News2009

The All Party Parliamentary Group on Global TB, British Thoracic Society (BTS), Royal College of Nursing (RCN) and TB Alert today launched the results of the second national audit of English PCTs. The survey sought to assess local priority of TB and looked at the level of progress since the first survey in 2007.

Results show that progress has been made but that there is still much to do in ensuring the repsonse to TB in England is adequate. Recommendations of the report include the need to include TB patients and patient advocates in service planning and delivery and closer working relationships between PCTs and Local Authorities. The report was launched at the BTS Winter Conference.

Click on the title to open the full report in PDF format;

"Tackling tuberculosis in England: the PCT response to the challenge. Second National Tuberculosis Survey of English Primary Care Trusts"

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(04/11/09) Sad news at the death of Sir John Crofton

Our founder and Honorary President Sir John died peacefully at home yesterday at the age of 97.

Emeritus Professor of Respiratory Diseases and Tuberculosis, University of Edinburgh Sir John Crofton was knighted in 1977 for his contributions to TB control.

On return from the battlefield hospitals of World War Two, Sir John was at the sharp end of Scotland’s post-war tuberculosis epidemic when he was put in charge of 400 TB hospital beds in Edinburgh. It was this work that led him to a series of discoveries about the disease. Sir John led the team responsible for bringing TB under control in only 6 years – 1/3 of the time predicted. This was the first demonstration of mass control of TB, and crucially, Sir John and his research team made the breakthrough that a combination of three separate antibiotics was required to combat the killer condition. This multi-drug regimen (which became known as the “Edinburgh method”) is now used to fight TB worldwide, and has since saved millions of lives.

An indefatigable pioneer and international physician, Sir John has been a leader in the work of the World Health Organisation (WHO) and other international bodies, a celebrated author and an influential teacher.

The International Union Against Tuberculosis and Lung Disease (IUATLD) awarded Sir John the organisation’s highest award, The Union Medal, which recognises outstanding contributions to the control of tuberculosis and lung disease, on October 19th 2005.

Never one to slow down, almost to the very end of his life Sir John continued as an inspiring worker in the field of tuberculosis and tobacco control, and fundraising tirelessly on behalf of TB Alert.

To the staff and trustees of TB Alert he has been an inspiration throughout the 10 years of our charity's existence, greatly admired and respected. He will be sadly missed.

Sir John's funeral will be held in Edinburgh on Tuesday 10th November. His family have requested no flowers, but donations if wished, to TB Alert.

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In his own words
"Confessional" - an amusing look back at his early career by Sir John - published in A 1992 Edition of Thorax

Tributes and obituaries:
Read a tribute to Sir John from the Stop TB Partnership
Article in the Herald
Article in news.scotsman.com
BBC News Scotland article
Obituary in the Independent by Tam Dalyell
Comment from The Royal College of Physicians, Edinburgh

Early Day Motion in Parliament 4/11/09:
"That this House mourns the sad loss of tuberculosis (TB) pioneer Sir John Crofton who died on 3 November 2009, aged 97; recognises his outstanding contribution to the control of TB during his lifetime with his work in the field helping to cure over 10 million people of the disease worldwide; notes that Sir John was awarded the Union Medal, the highest honour awarded by the International Union against TB and Lung Diseases for his groundbreaking work; and sends condolences to the friends and family of Sir John who will no doubt be very proud of a remarkable man."

Motions in the Scottish Parliament 4/11/09:
S3M-5135 Dr Richard Simpson: Sir John Crofton—That the Parliament is united in sadness at the death of Sir John Crofton and considers that Scotland has lost one of its most inspirational health pioneers; further notes his many achievements, such as the development of a new and effective way of treating tuberculosis (TB) in the 1950s that reduced TB in Edinburgh to almost zero in six years; commends his contribution to raising awareness about the harm caused to public health by tobacco, arguing for policies to control smoking and tobacco and calling for smoke-free legislation long before it became law in Scotland, knowing the important contribution that it would make to future public health; recognises the pivotal role that Sir John and his wife, Dr Eileen Crofton, also played in founding ASH Scotland in 1973 and believes that the ban on smoking in public places implemented by the previous Scottish Executive is a fitting tribute to his lifetime work, and welcomes the launch, earlier this year, of the Crofton Award by the Royal Environmental Health Institute of Scotland in partnership with ASH Scotland to recognise the achievements of young people in reducing tobacco and smoking-related harm in Scotland and in honour of Sir John and Lady Eileen Crofton’s tireless work over the decades on tobacco control.

S3M-5130 Shirley-Anne Somerville: Sir John Crofton—That the Parliament notes with sadness the passing of health pioneer Sir John Crofton, who died on Tuesday 3 November 2009 in Edinburgh, aged 97; highlights Sir John’s inspirational health career that included his development of a new and effective way of treating tuberculosis (TB) in the 1950s and the reduction of TB in Edinburgh to almost zero in six years with his groundbreaking and revolutionary Edinburgh method of treatment with a combination of drugs; further notes that his work led to the mass BCG vaccination that reduced TB in Britain from 50,000 recorded cases in the 1950s to just 5,500 in 1987; acknowledges that Sir John spent much of his life fighting to raise awareness about the harm caused to public health by tobacco and called for smoke-free legislation long before it became law in Scotland, and notes that Sir John and his wife, Dr Eileen Crofton, played a pivotal role in founding the tobacco control charity, ASH Scotland, in 1973 and that a Crofton Award was recently launched by ASH Scotland and the Royal Environmental Health Institute of Scotland, recognising the achievements of young people in reducing tobacco and smoking-related harm in Scotland.

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(19/10/09) Oxford Immunotec launches new Medical Information website

Diagnostics company Oxford Immunotec today launched a new website intended for Respiratory Physicians and other healthcare workers involved in the management of TB. The site covers various aspects of TB, including pathogenesis, diagnosis and management. The site can be found at www.learntb.com
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(02/10/09) TB Survival Prize 2009 - call for nominations

The Tuberculosis Survival Project is seeking nominations for innovation in TB/MDR-TB Advocacy and social mobilisation. An award of $2000 will go to the winner. For more information click here.
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(17/09/09) Revolutionary discovery to beat TB

Researchers in the US have discovered a way to disable a key protein complex in the TB bacterium and kill the organism - raising the possibility of new TB drugs. Click here for the science ...
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(28/08/09) Smoking increases TB risk

Smokers are twice as likely to develop active tuberculosis (TB) compared to people who have never smoked, according to the American Journal of Respiratory and Critical Care Medicine, prompting a call for policymakers to be tougher on smoking.

One thirds of the world’s population is infected with TB, but 90 percent of these remain latent infections. The remaining 10 percent develop active TB at some point in their lives because of weak immune systems. For example, many people who are infected with HIV/AIDS fall sick and die from TB. TB continues to be a leading cause of death in the world. There were 9.3 million new cases of TB in 2007 and 1.8 million deaths. The World Health Organization aims to bring the incidence of TB down to one case per million each year by 2050.

Researchers studied 17,699 participants above 12 years of age in Taiwan to investigate the association between tobacco smoking and active tuberculosis in the general population. The participants were followed for three years. Out of 17,699 participants, 3,893 were current smokers, 552 were former smokers and 13,254 had never smoked. Data regarding the sex, age, living in a crowded home, household income, marital status, alcohol use and employment of participants was also collected.

Fifty-seven new cases of active TB were diagnosed at the end of the three-year follow-up. It was found that current smokers had a higher risk of developing active TB. Current smokers had a two-fold higher risk of active TB compared with those who had never smoked, and 17 percent of active TB cases in this population were due to smoking.

The researchers concluded that smokers have an impaired ability to fight infections, such as TB, and suggested policymakers and public health personnel to consider addressing tobacco cessation as part of tuberculosis control.

As reported by Doctor N.DTV.

Relevant websites:
American Journal of Respiratory and Critical Care Medicine

Other reports on this topic:
Ivanhoe - Smoking Increases TB Risk
id: 280809Smoking

(24/08/09) WHO warns against homeopathic treatments for serious illnesses such as HIV and TB

The WHO has warned that people with conditions such as HIV, tuberculosis and malaria should not rely on homeopathic treatments.

The agency was responding to a June letter (full text available here), in which researchers from the Voice of Young Science Network called on the agency "to condemn the promotion of homeopathy for treating TB, infant diarrhoea, influenza, malaria and HIV."

The group, which is part of the Sense About Science organisation that advocates for "evidence-based" care, has conveyed the WHO's views in a letter to health ministers, according to the BBC.

According to a Sense About Science release, the organizations received comments from five WHO officials, which "clearly express WHO's position". Mario Raviglione, director of the Stop TB department at the WHO, said, "Our evidence-based WHO TB treatment management guidelines, as well as the International Standards of Tuberculosis Care do not recommend use of homeopathy."

In addition, a spokesman for the WHO department of child and adolescent health and development said of treating diarrhea in children: "We have found no evidence to date that homeopathy would bring any benefit," the BBC writes.

The release includes additional comments from the associate director of WHO's global malaria program, the HIV/AIDS department interim director and others.

Robert Hagan, a researcher in biomolecular science at the University of St. Andrews and a member of Voice of Young Science Network, said, "We need governments around the world to recognise the dangers of promoting homeopathy for life-threatening illnesses. We hope that by raising awareness of the WHO's position on homeopathy we will be supporting those people who are taking a stand against these potentially disastrous practices," BBC writes.

As reported by The Medical News.

Relevant websites:
World Health Organisation (WHO)
Sense About Science

Other reports on this topic:
BBC - Homeopathy not a cure, says WHO
Press TV - WHO rejects homeopathy for serious diseases

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(06/08/09) Help TB Alert support Patients like Natalie

Dear Supporter

When patients need a little help...

TB treatment lasts 6 months and completing the full course of medication is vital in order to avoid drug resistance (which is harder to treat and more likely to be fatal). But despite the fact that TB treatment is free, through no fault of their own, patients often find it difficult to complete their treatment. Extra travel costs can mount up, good nutrition is vital to aid recovery but not always easy on a limited budget, and just keeping in touch with the nurse can be difficult for a patient who doesn’t have a phone at home.

TB Alert’s UK Patient Support fund is there to help. By making grants of anything from £50 to £500, we provide a safety net to enable TB nurses and key workers to support patients through their treatment – making a small but meaningful difference to the patient and helping them to stay on track.

A thank you from Natalie

Natalie, who received help from the Patient Support Fund was so grateful that she asked us to tell her story - click here to read it now. Natalie is better now and wants to make sure more people like her have the chance of help when they need it most.

Please help make sure we don’t have to say "no"

TB can affect absolutely anyone, but it’s more likely to hit those who are already disadvantaged in society, and for some people it can really mean the difference between just about managing or struggling financially. In 2008 we helped 78 UK patients with grants averaging £130 each. Sadly in today’s economic climate more people are finding things tough and we are already seeing a marked increase in applications to our Patient Support fund.

Our Patient Support Fund is an essential part of the fight against TB in this country. Together with our telephone advice line and patient information leaflets it complements the excellent work done by TB services. We want to continue and expand the support we can provide - please help us if you can with a donation towards this work over the next year - just click here to donate now.

Yours sincerely

Mike Mandelbaum
Chief Executive

PS. A small gift can go a long way for someone in need who may just need help for a few weeks before their benefits come through. Anything you can donate would be gratefully received. Click here if you would like to donate to our appeal.

id: 060809psf

(30/07/09) Letter to European Health Ministers

The European Commission, the European Centre for Disease Prevention and Control and the World Health Organisation (WHO) co-hosted a meeting on tuberculosis in Luxemburg on 30 June – 1 July 2009. The purpose of this meeting was to follow up on the Berlin Declaration on Tuberculosis, which was adopted at the European Ministerial Forum on Tuberculosis in 2007.

Fifteen out of the 27 high-burden MDR-TB countries are within the WHO’s European region (which includes East European and Central Asian countries). TB Alert joined with a group of civil society organisations, co-ordinated by Global Health Advocates, to present a letter to the meeting (PDF File) urging European Ministers of health to raise the standards of care and response to fight TB at national level. The letter requested that special efforts are made to address multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB and better integrate TB and HIV/AIDS interventions

Many participants expressed disappointment at the negligible progress on commitments set forth in the Berlin Declaration, but our organisations will continue advocating for more progress on the TB response in Europe as we laid our in our letter (PDF File). If you represent a health-related non-governmental organisation and would like to get involved in this campaign, you can contact Charlotte Goyon at Global Health Advocates.

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(25/07/09) TB Alert on the fourth plinth

On Saturday July 25th at just after 6am TB Alert supporter Simon Sweetman wore his TB Alert T-shirt on the fourth plinth as part of Anthony Gormley's One and Other "live artwork" exhibition in Trafalgar Square. Simon, who described himself for the project as "Socialist, writer, and Grandpa", told his "life in T-shirts" during his hour on the plinth. If you would like to see Simon's hour on webcam, click here.

We'd love to have another TB Alert "plinther" - and if you are reading this before 1st September there is still time to apply! Just go to the One and Other website and sign up. The last draw takes place on 1st September for places for October. If you get a place you will of course receive a TB Alert T-shirt, and we will happily send you some other TB Alert gifts including a TB Alert water bottle to keep you hydrated up there!
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(09/07/09) Call for national minimum standards for TB care in the UK

The All-Party Parliamentary Group on Global Tuberculosis has called for the introduction of national minimum standards for TB care in the UK.

The report, published jointly with the British Thoracic Society and the RCN, concludes that while much progress has been made in the fight against TB more needs to be done if the increase in UK cases is to be reversed.

The report highlighted variations in service provision across the country, with national clinical guidance and policy being implemented more effectively in some areas than in others.

It concludes that national minimum standards would ensure that PCTs and service providers were held to account over care for TB patients and ensure consistency in TB care across the country.

Julie Morgan MP, co-chair of the group, said: ‘Whilst I am pleased with the advances that have been made in TB services over the past two years, this report shows that there is evidently much work left to do in ensuring that the care received by TB patients is first class.’

RCN general secretary Peter Carter added: ‘There is an urgent need to introduce national minimum standards to prevent TB becoming an even greater problem in the UK in the future.’

As reported by Steve Ford for the Nursing Times.
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(03/07/09) Global Fund says faces about $3 bln aid shortfall

GENEVA, July 3 (Reuters) - The Global Fund to Fight AIDS, Tuberculosis and Malaria is facing a budget hole of about $3 billion as the recession dries up foreign aid, the Geneva-based funding body said on Friday.

Spokeswoman Marcela Rojo said that $170 million is still needed to pay for the programmes the Global Fund committed to supporting last year, and it will need $2.5 billion to $3 billion to maintain and finance programmes planned for 2010.

"The Global Fund will need a substantially higher amount than the one pledged at the last replenishment in Berlin in 2007 ($10 billion)," she told Reuters, saying fundraising drives in 2010 "will be absolutely critical".

"The decisions that are made in the next 18 months will be critical for sustaining the gains achieved in global health so far and further scaling up programmes," Rojo said.

The United States -- whose economy has contracted sharply following last year's credit crunch and which has funnelled public funds into bailing out banks -- is the largest donor supporting public health programmes through the Global Fund.

Washington has pledged more than $4.4 billion since the body was created in 2002 to tackle the three deadly epidemics.

Japan, another major aid provider whose economy has faltered in the global downturn, has given more than $1 billion to date.

Question marks over funding for the Global Fund's long-term programmes may raise public health threats, because patients receiving AIDS and tuberculosis drugs need to keep taking the treatment to avoid developing resistance to it.

The body, which works with United Nations agencies and also raises money through the sale of computers, clothing and retail goods with the product (RED) label, has approved $15.6 billion in funding in 140 countries to date. It has disbursed nearly $8 billion so far.

As of the end of last year, it had provided AIDS treatment to 2 million people and tuberculosis treatment to 4.6 million people, and distributed 70 million insecticide-treated bed nets worldwide to prevent malaria infections.

Earlier this week, the head of the United Nations agency UNAIDS Michel Sidibe called on donor countries to maintain their commitments to help the 33.2 million people worldwide infected with HIV, the virus that leads to AIDS.

He estimated that the Global Fund was running $4 billion short of the amount it needed to fund AIDS projects it was already running or had committed to financing. (Editing by Louise Ireland and Stephanie Nebehay)

Information taken frm Reuters USA: http//www.reuters.com

See all stories on this topic

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(03/07/09) Parkinsons drugs may thwart treatment-resistant strain, study finds

FRIDAY, July 3 (HealthDay News) -- Extreme drug-resistant tuberculosis might someday meet its match in two drugs now used to treat Parkinson's disease, suggests a new study.

Researchers, led by a team from the University of California, San Diego, report in the July 3 issue of PLoS Computational Biology that commercially available entacapone and tolcapone have the potential to treat the difficult-to-kill strain of TB.

The discovery was made after a computational analysis that found the chemical structure of the two Parkinson's drugs might work to thwart the TB enzyme InhA, which previous research had determined to be a prime target in treating the disease. A subsequent lab experiment found that the active ingredient in the two drugs inhibited the M. tuberculosis bacterium without being deadly to its host cells.

"We have computational and experimental data to support this [drug] repositioning," principle investigator Philip E. Bourne, a professor of pharmacology at the university's Skaggs School of Pharmacy and Pharmaceutical Sciences, said in a university news release. "Here we have drugs that are known to be safe and with suitable binding properties which can be further optimized to treat a completely different condition."

About 2 million people each year die from extreme drug-resistant tuberculosis, which poses a worldwide threat.

The study's lead author, graduate student Sarah L. Kinnings, said the lab experiment was just a step in the long process of possibly creating a new TB treatment.

"Given the continuing emergence of M. tuberculosis strains that are resistant to all existing, affordable drug treatments, the development of novel, effective and inexpensive drugs is an urgent priority," she said in the news release.

Information from Forbes-NY, USA http//www.frobes.com

More information:

The U.S. Centers for Disease Control and Prevention has more about tuberculosis

See all stories on this topic

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(01/07/09) Why people living with HIV are vulnerable to TB

In their study paper, a team of researchers led by Dr. Naimish Patel have described how HIV switches off the immune response to Mycobacterium tuberculosis.

The researchers have detailed how HIV interferes with the cellular and molecular mechanisms used by the lungs to fight TB infection.

With this discovery, the researchers have taken an important first step toward the development of new treatments to help people with HIV to prevent or recover from TB infection.

"HIV/TB co-infection is a critical global health problem , especially in developing countries. We hope that these findings will lead to further studies and possible new therapies for treating or preventing tuberculosis in HIV disease," said Patel.

For their study, the researchers extracted immune cells called "alveolar macrophages" from the lungs of otherwise healthy, asymptomatic HIV-positive patients as well as from people who did not have HIV.

In people who are HIV-positive, the macrophages have a decreased response to the TB bacterium when compared to people who did not have HIV.

To know why this happens, the scientists examined lung specimens from the HIV-positive patients, and found increased levels of a molecule called IL-10.

IL-10 elevated the amount of a protein called "BCL-3" in alveolar macrophages, which in turn reduced their ability to ward off TB infection.

"HIV and TB represent two of the most significant health challenges in human history and the combination of the two infections is particularly devastating because HIV dramatically increases the severity of TB infection," said Dr. John Wherry, Deputy Editor of the Journal of Leukocyte Biology.

He added: "There are still many unknowns about how HIV reduces the ability of the body to combat other infections. This study sheds light on co-infection with HIV and TB, which up to this point, has perplexed scientists and physicians alike."

The study has been published in the Journal of Leukocyte Biology.

See all stories on this topic

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(01/07/09) WHO Paper : TB vaccine could kill babies with HIV

GENEVA (AP) — The World Health Organization says a study has shown that babies with HIV could die if given a standard tuberculosis vaccine.

WHO says a three-year study in South Africa found babies born with HIV had a higher risk of contracting a deadly form of TB if given the widely used BCG vaccine.

The study recommends not vaccinating babies with HIV and delaying vaccination for those babies whose HIV status is unknown.

The study was published Wednesday in the journal Bulletin of the World Health Organization.

On the net:
http://www.who.int/bulletin/volumes/87/7/08-055657.pdf

See all stories on this topic

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(01/07/09) Remembering Seonai - TB Activist and Journalist

TB Activist and journalist, Seonai Gordon, died on Tuesday 23rd June at 20.15 in Martletts Hospice, Hove, of Bronchiectasis (a lung condition which can occur when the lungs are severely damaged by TB or other diseases).

Seonai, 47, had TB twice and chronicled her thoughts about TB and life in a diary on the TB Survival Project website. Described by her friends as great fun, with a wicked sense of humour, Seonai leaves behind many loved ones, including her 14 year old son, Ziyo. TB Alert came into contact with Seonai four years ago when she called our advice line, and throughout her illness she worked as a TB advocate with TB Alert and the TB Survival Project to raise awareness of the disease and support people going through it.She will be greatly missed by members of the staff here who came to know her as a close friend.

Read an article in the Brighton and Hove Argus from 2008: http://www.theargus.co.uk/search/2373062.Living_with_an_invisible_enemy/

Seonai became ill with TB first in 1999 whilst working for the Glasgow Herald, and fully recovered. In 2004 while living and working as a journalist in Thailand, she became very ill again and deteriorated over a period of 18 months. Her doctor didnt suggest TB and she didn't know you could get it twice. By the time she was diagnosed and moved back to the UK the disease was very advanced – she had only 25% lung function. By 2008 it was deemed that her condition was inoperable, due to the Bronchiectasis – doctors felt she was likely to bleed to death on the operating table.

For the last few months of her life, Seonai was in a wheelchair and on a permanent oxygen line which was installed at her home. She spent the last weeks of her life in Martletts and died peacefully in her sleep. Tina Harrison of TB Alert who was Seonai’s first contact with the organisation and had become a close friend said of Seonai "She brought so much into my life and was an inspiring woman".

An online obituary has been published in the Phuketwan Press.

A website has been set up in Seonai's memory. Please visit the site if you would like to share your memories, thoughts or photos of Seonai, or to read the thoughts shared by others.

Seonai's death could have been prevented if she had been diagnosed sooner before the TB did permanent damage to her lungs. Seonai’s friends hope to make her story widely known to try and prevent others going through what she did. Our thoughts are with her friends and family.
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(19/06/09) HIV positive speaker denied entry to Seattle Health Conference

As global health leaders from around the world met in Seattle for the first day of the Pacific Health Summit 2009, one speaker was notably absent.

Paul Thorn, a British activist scheduled to speak today, said he was denied a U.S. visa because he is HIV positive. Thorn, project director of The Tuberculosis Survival Project, was scheduled as to participate in a discussion about the TB battle from the front lines.

The summit focuses on tuberculosis this year, drawing top global experts from government health authorities, research institutions, NGOs, pharmaceutical companies and private foundations.

In a written statement read aloud during that discussion, Thorn apologized for his absence and expressed his disappointment.

"The U.S. government actively discriminates against people who have been tested for the HIV virus and have been diagnosed HIV-positive," he said in the statement read by Lucy Chesire of the Kenya AIDS NGO Consortium.

Thorn said his application was turned down despite the interventions of Senator Patty Murray and Congressman Jim McDermott and appeals to the U.S. Consulate in London.

The U.S. policy gives people two choices: to lie on the application, committing a felony, or to be honest and have the visa rejected "because you are considered an undesirable person and unfit to enter the U.S.," Thorn said.

"I don't want to be either, but being an undesirable seemed like the lesser of the two evils, so I decided to be honest."

Thorn said the policy is wrong because many people who are unknowingly HIV-positive enter the U.S. every year. "The U.S. ban on people with the HIV virus entering the U.S. is one more reason why someone who believes that they may be HIV positive would just rather not know, putting themselves and others at risk of ill health and possibly an early grave."

If the U.S. wants to demonstrate leadership on HIV/AIDS and global health, through hosting such international health conferences, "then they need to accept that non-U.S. citizens with HIV are going to need to be there and participate."

He called on the Obama Administration to change it and others to keep up pressure to that aim. Here is a more in-depth analysis of that policy.

"I think it's outdated," said Darryl Johnson, a retired U.S. ambassador participating in the health summit. Johnson added, though, that he didn't understand why Thorn would not have been granted a waiver.

Thorn created the TB support project after fighting HIV and multi-drug resistant tuberculosis himself. He has been free of TB for more than 12 years after undergoing treatment lasting three years, Thorn said in this interview. He was infected with TB from a nearby patient during a hospital stay in the early 1990s

(Update: Thorn confirmed in an email message to me June 19: the rejection "wasn't because I had MDR-TB, that was back in 1995 and has been cured. The visa waiver form also specifically asks if the TB is active or not. I was rejected on the visa waiver because I had to tick yes to having a communicable disease as I am HIV-positive.)

One of the key topics for the Seattle conference is the deadly combination of tuberculosis and HIV/AIDS. People with HIV are more susceptible to developing TB, and TB is the leading cause of death among people with HIV/AIDS. In fact, cases of co-infection are as high as 70 percent in some countries. A mutated version of TB that resists most antibiotics spreads most quickly among people with weakened immune systems.

Many deaths could be prevented right now by merging the two forms of diagnosis and treatment, which remain separate in most countries, said Laurie Garrett, senior fellow for global health at the Council on Foreign Relations.

"Shame! Shame! Shame!" Garrett scolded health leaders at a conference kick off dinner Tuesday night.

Tests should be worked up for both diseases "regularly, in the same place by the same people," she said. Instead, they are handled by different departments, with many cases falling through the cracks, and patients spreading TB in waiting rooms when they pick up their HIV medicines. The two diseases are much more destructive together than alone.

Tuberculosis is the number one killer of people with HIV in Africa. In Lesotho, 70 percent of TB cases are co-infection with HIV/AIDS. More coverage on that is here.

If TB diagnosis and treatment were integrated with HIV/AIDS, that alone could make more difference than all "these new drugs you're talking about," Garrett said.

In the Global Fund to Fight AIDS, Tuberculosis and Malaria, most grants go to one designated disease or the other, she said, and the U.S. President's Emergency Plan for AIDS
Relief (PEPFAR) does not adequately fund or track TB.
"How is it morally acceptable for American taxpayers to fund one disease and allow another to run rampant and kill the people they were trying to save with the funding?" Garrett asked.

Leading disease experts from the Center for Global Health Policy will call on President Obama and Congress to mount a concerted and comprehensive response to the deadly combination of HIV/AIDS and TB at a Congressional briefing on June 25.

As reported by the Seattle Times.nwsource.com

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(15/06/09) South African AIDS Advocate Who Created Radio Diaries Dies Of Drug-Resistant TB

South African AIDS activist Thembi Ngubane recently died of drug-resistant tuberculosis at the age of 24, the AP/Washington Post reports (Nullis, AP/Washington Post, 6/14). According to the Wall Street Journal, "millions of radio listeners around the world" heard Ngubane's voice in "Thembi's AIDS Diary," which was broadcast in English in 2006 on National Public Radio in the U.S., and then in the U.K., Australia, Canada and South Africa (Miller, Wall Street Journal, 6/13).

Joe Richman, who produced the diaries, said Ngubane's TB was diagnosed too late to save her life. "Ngubane was 19 when she was given a tape recorder to make an audio diary about living with HIV in a country where nearly one-third of young women are infected with the virus. Few families have been left unscathed by the epidemic and yet the stigma remains so strong that many people are too scared to tell even their closest family and friends," the AP/Washington Post writes (AP/Washington Post, 6/14).

The diary was translated from English into Zulu and Ngubane's first language – Xhosa. "She became a celebrity for defying the stigma the disease still carries in much of South African society," according to the Wall Street Journal. According to statistics from the U.N. and the South African government, more than five million people in South Africa are HIV-positive, including almost 30 percent of pregnant mothers. "Ngubane put a human face on those demographics," the Wall Street Journal writes (Wall Street Journal, 6/13).

Ngubane, who carried her tape recorder for more than a year and recorded her first conversation with her mother about AIDS, said, "Our parents struggled against apartheid, they wanted to be free. And it is the same with HIV/AIDS. This is the new struggle." Ngubane said that finding "the courage to speak out in South Africa is the most important thing I have done" (AP/Washington Post, 6/14).

BBC has an extract from one of Ngubane's diary broadcasts and an audio interview with Richman (BBC, 6/12).

Richman's reporting was supported by a 2003 Kaiser Family Foundation Media Fellowship. KFF interviewed Richman about the project. The audio interview and transcript are available here. The original NPR story is available here.

This article is been taken from The Kaiser Daily Global Health Policy Report which is published by the Kaiser Family Foundation.

http://globalhealth.kff.org/Daily-Reports/2009/June/15/GH-061509-Ngubane.aspx

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(15/06/09) Obama Pledges $73M To Zimbabwe

Following talks with Zimbabwean Prime Minister Morgan Tsvangirai at the White House Friday, President Obama pledged $73 million in aid to the country, AFP/Google.com reports (Carmichael, AFP/Google.com, 6/13). The U.S. aid, however "will not be going to the government directly because we continue to be concerned about consolidating democracy, human rights and rule of law," Obama said (Stolberg, New York Times, 6/13), but channeled through appropriate aid agencies (ZimOnline, 6/15).

"The president, President Mugabe, I think I've made my views clear, has not acted, oftentimes, in the best interests of the Zimbabwean people and has been resistant to the kinds of democratic changes that need to take place," Obama said. Regardless, "[t]he people of Zimbabwe need very concrete things: schools that are reopened, a health-care-delivery system that can deal with issues like cholera or HIV/AIDS, an agricultural system that is able to feed its people," he said (Fletcher, "44," Washington Post, 6/12).

"Of course we need billions of dollars, but as far as we are concerned, this is the step in the right direction," Tsvangirai told reporters after meeting with Obama, adding, "It is an endorsement of confidence in the process. It is an appreciation that whatever we do to improve our conditions must be rewarded because that is how you consolidate the process" (AFP/Google.com, 6/13). During a meeting between Tsvangirai and Secretary of State Hillary Clinton Thursday, Clinton said she wants "to look for ways that [the U.S.] appropriately can be supportive" after acknowledging the steps Tsvangirai's government was making "to move Zimbabwe forward into a better future" (Carmichael, AFP/Google.com, 6/12).

Tsvangirai will travel this week to "Germany, France and other European countries to continue diplomatic re-engagement and make the case for transitional support to Harare," VOA News reports (Zulu, VOA News, 6/12).

This article has been taken from Kaiser Family Foundation, http://globalhealth.kff.org/Daily-Reports/2009/June/15/GH-061509-Zimbabwe-Aid.aspx

id: 170609obamazimbabwe

(04/06/09) Experimental Drug Five Times More Effective Against MDR-TB

A Johnson & Johnson-run study found that its experimental drug TMC207 could make conventional tuberculosis treatment five times more effective against multi-drug resistant TB (MDR-TB) because it cleared traces of the TB bacteria in the sputum of 48 percent of study volunteers after eight weeks, Reuters reports (Emery, Reuters, 6/3). The results were published on Wednesday in the New England Journal of Medicine.

TMC207 was tested in a Phase 2 trial of 47 South African patients with newly diagnosed MDR-TB, the Dow Jones Newswires/Wall Street Journal reports. "About half received TMC207 and the rest received a fake drug for about eight weeks; all patients took a standard regimen of five existing TB drugs. A higher proportion of patients who received TMC207 tested negative for TB in lung-fluid cultures at eight weeks than the placebo, 48 percent versus 9 percent," the Dow Jones Newswires/Wall Street Journal reports (Loftus, Dow Jones Newswires/Wall Street Journal, 6/3).

According to Reuters, TMC207 is "being billed as the first new TB drug in 40 years." David McNeeley of Tibotec Inc., the subsidiary of Johnson & Johnson that developed the drug, said that TMC207 differs from other TB drugs because it "starves" the bacteria. "It's like cutting off your food supply," he said (Reuters, 6/3).

In a related NEJM editorial, Clifton Barry of the National Institute of Allergy and Infectious Diseases, writes that the development of TMC207 "represents an important advance in the chemotherapy of TB" and outlines three reasons why. According to Barry, "It is also a humbling case study that is worth some reflection," for those in the "tuberculosis field [who] turned up our noses at looking for compounds that killed anything less than the real human pathogen" (Barry, NEJM, 6/4).

NEJM published a second study that "describes an international effort to detect" TB in immigrants and refugees that come to the U.S., HealthDay News/Forbes reports. "The TB rate in [foreign-born individuals] is 9.8 times higher than among U.S.-born individuals – 20.6 cases per 100,000 people versus 2.1 per 100,000 people for the native-born. Nearly 58 percent of the new TB cases in the United States in 2007 were diagnosed in the foreign-born group," according to HealthDay News/Forbes (HealthDay News/Forbes, 6/3).

As reported by the Kaiser Family Foundation at www.globalhealth.kff.org

Further details can be found on the New England Journal of Medicine.

id: 230609experimental

(27/05/09) TB Alliance Announces Four Drug Discovery Collaborations

Early-Stage Research Partnerships Aim to Stock Tuberculosis Drug Pipeline

The Global Alliance for TB Drug Development (TB Alliance), a not-for-profit product development partnership accelerating the discovery and development of new drugs to fight tuberculosis (TB), announced today, at the 2009 Global Health Council Conference, that four drug discovery collaboration agreements have been signed. All four projects have the potential to generate compounds active against drug-resistant tuberculosis and show promise to advance the science of TB drug development.

"These partnerships show that the TB Alliance is aggressively increasing the depth and strength of its portfolio to ensure that promising new TB drug candidates continue moving toward the clinic," said Dr. Mel Spigelman, CEO of the TB Alliance. "Tuberculosis is responsible for the death of one person approximately every 20 seconds — and there is a significant need for novel medications to combat growing bacterial resistance to current drugs and to reduce the duration and complexity of therapy."

These recent discovery partnerships include programs with:

Anacor Pharmaceuticals, a biopharmaceutical company developing small-molecule therapeutics derived from its boron chemistry platform, to explore a novel anti-bacterial drug target for use in tuberculosis therapy. Under the agreement, Anacor will provide the TB Alliance with a non-exclusive, royalty-free worldwide license for any compounds ultimately registered for a TB indication. Compounds that attack novel targets have the potential to be effective against drug-resistant disease.

Colorado State University to test whether inhibition of menaquinone biosynthesis — a key component of the energy generation system in M. tuberculosis (M.tb) — has the potential to eradicate the disease in vivo. The compounds, first developed as cholesterol synthesis inhibitors, will be "retro-designed" via cycles of synthetic medicinal chemistry and evaluated as inhibitors of menaquinone biosynthesis and bacterial growth. The most promising compounds will be employed in an animal model of TB, and a more advanced discovery program could be developed if the studies are successful. Inhibition of menaquinone biosynthesis is a novel approach and therefore compounds that inhibit this process have the potential to be effective against drug-resistant disease.

Institute of Microbiology (IMCAS), a member institute of the Chinese Academy of Sciences, to discover and develop novel anti-TB agents from natural sources, including microbial metabolites and traditional Chinese medicines. IMCAS will test 24 natural product extracts with potential anti-tubercular activity and will collaborate to further test these extracts, purify and identify the active components, and develop those that prove most promising. The deficiency in natural product screening directly against M.tb combined with China's strong track record of successfully developing new drugs from traditional Chinese medicines, suggest that such screenings may yield novel active compounds, which would have the potential to be effective against drug-resistant disease.

New York Medical College to explore the type 1 topoisomerase (Topo 1) enzyme that facilitates the unwinding of DNA, which is required during normal cell processes. (The type II topoisomerase DNA gyrase is already a proven target for anti-tuberculosis therapy.) The goals of the Topo I program are to determine, using genetic techniques, whether inhibiting Topo I would kill tuberculosis bacteria, as for DNA gyrase, and to develop a method to identify Topo I inhibitors. Since bacterial Topo I is a new drug target, inhibitors that kill tuberculosis bacteria have potential for use against both drug sensitive and drug-resistant tuberculosis.

Every year, nearly 9 million people worldwide fall ill with TB and nearly 1.8 million people died from the disease in 2007 alone. It is estimated that the bacillus that causes TB infects one-third of the world's population, and the threat of drug-resistance is growing at an alarming rate. TB hits the some of the world’s most vulnerable populations and devastates whole families, villages and even whole nations. New, faster-acting, simpler drug regimens are critical to defeating this ancient disease. The TB Alliance is leading this global effort, discovering and developing new compounds and acting as a catalyst to encourage information sharing and coordinated efforts among all organizations involved in finding new treatments.

Useful wesites:

TB Alliance - tballiance.org

id: 270509TBAlliance

(28/04/09) Cepheid 2-hour TB test approved in Europe

Cepheid Inc. on Monday announced the release of Xpert in Europe for in vitro diagnostic medical devices, a test that can simultaneously identify mycobacterium tuberculosis and resistance to rifampicin, a common first-line drug for treatment of the disease.

Sunnyvale-based Cepheid (NASDAQ:CPHD) said the new test, developed in partnership with the Foundation for Innovative New Diagnostics, the University of Medicine and Dentistry of New Jersey, and funded by the National Institute of Allergy & Infectious Diseases, uses its GeneXpert System to deliver a diagnosis of the disease in less than two hours.

According to the World Health Organization, approximately two billion people are currently infected with MTB. An estimated nine million people develop active TB each year, and two million people lose their lives to the illness. This equates to one life every 20 seconds.

As reported by Business Journal.com

Related articles:
GenomeWeb Daily News

More info on the product Xpert MTB/RIF, using Cepheid's GeneXpert(R) System:
Newswire.co.uk
Cepheid.com

id: 2804092hrtest

(28/04/09) New Tuberculosis vaccine begins trial in South Africa

A new tuberculosis vaccine, which would be given alongside the vaccine already used against the disease (BCG), has begun a clinical trial in South Africa. Some 2750 children, who have already been given BCG at birth, will participate in the trial. The aim is to have the vaccine ready for use in public health programmes by 2016.

The new MVA85A vaccine is regarded as the most advanced of a new generation of preventive TB vaccines under development. Earlier trials have shown the vaccine to be safe. The new study, which will be conducted by the South African Tuberculosis Vaccine Initiative of the University of Cape Town, is described as a “Phase IIb proof-of-concept trial”. It is the first such trial of a TB vaccine for over 80 years.

MVA85A was originally developed at the University of Oxford by Dr Helen McShane, Dr Sarah Gilbert and Professor Adrian Hill, with funding from the Wellcome Trust. It was licensed to the Oxford-Emergent TB Consortium in July 2008. Now the Aeras Global TB Vaccine Foundation is working with the Consortium to develop MVA85A/AERAS-485, with further Wellcome support. It has been awarded orphan drug status by the European Medicines Agency.

Helen McShane said, “We believe this is the most exciting advance in the field of TB vaccines for over 80 years and is a testament to the commitment shown by the partners and funders involved. We have shown that this vaccine is safe and stimulates strong immune responses. This trial will hopefully show that the vaccine can protect people from getting TB and enable the global community to begin to control this devastating disease.”

Dr Jerald Sadoff, President and CEO of the Aeras Global TB Vaccine Foundation commented, “The search for a new TB vaccine is a complex and challenging process requiring a broad commitment, and we are pleased to be collaborating with so many dedicated and talented researchers on this important effort. There is still a long road ahead, but this marks an important milestone toward the goal of a more effective TB vaccine.”

“The world desperately needs new and better approaches to combat TB,” said Dr Marcos Espinal, Executive Secretary of the Stop TB Partnership. “The advancement of a new TB vaccine candidate to this stage is an exciting development for all of us who seek to end this terrible epidemic.”

Tuberculosis kills 1.8 million people per year and more than two billion people worldwide are infected with Mycobacterium tuberculosis – approximately one out of every three people on the planet. New vaccines are urgently needed as part of the global response to TB. Bacille Calmette-Guérin (BCG) is currently the only available vaccine against TB. Administered to infants throughout the developing world and in certain countries in the developed world, BCG provides some protection against paediatric TB. However, it only provides variable protection against pulmonary tuberculosis, which accounts for most of the worldwide disease burden.

As reported by Paul Chinnock for TropIKA.net

Read related articles:
BBC.co.uk
Physorg.com
Wellcome Trust
ASNS News

id: 280409Newvaccine

(01/04/09) Margaret's Fund - the new name for the Margaret de Sousa-Deiro Fund

Margaret's Fund (previously known as The Margaret de Sousa Deiro Fund) is a registered charity that provides financial assistance to women who are in need, and who are in ill health.

Margaret's Fund is a charitable trust founded in 1927 by Miss Anstace Howard in memory of the late Miss Margaret de Sousa-Deiro. The fund was originally intended "to provide or assist in providing treatment for indigent women suffering from early pulmonary tuberculosis". With the decline in the rate of TB though most of the 20th century, the objects of the Fund were extended by Orders of the Charity Commissioners, to help in the care, rehabilitation and after-care of women in financial need suffering from any disease. Since the UK has experienced an increase in TB cases from 1987, the Trustees now feel it appropriate to give renewed focus to the Fund's original purpose. Here at TB Alert we are very grateful to Margaret’s Fund for their continuing support of our Patient Support Fund for women with TB.

For all non-TB specific cases, caring professionals can apply directly to Margaret's Fund for grants for women in ill health.

More information about Margaret’s Fund can be found on their website, please visit it by clicking here.
id: 010409Margarets

(26/03/09) UN Chief calls for global co-operative in fighting TB

UN Secretary-General Ban Ki-moon Tuesday called on all countries in the world to work together and fight against tuberculosis (TB) amid the spreading financial crisis.

In a message marking World TB Day, Ban said although strides have been made on combating TB, the pace of the disease's decline is "far too slow," with the contagium still claiming a life every 20 seconds.

He underlined the need to prevent infection, to detect cases at an early stage and to provide treatment for all. Ban also stresses the importance of redoubling efforts to fight multi-drug-resistant (MDR-TB) and extensively drug-resistant (XDR-TB) forms of TB as well as the TB/HIV co-epidemic.

The secretary-general urged countries to "protect investments in global health, particularly to protect the most vulnerable" in this time of economic crisis.

"Global cooperation in fighting tuberculosis, and all the Millennium Development Goals (MDGs), must be essential to our task ahead," he said, calling for partnership and innovation to "prevent disease, save lives and enable communities to thrive."

According to the 2009 Global TB Control Report, released Tuesday by the World Health Organization (WHO), the total number of new cases in 2007 has stabilized, up to 9.27 million from 9.24 million the year before.

The report shows that one-quarter of all TB deaths are HIV-related, twice as many as previous recognized. In 2004, only 4 percent of TB patients in Africa were tested for HIV, but that has surged to 37 per cent in 2007. Some 1.37 million people living with HIV fell ill to TB around the world in 2007.

The secretary-general also welcomed the commitments made by governments, multilateral organizations, non-governmental organizations (NGOs), foundations, the private sector, academia and researchers to halt and reverse the spread of the disease and press ahead with efforts to reach the MDGs, eight anti-poverty targets with a 2015 deadline.

As reported by China View.

Relevant website and information:

The United Nations

Read the daily press briefing by the office of the spokesperson for the secretary-general for March 24th 2009 here.

Read Ban Ki-moon's message for World TB Day here.
id: 260309Bankimoon

(25/03/09) Interview with TB activist - Paul Thorn

As the international community marks World TB Day on 24 March, the International Federation of Red Cross and Red Crescent Societies (IFRC) is calling for more communication activities around tuberculosis, especially for those who are affected by stigma and discrimination among their own community.

Jean-Luc Martinage asked British TB activist Paul Thorn to explain why there is a need for more community-based support programmes such as the ones implemented by Red Cross and Red Crescent volunteers.

Why did you decide to advocate on behalf of people with TB?
I had already been working as an HIV activist for a peer-led organization a few years before developing multi drug-resistant tuberculosis (MDR-TB) in 1995. I was infected with MDR-TB whilst a patient on an HIV unit in a West London Hospital. It was the first outbreak of its kind in the UK and there was no protocol for dealing with the situation.
My main motivation to advocate for people with TB/MDR-TB is that the UK HIV community and non-governmental organizations (NGOs) panicked and cut me off from using their services and were ignorant about TB/MDR-TB and the impact that it has on people who are HIV-positive. They just didn't see it as their problem. I determined to try and change this.

What are the main problems TB patients need to face besides treatment itself?
The problems are that people with TB/MDR-TB primarily face stigma from society at large. The medication can make you feel very sick. Even looking at the tablets before I took them I was retching to be sick and sometimes was. Then there is the economic impact, not being able to work either for feeling too ill, or being fired from your job because of having the illness. The psychological impact can also be devastating and there seems to be little provision to help people through the mental and emotional aspects of having TB/MDR-TB.

What do you think can be done to improve conditions for people with TB? How are you helping them?
We must not think of people with TB/MDR-TB as statistics. They are all individuals who often have people who love them and care about them. It is a human problem and requires a compassionate human response. It is a tall order, but until the issues of world poverty, poor housing, hunger, universal access to medication for HIV (and indeed TB/MDR-TB) are properly addressed by all countries of the world then I worry about what impact we can really make.
I try to help other people with TB/MDR-TB by offering the hand of friendship. To make people with TB/MDR-TB aware that they are not alone, that it is curable and to help them with information and their adherence. The organization that I run - called the TB Survival Project - is my main tool for doing this. I continue to write a lot, creating books and using any other channels I can such as the media to get my message across. I have some funding from the Lilly MDR-TB Partnership which makes my work possible. I try and speak up as much as I can for people with TB/MDR-TB. Although I am not an elected representative or formal ambassador for TB, I try to speak from the heart and my own experience in the hope that people listening will connect with it at an emotional level. My experience is that if you can do this you can create change.

How serious is the situation in terms and stigma and discrimination against people with TB? What can be done to make things better?
That is a broad question. It depends where you live in the world. For example, some women are too scared to seek medical help for fear that they will be rejected by their husbands. Others are forced from their jobs, unable to provide for their families. For people who live in small communities, rather than the anonymity of the cities, it can be very hard. The bottom line is that stigma is counter-productive. It stops people from being tested and treated for TB/MDR-TB for fear of what others may think.
I think that the answer to making things better is that we need to re-brand the disease. I think money spent with a top advertising agency would be money well spent. People need to think of TB/MDR-TB in the same way that they do about cancer. The biggest challenge is that cancer isn't infectious, which makes it more acceptable. As human beings we have a natural fear of disease as a survival instinct and defence mechanism. We need to get across what can be done about TB/MDR-TB, that it is a curable disease when diagnosed and treated properly like many other infections.

Do you think that more community-based action such as the ones conducted by Red Cross Red Crescent volunteers should be encouraged?
Absolutely, the great thing about the Red Cross Red Crescent volunteers is that they are a motivated grassroots network where TB/MDR-TB care, control and cure actually happens at local level. They understand the issues that the people around them really face. It would be good to see more people who have had TB/MDR-TB recruited as volunteers for organizations such as Red Cross Red Crescent.

As reported by the Thomson Reuters Foundation.
Source: International Federation of Red Cross and Red Crescent Societies.

Visit the TB Survival Project's new website by clicking here.

id: 250309PThorn

(25/03/09) World Health Organisation (WHO) stresses TB-HIV link

HIV patients accounted for roughly a quarter of people who died from tuberculosis in 2007, according to new World Health Organization estimates that highlight a closer connection between the two diseases than previously known.

In addition, of a total of 9.3 million new TB cases world-wide in 2007, 1.4 million, or 15%, occurred in people infected with HIV, according to the WHO's annual TB report. The overall number of those infected with both diseases is roughly twice as high as found by the United Nations agency in previous years.

The new numbers don't indicate an actual increase in the number of HIV patients dying of TB, or in the overall number of TB cases among HIV patients. Rather, stepped-up HIV testing among TB patients has revealed cases of HIV that previously went undetected.

"We've all suspected that there are huge numbers of people who have HIV and TB," said Wafaa El-Sadr, a professor of medicine and epidemiology at Columbia University in New York. "It demonstrates that one cannot think of tackling or controlling the TB epidemic globally without thinking of how we're going to do it in HIV-infected populations."

TB is a bacterial infection that typically affects the lungs. It usually can be treated with widely available drugs and has been largely eliminated as a cause of death in wealthy countries. But it continues to be a scourge in much of the developing world, contributing to the deaths of an estimated 1.8 million people a year.

HIV, the virus that causes AIDS, attacks the immune system, leaving patients vulnerable to many types of infections. Being infected with HIV can increase the risk of getting TB by a factor of 20 or more, the WHO says.

Previously, WHO estimates of patients infected with both diseases used data from 15 countries. The latest figures are from 64 countries, including several in sub-Saharan Africa, home to most of the patients infected with both diseases. The report notes better data are still needed "to increase the reliability of these estimates."

As reported by Jacob Goldstein for the The Wall Street Journal

Related articles on WHO's global tuberculosis report:
The Associated Press
Newsweek

id: 250309WHO report

(24/03/09) UK Coalition To Stop TB Calls For Universal Access to TB-HIV Services by 2015

This World TB Day is marked by the release of dramatic new data from the World Health Organisation (WHO) showing rates of TB-HIV co-infection are twice as high as originally estimated.

In Sub-Saharan Africa, HIV has caused TB incidence to triple since the 1990s and in some countries 80% of TB patients are co-infected with HIV.

A lack of integrated TB and HIV services is one of the biggest problems in controlling these two epidemics. Only 1% of people living with HIV in 2008 had been screened for TB.

Kate Finch of the UK Coalition to Stop TB said, "If there was ever any doubt about the need to integrate the responses to TB and HIV, this is compelling new evidence we cannot ignore. We are calling on UK Prime Minister Gordon Brown to push for the scale up and better link of TB and HIV activities to reach a goal of universal access to TB-HIV care by 2015."

The Coalition has been joined in a message of support from the Archbishop of Canterbury, Dr Rowan Williams: "Tuberculosis is preventable, treatable and curable yet it kills close to 2 million people a year. 'World TB Day' emphasises the need for global health efforts to provide adequate care for the millions worldwide affected by HIV and related illnesses such as TB."

The Coalition to Stop TB is urging Gordon Brown and world leaders attending the forthcoming G20 meeting to deliver on their funding pledges to stop TB and to scale up a coordinated and coherent response to TB-HIV programming.

An investment of US$14 billion would reduce TB deaths in people living with HIV by 80-90%.

"At a time when many investments seem insecure we know that investing in community responses to TB and HIV will pay off," said Alvaro Bermejo, Executive Director of the International HIV/AIDS Alliance.

"We must make sure that people living with HIV and TB have access to appropriate services. Access to drugs, diagnostics and vaccines but also the power to speak out confidently about the issues surrounding HIV and TB that affected marginalised and poor people," he said.

"In the current financial crisis with donors questioning their commitment to international aid and increased pressure on programme accountability and effectiveness, continuing to approach these two diseases separately would not only be inefficient, it would be negligent," Kate Finch commented.

Notes

1. For more information please contact Kate Finch, RESULTS UK on 01926 435 430 or 07751 724 139; or Sarah Wheeler, HIV/AIDS Alliance on 01273 718 900 or 07590 358 391.

2. The UK Coalition to Stop TB was formed in 2008 to increase political support and funding for the global campaign to stop TB. The current members are:

Advocacy Partnership, Aeras Global TB Vaccine Foundation; All-Party Parliamentary Group on Global Tuberculosis; AMREF; AstraZeneca; British Lung Foundation; British Medical Journal; British Thoracic Society; Centre for Infectious Diseases & International Health, University College London; COMDIS Research Consortium; FIND Diagnostics; Genus Pharmaceuticals; Global TB Drug Alliance; GlaxoSmithKline; Health Protection Agency; International HIV/AIDS Alliance; The Lancet; London School of Hygiene & Tropical Medicine; Medecins Sans Frontieres; NAM; NHS Leeds; Panos London; RESULTS UK; Royal College of General Practitioners; Royal College of Nursing; Royal Society of Tropical Medicine and Hygiene; Target TB; TB Alert; TB Survival Project; UK Clinical Pharmacy Association; UK Public Health Association; World Without TB.

3. Members of the UK Coalition to Stop TB and UK Stop AIDS Campaign will be presenting an invitation to Gordon Brown to join the fight to stop TB-HIV co-infection. They will be presenting the invitation at 10 Downing Street on Tuesday 24 March at 1.30pm. For more information, contact Kate Finch on the numbers above.

4. On 9 June 2008, the first HIV/TB Global Leaders' Forum was held at the United Nations in New York. To coincide with this event, civil society organisations from around the world called on all governments to commit to achieve universal access to TB-HIV care by 2015. If achieved, this would result in every person living with HIV being screened for TB, every person with TB being offered HIV counselling and testing, and treatment, prevention, and care being made universally available and coordinated for both diseases.

As reported by Medical News Today.

Read related articles:
Action For Global Health

id: 240209Coalition

(24/03/09) Tuberculosis cases see 2% increase in UK

Cases of tuberculosis (TB) in the UK have increased, according to new figures.

Provisional statistics released by the Health Protection Agency (HPA) to coincide with World TB Day revealed that cases of the infection rose by 2% from 2007 to 2008.

The number of people infected by the illness increased from 8,496 to 8,679, according to the figures.

The highest rise in reported cases was in London, with 3,415 new diagnoses recorded last year, which constitutes 39% of the total for the UK and an increase of 2% on 2007.

The West Midlands reported the second highest number of cases with 1,027 for 2008 - up 9% on 2007.

Dr Ibrahim Abubakar, a TB expert at the HPA's Centre for Infections, said: "The number of cases of TB in the UK is still too high. The key to halting the health burden which this disease causes in the UK is the prompt diagnosis and treatment of infectious cases. Various myths still exist about TB and how it is spread.

"The Agency is committed to raising awareness of the disease in a bid to see fewer cases occurring and old-fashioned attitudes diminished."

TB is caused by bacteria and usually manifests in the lungs, but can also affect the skin and other organs.

The infection is contagious, usually spreading in the air, but normally requires prolonged and close contact to spread from person to person. Symptoms, which can take several months to appear, include weight loss, a persistent cough, fever and night sweats.

The disease is often treated with a course of antibiotic medication.

As reported by The Press Association.

Please go to the Health Protection Agency (HPA) website for more detailed statistical information by following this link.

id: 2403092%increase

(23/03/09) Urgent action needed to tackle TB - letter to 'The Times'

Challenges ahead: tuberculosis is the single biggest killer of HIV patients worldwide

Sir, Remarks by the Pope (report, Mar 17) that condoms could make the global HIV epidemic worse reflect an attitude that will only serve to hinder progress made to combat this ruthless disease. However, there are greater challenges to HIV/Aids programmes than religious dogma. Tuberculosis is the single biggest killer of HIV patients worldwide, and in sub-Saharan Africa HIV has caused TB incidence to triple since the 1990s. Without proper treatment, it is estimated that 90 per cent of people living with HIV die within months of developing TB.

Data to be released by the World Health Organisation today, World TB Day, are expected to report levels of TB-HIV co-infection significantly higher than originally estimated. Evidence shows that prevention and care for patients are far more effective when TB-HIV services are combined, but sadly insufficient money and resources have been dedicated to developing integrated services. It is critical that this is scaled up as soon as possible; a failure to respond will result in thousands more preventable deaths each year. This, of course, will depend on the response of international donors in the face of the global financial crisis. Despite recent pledges from the US and renewed commitment from the UK, the Global Fund to Fight Aids, TB and Malaria and the Global Plan to Stop TB are still facing serious shortfalls in funding. Through the programmes they support, these institutions have made a real impact on the fight against communicable disease. A drop in funding threatens to halt or even reverse progress made.

With TB-HIV co-infection rates rising rapidly, as well as cases of drug-resistant TB emerging in many countries (including the UK), world leaders attending the forthcoming G20 meeting need to fulfil urgently the promises they have made to avoid potentially devastating effects.

Mike Mandelbaum Chief Executive,
TB Alert

Louise Holly Deputy Director,
Results UK

Sheila Davie
Advocacy Partnership

Paul Thorn Project Director,
the Tuberculosis Survival Project

Nikki Jeffrey Director,
Target Tuberculosis

Gerri Mchugh Chief Executive,
Royal Society of Tropical Medicine and Hygiene

Lara Brehmer
Comdis (Communicable Disease Research Programme Consortium)

Lynn Young
Royal College of Nurses

Toby Capstick Lead Respiratory Pharmacist,
St James University Hospital

Evelyn Harvey
Health Development Networks

Dr Luciana Brondi and Ruth Mcnerney
The London School of Hygiene and Tropical Medicine

id: 230309TheTimes

(18/03/09) UV light cuts spread of Tuberculosis

Ultraviolet lights could reduce the spread of tuberculosis in hospital wards and waiting rooms by 70 per cent, according to a new study involving researchers from the University of Leeds.

The study, published in PLoS Medicine today, explores the transmission of tuberculosis ( TB ) from infected patients, and suggests that installing simple ultraviolet C ( UVC ) lights in hospitals could help reduce the transmission of even drug-resistant strains.

Every year, more than nine million people are infected with tuberculosis and approximately two million people die from the disease, according to the World Health Organisation. Infection rates are particularly high in places where vulnerable people are crowded together, such as hospitals, homeless shelters and prisons.

When a tuberculosis patient coughs, bacteria are sprayed into the air in tiny droplets, floating around the room and infecting other patients, visitors and healthcare staff. These bacteria can be killed by hanging a shielded UVC light from the ceiling and ensuring an effective system to move and mix the air, say the researcher team, which includes the University of Leeds, Imperial College London, Hospital Nacional Dos de Mayo, Lima, Peru, and other international institutions.

UVC light kills tuberculosis bacteria, including drug-resistant strains, by damaging their DNA so they cannot infect people, grow or divide. It is already used at high intensity to disinfect empty ambulances and operating theatres.

The impact of UV lights is greatest when combined with careful management of the air flow on the wards, as Dr Cath Noakes from Leeds’ Faculty of Engineering explains: “The lights must be set high enough to ensure patients and health workers are not overexposed, but if the lights only treat air at that level, there will be little benefit. To be most effective, ventilation systems need to create a constant flow of treated air down to patient level, and potentially infected air up towards the lights.”

A specialist in hospital ventilation and air flow management, Dr Noakes is already building on the results of the Peruvian trial in new research aimed at developing practical guidelines for the installation of UV infection control systems. By creating computational models of UV lights in realistic environments such as hospitals and clinics, Dr Noakes will determine in which environments the UV is most beneficial and design systems to interact effectively with the air flow in the building.

“The trial showed that UV can work,” says Dr Noakes. “For hospitals and other institutions to be able to use it with minimum cost but maximum impact, we now need to know the details – where the UV lights need to be placed to work most effectively and safely and what changes to ventilation systems may be required.”

Lead researcher Dr Rod Escombe, from the Wellcome Trust Centre for Clinical Tropical Medicine at Imperial College London says: “Thankfully, the rate of tuberculosis infection in countries like the UK is relatively low and people who are infected can be treated using antibiotics, which are readily available here. People are more likely to die from the disease in developing countries like Peru, because there are limited resources for isolating patients, diagnosing them quickly and starting effective treatment. Also, the prevalence of drug-resistant TB is much higher in the developing world. Preventing infection is much easier and cheaper than treating a patient with tuberculosis.”

Plans are already underway to install upper room UV lights in the chest clinic at St Mary’s Hospital, London, which will be the first hospital to have them in the UK.

This research was funded by the Wellcome Trust, Sir Halley Stewart Trust and the Sir Samuel Scott of Yews Trust, Proyecto Vigia ( USAID ) and the charity Innovation for Health and Development ( IFHAD ). Dr Noakes’ current research project to develop UV usage guidelines is funded through the Engineering and Physical Sciences Research Council ( EPSRC ).

As reported on Media-Newswire.com

id: 180309UV

(24/02/09) March Issue of Lancet Infectious Diseases Focuses on TB Ahead of WSTB Day

March Issue of Lancet Infectious Diseases Focuses on TB Ahead of World Stop TB Day

The March issue of the journal Lancet Infectious Diseases focuses on tuberculosis to coincide with World TB Day 2009, which is scheduled for March 24. The theme of this year's World TB Day is celebration of the lives of people affected by the disease. According to the Lancet, the lives of 14 million people with TB could be saved by 2015 if the Stop TB Partnership's treatment and control recommendations are successful. The Lancet published several articles related to TB control and treatment and challenges in fighting the disease (Lancet, March 2009). Summaries appear below.

"Are We Really That Good at Treating Tuberculosis?": The success of TB programs is measured by treatment success rates because of the "inherent difficulty in estimating the true number of incident TB cases and therefore case detection," Helen Cox of the Macfarlane Burnet Institute for Medical Research and Public Health in Melbourne, Australia, and colleagues write in a reflection and reaction piece. According to the authors, treatment success rates in many countries "are received with skepticism among health care workers struggling with TB at the clinic level" because of the "obvious difficulties in implementing DOTS programs, maintaining program quality, and achieving adequate financing and human resources in high-TB burden settings." The authors add that many TB programs focus specifically on new sputum smear-positive cases, which "risks focusing attention" only on new TB patients. "Our failure to control TB reflects our failure to detect and cure enough cases to interrupt transmission," the authors write, adding that there is a "pressing need for appropriate performance-management tools that encompass the range of activities and outcomes performed by TB programs" (Cox et al., Lancet Infectious Diseases, March 2009).

"Screening Migrants for Tuberculosis: Where Next?": More than half of new TB cases in Europe occur among foreign-born individuals and "these numbers could rise" because of "unprecedentedly high levels of global migration," Sally Hargreaves, a research fellow at Imperial College London and a senior editor for Lancet Infectious Diseases, and colleagues write in a reflection and reaction piece. Hargreaves and colleagues write that increasing rates of HIV and "overstretched" public health services have "led to calls for renewed thinking about policies" on TB screening among migrants. According to the authors, "inclusive policies that encourage greater participation in health services by hard-to-reach migrant groups" and that include TB screening and screenings for other infectious diseases, such as HIV and hepatitis, are needed. In addition, European guidelines on "standard policies for testing and treating" TB among migrants that also address latent TB should be developed and implemented, the authors write (Hargreaves et al., Lancet Infectious Diseases, March 2009).

"Global Tuberculosis Control Amid the World Economic Crisis": "With many demands on political attention in a global economic downturn, will progress on tuberculosis fall behind?" Kelly Morris asks in a Lancet Infectious Diseases article. She writes that the Global Fund To Fight AIDS, Tuberculosis and Malaria and the Stop TB Partnership are facing funding deficits, adding that "investment could fall rather than increase" in the current economy. According to Morris, although DOTS implementation has improved, multi-drug resistant and extensively drug-resistant TB "are at their highest levels ever, placing a further burden on programs." In addition, progress to address HIV/TB coinfection "has been uneven because of weak health systems and the HIV epidemic." She continues that "many experts believe that the economic crisis will have a major impact on worldwide TB efforts," adding that "drug resistance may increase, with an additional negative impact from" HIV/TB coinfection. In addition, the World Bank predicts that the economic downturn could increase poverty rates, which might create conditions that facilitate the spread of TB, Morris writes. She concludes that many global health advocates "are pointing out that investment in health care can not only ameliorate the effects of recession, but could stimulate economic growth and also have positive effects on development" (Morris, Lancet Infectious Diseases, March 2009).

"Moving Closer to a New Tuberculosis Vaccine": Researchers currently are conducting or preparing trials of several TB vaccine candidates, and "it seems possible that the first new TB vaccine for nearly 90 years could be available in less than a decade," Kathryn Senior writes in a Lancet Infectious Diseases article. Although the BCG vaccine "lowers childhood mortality and reduces the incidence of TB meningitis," the 87-year-old vaccine does not provide equal protection in different settings or among different populations. Senior writes that researchers "now accept that testing new vaccine candidates for TB needs to be done in various locations," adding that researchers are conducting trials of the MVA85A candidate among latent TB patients in South Africa and the United Kingdom; among patients coinfected with HIV/TB in Senegal, South Africa and the U.K.; and among children and infants in South Africa and The Gambia. In addition, the AERAS-402/Crucell Ad35, which is "[c]lose behind MVA85A in terms of clinical development," appears to have the "promising" effect of inducing high levels of cellular immunity, Senior writes. She continues that recombinant vaccines also are "producing interesting results" in clinical trials but adds that some researchers believe increased safety concerns might slow the development of an effective TB vaccine (Senior, Lancet Infectious Diseases, March 2009).

As reported by GlobalHealthReporting.org

id: 240209lancet

(20/02/09) How TB crept up on young mum Natalie

A young mum is recovering from a disease that could leave her with permanent kidney damage.

Natalie Winter went through test after test before she was diagnosed with TB – in her kidneys.

Only two per cent of TB cases affect the kidneys. Normally it affects the lungs.
Diagnosed in November 2007, Miss Winter is now off medication but could have long-term damage.

Still being monitored and undergoing further tests, the 24-year-old mum of two wants to highlight the disease and its effects.

Thousands of cases are recorded each year and now Miss Winter, of South Parade, Elland, has become a campaigner for TB Alert.

TB is often passed through coughing and Miss Winter believes she caught it while working in nursing homes on 12-hour shifts in close contact with patients.

It then lay dormant and spread from her lungs into her kidneys and when her immune system was low it flared up.

Miss Winter has two sons, James, four, and Thomas, two.

During each pregnancy she suffered severe kidney pains.

"It took a few years before being diagnosed," she said.

"I kept having lots of problems and kept going back to the doctor but nothing worked."

She was treated for appendicitis and given antibiotics but problems persisted and she was finally tested for TB.

A dedicated TB nurse cared for her during treatment, which caused severe side-effects.

"I had rashes and sickness," she said.

"And, while I stopped the medication after six months, there could be long-term damage to my kidneys."

Miss Winter is now helping educate medical staff and the public about TB, which she said hadn't had the prominence it deserved because of a general view it was a disease from the past.

Bradford has a high incidence rate and she has spoken to doctors and nurses through Bradford Primary Care Trust.

She has also been involved in making a DVD with TB Alert and the setting up of TBAG – TB Action Group.

"We are trying to get more support for people with TB," she said.

"The medication was the worst part for me as it made me feel so ill.

"And rates are increasing. It is the biggest- killing preventable disease," said Miss Winter.

As reported by Brian Coates for the Halifax Courier

id: 200209Natalie

(18/02/09) GPs warned to consider TB in pregnancy

GPs warned to consider TB in pregnancy

GPs should be aware that tuberculosis (TB) may present differently in pregnant women, UK researchers have warned.

They found that deaths from TB in pregnancy are increasing and that cases seem to exclusively occur in women from ethnic minorities and almost exclusively in those born overseas.

A total of 33 cases of TB during pregnancy diagnosed between August 2005 and August 2006 were identified using the UK Obstetric Surveillance System (UKOSS). The results published in BJOG: An International Journal of Obstetrics and Gynaecology showed that all occurred in non-white women and the majority were born outside the UK.

Dr Marian Knight, senior clinical research fellow and honorary consultant in public health at the National Perinatal Epidemiology Unit, University of Oxford, said that while screening for TB during pregnancy is recommended it is not undertaken routinely and that this may contribute to a delay in diagnosis in pregnant women.

"Both women and their doctors and midwives should be aware that the symptoms of TB in pregnancy may be different, and consider the diagnosis, especially in recently arrived immigrant women, presenting with non-specific symptoms," she said.

As reported at OnMedica.com, to view the article click here.

Related articles can be viewed by following the links below:
Medical News Today
Anaesthesia UK
Healthcare Republic
Healthcare Today

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(23/01/09) Scientists studying shorter, safer treatment for Latent TB

Washington, January 23 (ANI): Scientists at the Research Institute of the McGill University Health Centre (MUHC) have come up with a potential new treatment for the latent form of tuberculosis (TB).

Dr. Dick Menzies says this work attains significance because patients with the latent form of TB, although they do not show symptoms and are not contagious, pose the biggest challenge when it comes to controlling the disease.

“Our results show that a four-month treatment with a drug called rifampin is better tolerated than the traditional nine-month treatment with a drug called isoniazid,” explained Dr. Menzies in the study paper, recently published in the Annals of Internal Medicine.

“The side effects with rifampin are much less frequent, particularly liver toxicity - which is the most serious risk of the traditional therapy with isoniazid. In addition patients are much more likely to complete this treatment - another big drawback to the nine month standard therapy,” the researcher added.

Patients who currently receive a diagnosis of latent TB are treated for nine months with daily doses of isoniazid.

The treatment may be effective, but it is very long and has major side effects on the liver, which is why patients often do not complete treatment and its efficacy is reduced.

Dr. Menzies said that the new therapeutic option, upon which the latest study was focused, would last only four months and cause a lot less liver damage.

Patients therefore adhere better to their treatment regimens, which is a critical first step towards ensuring the efficacy of the medication, according to the researcher.

The study was conducted on 847 patients in Canada, Brazil and Saudi Arabia, and thus the results can be generalized to a very broad population.

Currently, rifampin is most often used to treat the active form of TB. While it is suggested that further studies are needed to test the effectiveness of the medication against latent TB, the study researchers consider it to be very promising. (ANI)

As reported on Newspost Online.

Related articles:
"New Treatment Option for Latent Tuberculosis" - Infection Control Today Magazine
"New treatment for latent tuberculosis" - UPI.com

id: 230109latent

(08/01/09) Text messages could help Tuberculosis drug compliance

London, UK - Use of mobile phone text-messaging (or short message service/SMS as it is also known) could help tuberculosis patients in the world’s most remote locations adhere to their treatment. The promising early results of this strategy are discussed in the World Report in this week’s edition of The Lancet, written by freelance journalist Eliza Barclay.

Treatment for tuberculosis is a combination of strong antibiotics that must be taken for at least six months — and this can cause side-effects such as nausea, which can put patients off taking their tablets. To help people complete their treatment, WHO currently recommends the DOTS (directly observed, short course) strategy, in which a health worker watches the patient take their antibiotics every day. While this strategy has helped dramatically improve tuberculosis control around the world, it is insufficient or inaccessible for thousands of patients. It is also expensive and human-resource intensive.

Several disease control and technology specialists are now looking to SMS as a cost-effective way to communicate with and monitor hard-to-reach patients in remote locations. “The problem is enormous, and everything has to be done in order to prevent patients from defaulting”, said Mario Raviglione, director of WHO’s Stop TB Department. “Anything that can be done technologically to help solve this issue like these cellphone technologies would be useful.”

Although tuberculosis is a disease affecting poor people, even those living on US$1 per day increasingly have access to mobile phones. There are more than 3•3 billion mobile-phone subscriptions worldwide. By the end of 2006, according to the International Telecommunications Union, 68% of those subscriptions were in developing countries. South Africa has proven a fertile testing ground for new drug-compliance technologies — 71% of DOTS treated patients were cured from tuberculosis; most patients who were not successfully treated under DOTS had stopped taking their medication.

The way the SMS strategy could work is provided in this example: London-based company SIMpill have made a small pill bottle that contains a SIM card and when opened, the SIM card delivers a SMS with a unique pill box identification number to a central server. The central server receives the incoming SMS and stores the data, but if no SMS is received at the designated time, the server contacts the patient via phone alerting them to take their medication. If the patient does not respond, the server contacts a caregiver who can follow-up with the patient. A trial at three clinics in Cape Town showed that, after 10 months of SIMpill, treatment adherence among 155 tuberculosis patients was 86-92% with a treatment success rate of 94%. As well as helping treatment adherence, the SMS strategy allows health workers to use their precious time for other tasks.

Other products and trials are also discussed in the World Report. X out TB is an SMS-based system in which patients urinate on a filter-paper diagnostic device after taking their medication. If their urine contains, as it should, the metabolites of their tuberculosis drugs, a code is generated which patients send via SMS to a central data system. Based on accumulated right answers (ie, correct codes) at the end of the month, patients receive rewards such as free mobile phone credit.

However, not all experts believe that mobile phone technology is necessary. According to Hamish Fraser, director of informatics and telemedicine for Partners in Health (PIH) and assistant professor at Harvard Medical School, the success of PIH’s programmes without the use of SMS communication indicate that SMS-based health technologies may be unnecessary. “I think in developing countries, having a DOTS worker visit patients in their home is extremely effective”, said Fraser. “We don’t immediately feel there’s a big gap there so I’m less sold on cellphones.”

Raviglione, however, believes that SMS health technologies could have a role in improving communication in tuberculosis treatment and care. “Though the human aspect of tuberculosis care and control must not be forgotten or underemphasised, there’s always great value in increasing communication between the patients and the clinicians”, he said.

As reported by Exchange Magazine.

Read related articles:
Herald.ie
Thaindian News

id: 08/01/09SMS

(12/12/08) Secretary of State sends message to TB Alert supporters

Secretary of State for International Development, Douglas Alexander says in his seasonal message that he is proud to be in partnership with TB Alert in the fight against world poverty. Read more
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(24/03/09) TB Alert's 10th birthday

TB Alert was launched on World TB Day 1999, so this year we celebrate our 10th Anniversary. Click here to read our Anniversary Review - charting 10 years of progress of our charity.If you have not received your copy please email us with your full contact details.

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