AKAR, 24 March 2009 (IRIN) - Over the past three years, the number of countries reporting cases of extensively drug resistant tuberculosis (XDR-TB)- essentially untreatable in the developing world- has grown by almost 25 percent to reach 55 countries, as of 2009 World TB Day.

The World Health Organization (WHO) estimates about five percent of newly diagnosed cases of tuberculosis (TB) every year is multi-drug resistant (MDR-TB); of these cases, some 60,000 infections are of the fatal, almost impossible to treat variety.

“The news is not good,” said the director of WHO’s “Stop TB Partnership,” Mario Raviglione. “If the world does not move, we are in deep trouble.”

Any type of multi-drug resistance is highly lethal in HIV patients, who are susceptible to developing full-blown TB infections because of their weak immune systems. WHO studies show fatality rates of more than 90 percent in HIV patients infected with XDR-TB.

But the extensive drug resistant strain is deadly for even non-HIV patients. “This form of tuberculosis is resistant to almost all effective anti-TB drugs,” said the WHO tuberculosis director.

TB bacteria usually attack the lungs and spread through the air from one person to another; crowded, economically-destitute areas are fertile places for quick transmission, according to health workers.

Spotty information

Raviglione told IRIN that only about three percent of those infected with XDR-TB – the most extreme form of multi-drug resistance - will receive high-quality, timely care capable of curing the infection. While some medical studies have shown that countries with strong health systems can treat up to 60 percent of XDR-TB infections, Raviglione told IRIN most countries reporting such highly resistant bacteria do not have the human or laboratory resources to provide early, accurate diagnoses.

“Reliable information is limited to developed countries. In Africa we have little grasp [of the extent of XDR-TB infection],” said Raviglione. “The vast majority of affected countries do not have the means to put together proper surveys. These countries may simply not be reporting XDR-TB.”

If 60,000 are infected with XDR-TB every year, Raviglione estimates more than 40,000 will not be cured and will continue to spread the highly-resistant bacteria further.

Based on WHO’s 2009 Tuberculosis report, more than half a million new multi-drug resistant cases were reported in 2007. Resistance develops when people improperly follow the required six-month medication treatment, or when they are infected by someone with MDR-TB. India, China and the Russian Federation topped the list of reporting countries for MDR-TB cases in 2007.

One strike

In Burkina Faso, 26-year-old Herman Zombré told IRIN he stopped taking medication one month after his diagnosis in November 2008. “My employer did not want to give me time off [to take daily a dose at health clinic].” To ensure compliance, health centres often require patients take their medication under health worker surveillance.

In March, health staff managed to find Zombré and resume his treatment. Head of the nursing division at the government’s Centre of Tuberculosis Control, Augustin Darankoum, told IRIN health staff try to track down all patients who stop coming. “When Zombré stopped coming, we went to look for him. Before a patient starts treatment, we take down all his information and one of our staff is sent to accompany him home so we can know our patients’ homes.”

Darankoum said it is not medication that turns people away from treatment, but the lack of money for transport for daily medical visits. “To help patients, we help cover fuel costs and phone cards so they can contact us in emergencies.”

But it comes down to daily vigilance, said the nurse. “If we do not see a patient by 11 AM, we call them. And then we look for them,” Darankoum told IRIN. “We cannot leave them out walking around- they will [develop complications] and infect others who will also inherit those complications.”

There are 4,000 people being treated for tuberculosis in Burkina Faso, according to the government.
[...]
read full article at IRIN

Tue Mar 24, 2009 10:32am EDT

24 Mar 2009

By Laura MacInnis

GENEVA (Reuters) - Ventilation and some sunshine could go a long way to reduce tuberculosis risks in hospitals and prisons, two strongholds of the contagious lung disease, the World Health Organization said.

In its latest Global Tuberculosis Control report, released on Tuesday, the United Nations agency also doubled its estimate of how many HIV-infected people catch and die from tuberculosis, and warned especially deadly strains are continuing to spread in all corners of the world.

Mario Raviglione, director of the WHO’s Stop TB department, said that because tuberculosis bacteria thrive in stagnant air, “simply opening the doors” can reduce the chances that patients, inmates and others will become infected with the disease that killed about[...]

Read full article at Reuters

Source: BBC
Date: Tuesday, 24 March 2009

One in four TB deaths is HIV-related, twice as many as previously recognised, experts say.

Co-infection remains a major challenge and more efforts are needed to spot and treat the two conditions in tandem, says the World Health Organization.

HIV and tuberculosis services must be joined up if we are to achieve global disease control, warn disease experts.

Despite TB killing more people with HIV than any other disease, in 2008 only 1% of people with HIV had a TB screen.

Problems compounded

HIV disables the immune system, leaving the body vulnerable to opportunistic infections like TB.

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.

TB is preventable, treatable and curable yet it kills close to two million people a year
Archbishop of Canterbury Dr Rowan Williams

In 2007, worldwide there were an estimated 1.37 million new cases of TB among HIV-infected people and 456,000 deaths.

The situation is made more urgent by increasing rates of drug-resistant TB in areas with a high prevalence of HIV.

Again, in 2007, an estimated 500,000 people had multidrug-resistant TB, but less than 1% of them were receiving treatments meeting WHO’s recommended standards.

Dr Margaret Chan, Director-General of WHO, said: “These findings point to an urgent need to find, prevent and treat TB in people living with HIV and to test for HIV in all patients with TB.

“Countries can only do that through stronger collaborative programmes and stronger health systems that address both diseases.”
[...]
Read full article at BBC

Source: Wellcome trust
24 March 2009

Trust-funded researchers have developed a set of guidelines to help assess the quality of medicines and combat counterfeit drugs.

Writing in PLoS Medicine, the international panel of drug quality experts outlines recommendations to help research groups study and report the prevalence of fake and poor quality drugs, and indicates where such drugs are commonly available.

A significant proportion of medicines used in the developing world is of poor quality, with many actually counterfeit. These threaten public health programmes against major diseases such as malaria, and raise the risk of drug resistance. Yet little is known about the extent to which fake or substandard drugs have penetrated international markets.

The authors, from Kenya, Laos, Thailand, the UK and the USA, surveyed the limited number of published studies available and reviewed their strategies, techniques and experiences.

Based on this analysis, they produced recommendations on the best sampling strategies, ways of standardising reports on the sampling of drugs and issues that should be addressed in future studies.

“The health of people living in developing countries is critically dependent upon the availability of medicines, and poor-quality medicines are a major impediment to improvements in public health. Despite this there are few reliable data describing their epidemiology, or their effects on health and drug resistance,” said Dr Paul Newton, from the Wellcome Trust-Mahosot Hospital-Oxford University Tropical Medicine Research Collaboration in Laos, and lead author on the study.

“Ensuring that essential medicines are of good quality is as important as ensuring that they are available. We hope that this field will attract the interest and support it deserves, and that the recommendations made here will evolve substantially.”

Reference

Newton PN et al. Guidelines for field surveys of the quality of medicines: a proposal. PLoS Medicine, 24 March 2009.