said.

Nigeria holds conference on tuberculosis

To achieve the Millennium Development Goals (MDGs) by 2015 on the control of Tuberculosis, HIV, tobacco, asthma and other lung diseases, experts are converging on Nigeria.

The conference with the theme: TB, TB/ HIV and other lung diseases: Challenges to the attainment of the MDGs in Africa will hold between Wednesday and Saturday, March 2-5 at the International Conference Centre, Abuja.

There will be simultaneous interpretation in French and English during the conference.

At a briefing on the international event, the Director, National Institute of Medical Research (NIMR), 　Yaba, Lagos, 　Dr 　Oni Idigbe, said though Africa region has made some progress in the control of TB, HIV, tobacco, asthma and other lung diseases but serious challenges still exist for the region to achieve the MDGs by 2015.

"Nigeria is set to host the 18th Conference of the Union Africa Region on tuberculosis (TB). The conference will afford Africa the opportunity to critically review the progress made towards the attainment of MDGs and share best practices in overcoming the challenges in the control of the diseases."

According to Idigbe, 　"One case can infect 10 people within a year, 10 cases can infect another 100 people. TB infection is in geometric form one to 10 and then 10 to 100. Every country must try to have detected 775 per cent active detection. 75 per cent of the detection with 85 per cent at the treatment mode. Nigeria is still at the level of 36 per cent case detection and 80 per cent treatment. Over 60 of the cases in the country are still not detected."

100 Students to be Screened For Tuberculosis (TB)

http://topnews.us

A recent case of tuberculosis has alarmed the authorities in Austin O'Brien Catholic High School. As per the latest report, more than 100 students will be screened for tuberculosis (TB). The schools authorities have send letters to the families of the children informing about the imminent screening program of tuberculosis (TB).

Tuberculosis (TB) is a contagious bacterial infection that mainly attacks the lungs and can prove to be fatal, if remains undetected for a long time. Though the news struck hard, to many of the students, they understand the need of the screening process to cure tuberculosis (TB).

Dr. Marcia Johnson with Alberta Health Services reportedly claimed that every other person should be aware of the possible treatment to combat the deadly tuberculosis (TB).Further, Johnson informed about the strenuous process of discovering the tuberculosis (TB) as it has the potential of staying in the human body for a long time.

In the wake of rising concern among the families of the students, health experts have been roped in by the school authorities to conduct a full fledge screening program to diagnose tuberculosis (TB).

Health officials have given a tentative time of eight to ten weeks to track down the disease and assured of appropriate medication to curb the spread of disease.

Plan chalked out to control TB treatment default rate

http://app.com.pk

The ministry of health has planned to address concerning issue of treatment compliance and default rate of tuberculosis through community involvement and strengthening drug management.According to an official of National TB Control Programme, the ministry has made a comprehensive plan to control the disease default rate which is currently reported as 11%.

He said under the plan Lady Health Workers will be given tasks besides expanding public and private support and increasing awareness among general public through advocacy.

He added the ministry is strengthening Smear Microscopy while logistic arrangements are being made for monitoring and supervision at national and provincial levels.

He said steps will be taken to strengthen and support the availability of TB drugs besides surveillance, monitoring and evaluation of the disease.

He said the ministry will also strengthen lab network trainings, procurement and installation of hardware equipment, operationalize quality control arrangements in districts, supervising and monitoring the lab network and strengthening of selected private sector laboratories.
The official said more than 700,000 TB patients have been treated free of cost and 100% DOTS coverage is achieved. He added training and health education material have also been developed.

He said some major steps have already been taken by the ministry including training of concerned health care providers, setting up of 982 microscopy centres for diagnosis of TB, ensuring availability of relevant drugs free of cost from public resources.
He added external quality assurance for sputum microscopy is implemented in 40 districts, adding, five reference laboratories have been established included one in federal capital and one each at provincial level.

The official said since June 2005, all the districts through public sector health facilities are providing quality and free of cost TB care services.

He said the National TB Control Programme has been integrated with the primary health care systems so that health facilities are present close to patients' dwellings and are well equipped with TB DOTS services.

He added Lady Health Workers and community volunteers are giving supervised treatment at the grassroots level. He added public private partnership has also initiated with NGOs and general practitioners.

He said tuberculosis is a major public health problem in Pakistan and the country ranks 6th globally among the 22 high disease burden countries, and contributes 43% of the disease burden towards the Eastern-Mediterranean region of World Health Organization.

He said presently case detection rate of disease is 80% while treatment success rate is 87%. He said incidence of TB is reported as 181 per 100,000 population while treatment success rate is 85%.