“Initially, we were focusing on Dzivarasekwa high density suburb as being the source of the disease outbreak but we are now receiving patients from different high density suburbs in Harare such as Kuwadzana and Warren Park,” Harare’s health director, Propser Chonzi, told IRIN.

There have been no confirmed fatalities from the disease, although senior health officials, who declined to be identified, told IRIN they were investigating the cause of some deaths at hospitals.

Chonzi said about 20 tuberculosis (TB) patients had been relocated from the 144-bed Beatrice Infectious Diseases Hospital on the outskirts of Harare to another infectious diseases institution, the Wilkins Hospital in central Harare, to make way for typhoid victims.

According to the UN World Health Organization (WHO), typhoid “usually occurs where water supplies serving large populations are contaminated by fecal matter.” The disease is “characterized by the sudden onset of sustained fever, severe headache, nausea, abdominal pains, loss of appetite, constipation or sometimes diarrhea. The illness can last for several weeks and even months,” it says.

Recent heavy rain in Harare is expected to compound the problem: Broken drains and water pipes have forced people to dig shallow wells, which are easily contaminated by human feces.

Read more of the story here at the IRIN news service:
ZIMBABWE: Typhoid stalks Harare

The team is in touch with the health authorities of Maharashtra, Mumbai Corporation, while also involving experts from concerned stake holders including Hinduja Hospital, Mumbai.

So far as report from Hinduja Hospital is concerned, this Hospital Laboratory is not accredited by the Revised National Tuberculosis Control Programme, GOI for culture and sensitivity for second line drugs to diagnose Extensively Drug-Resistant (XDR) / Totally Drug Resistant (TDR) cases and is only accredited for conducting Drug Susceptibility Testing (DST) by liquid culture and sensitivity for first line drug only. Recently, a proposal for accreditation of Line Probe Assay test (LPA) has been received and is under process.

As of now, the Revised National TB Control Programme has accredited only following three labs for conducting quality-assured second-line anti-TB drug susceptibility testing of flouroquinolones and injectables, viz (1) National TB Institute (NTI), Bangalore; (2) LRS Institute of TB and Chest Disease, New Delhi, and (3) National Institute of Research in Tuberculosis, Chennai.

In addition, the term TDR ‘totally drug resistant’ TB is non-standardized and is misleading; testing for resistance beyond XDR-TB is not advocated by WHO and poor clinical response to treatment has not yet been correlated with diagnosis of drug resistant TB without Laboratory conformation from Accredited Labs.

Multi-Drug Resistant (MDR-TB) is defined as resistance to at least isoniazid and rifampicin (two of the most potent first line anti-TB drugs), with or without resistance to other first-line drugs; Extensively Drug-Resistant TB (XDR-TB) is defined as resistance to at least Rifampicin, Isoniazid (i.e. MDR-TB) plus resistance to any fluoroquinolone, and to any of the 3 second-line injectable drugs (capreomycin, kanamycin and amikacin).

The term “totally drug resistant” tuberculosis is neither recognized by the WHO nor by Revised National Tuberculosis Control Programme (RNTCP). For now these cases are defined as Extensively Drug Resistant tuberculosis (XDR-TB), according to WHO definitions, and accordingly can be managed by national XDR-TB treatment guidelines. Current WHO recommendations advise against the use of the Drug Susceptibility Testing (DST) results for second line drugs beyond those used to identify XDR-TB to guide treatment.

Any type of Drug Resistant TB can only be diagnosed by Laboratory Test and not by clinical examination alone. Preliminary results of second-line DST for MDR-TB patients from DOTS Plus sites and also isolates collected from Gujarat and Maharashtra drug resistance surveys show that there is not yet any XDR-TB amongst new cases and ~0.5% amongst re-treatment cases.

Source: pib.nic.in

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For decades, data has shown that middle aged adults with low education levels—that is high school or less—are twice as likely to die as those with higher education levels. Professor Richard Miech, of the Department of Health and Behavioral Sciences at the University of Colorado Denver’s College of Liberal Arts and Sciences, and his colleagues wanted to better understand why this persists. They found that as new causes of death emerge, people with lower education levels are slower to respond with behavioral changes, creating a moving target that often remains a step ahead of prevention. Almost all causes of death that are on the increase are fueled by high rates of mortality among people with lower education, a trend that counters any progress made in the reduction of today’s health disparities.

“Money, power, prestige, knowledge, and beneficial social connections allow people of higher education status to take better advantage of health developments,” said Miech.

Despite efforts to reduce education-based mortality disparities, the gap remains because new health disparities counteract the efforts to reduce the death rates for those with less education. While the causes of death have changed, rates have not.

“One hundred years ago, the top causes of death were tuberculosis, diarrhea, and pneumonia,” said Miech. “They’ve been replaced by heart disease, cancer, and stroke. But, one thing that hasn’t changed is that people with lower levels of education continue to be the ones dying at greater rates.”

Science Brief thanks to EurekAlert.

Read more here:
Study takes aim at education-based death rate disparities

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According to a report released during the provincial TB and HIV seminar held earlier this week, more than 81 percent of people who were screened, tested and diagnosed with TB in the province’s public health facilities have been cured.

This is an increase from 64 percent in 2004 to 81 percent in June this year.

Gauteng Department of Health and Social Development MEC Ntombi Mekgwe attributed the positive results to the department’s intensified TB management program including door-to-door campaigns by Community Health Workers and Directly Observed Treatment Support.

“Through this approach, defaulters were traced and brought back for treatment, this has also helped ensure that more people take the test,” Mekgwe said.

She added that in the 2010/11 financial year, 52 118 new TB cases were diagnosed and the province is expecting the number of cases diagnosed as well as the cure rate to increase in the current financial year because of the introduction of the two Gene-Xpert machines located in Chris Hani Baragwanath Academic Hospital and Edenvale Hospital.

The machines allocated to the province in March this year help shorten the time taken to diagnose TB from two weeks to two hours.

“Between March and November 2011, 16 189 tests have been conducted using Gene-Xpert machine and 2 195 were positive and are currently undergoing treatment,” said the MEC.

During the seminar, the department acknowledged that districts had also intensified efforts of improving TB management by achieving a high cure rate, increasing awareness about the disease, educating people to complete treatment as well as educating communities on infection control.

Mekgwe urged patients on treatment to stay on their treatment and complete the courses thus avoiding Multi-Drug Resistant TB.

“The department’s awareness campaigns emphasize that TB is curable after six months of treatment even with people living with HIV. I would like to appeal to everyone who may have symptoms to seek treatment before it is too late.”

Signs and symptoms of TB are persistent cough for two weeks or more, night sweating, loss of weight, chest pain, coughing up blood, fever, chills, loss of appetite and tiredness.

Source: BUA News
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“We compared commercially available tests for latent tuberculosis infection (LTBI) in a diverse population with a low LTBI prevalence,” said James Mancuso, MD, DrPH, of the Walter Reed Army Institute of Research Preventive Medicine Residency Program. “Our results suggest that in low-prevalence populations, most positive results obtained with these tests are false positives.”

The findings were published online ahead of print publication in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

The cross-sectional study involved 2,017 military recruits at Fort Jackson, South Carolina, who completed a risk factor questionnaire and underwent testing with the 3 tests: 1) tuberculin skin test (TST), 2) the interferon gamma release assays (IGRAs) QuantiFERON®-TB Gold In-Tube test (QFT-GIT) and 3) the TSPOT® TB test (T-Spot). The Battey Skin Test (BST) was also administered to assess the impact of non-tuberculosis mycobacteria (NTM) reactivity on test discordance.

The specificities of TST, QFT-GIT, and T-Spot were not significantly different. Of 88 subjects with a positive test, 68 (77%) were positive to one test, 10 (11.4%) were positive to two tests, and only 10 (11.4%) were positive to all three tests. Bacille Calmette Guerin vaccination, tuberculosis prevalence in country of birth,and Battey skin test reaction size were associated with TST positive, IGRA negative test discordance, supporting evidence that NTM sensitization can cause false positive TST results. Greater quantitative test results and higher TB risk strata were associated with increased concordance between tests.

Science Brief thanks to EurekAlert.

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Discordance among commercially-available diagnostics for latent TB infection

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“Two billion men, women and children live with latent TB infection,” said Jim Connolly, President and Chief Executive Officer of Aeras. “It’s daunting to comprehend that there is a vast reservoir of people with a 5-10% lifetime risk of becoming sick with TB. A vaccine that prevents TB disease in this population could save millions of lives, and this trial is a first step in assessing a vaccine candidate designed for this purpose.”

The candidate TB vaccine (SSI H56-IC31) is a subunit vaccine containing recombinant TB proteins formulated in a proprietary adjuvant IC31® from Intercell. It is being developed under a consortium of researchers led by Peter Andersen at the Statens Serum Institut (SSI) based in Copenhagen. The consortium is supported as part of the Grand Challenges in Global Health, an initiative that fosters scientific breakthroughs needed to prevent, treat and cure diseases of the developing world.

“The development of urgently needed new TB vaccines requires a global effort,” said Prof. Peter Andersen, the Vice President of Vaccine Research & Development at SSI. “The advancement of this candidate from an idea to the clinic working in collaboration first with the Grand Challenges consortium and now with Aeras and SATVI is an important and exciting milestone for all the researchers involved.”

Science Brief thanks to EurekAlert.

Read more here:
Vaccine targeting latent TB enters clinical testing

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According to Nadeem Zaka, senior medical officer at the health department in Punjab, TB is responsible for 5.1 percent of the total national disease burden in Pakistan.

Muhammad Anwar, senior program manager for advocacy at NTCP, said: “The mission focuses on improving case detection, treatment adherence, combating stigma and treating TB patients.”

On the impact of the disease on patients, Anwar said: “The three major difficulties incorporated in their lives due to TB are financial problems, loneliness and hospitalization. NTCP is providing 90 percent of its treatment free of cost to poor patients and providing free medicines to private clinics and hospitals so that free TB medication is available to all segments of society.

“In 56 districts [in Punjab Province] over 5,000 health centers are working, while Rural Health Units are delivering their best in providing medical facilities to TB patients.”

Read more of the story here at the IRIN news service:
PAKISTAN: Tackling the burden of TB

Tuberculosis, a potentially fatal lung disease, causes an estimated 1.8 million deaths annually, according to the World Health Organization, and it especially impacts those with reduced immunity, such as HIV-infected individuals.

In an interesting twist, people with darker skin traditionally have had a higher susceptibility to tuberculosis, and areas of Africa lead the world with the highest infection rates. Scientists believe this may be partly due to the skin pigment melanin. Melanin is more abundant in darker skin, which helps shield the body from ultraviolet rays, but it also reduces vitamin D production.

Vitamin D — a natural hormone, rather than a vitamin — is known to be instrumental in bone development but also may protect against cancer and autoimmune diseases and fight infections.

In a study published online Oct. 12 in the peer-reviewed journal Science Translational Medicine, researchers examined the mechanisms that govern the immune system’s ability to kill or inhibit the growth of pathogens such as Myobacterium tuberculosis, the bacteria that causes tuberculosis.

The team found that T cells, which are white blood cells that play a central role in immunity, release a protein called interferon-g that triggers communication between cells and directs infected immune cells to attack the invading tuberculosis bacteria. However, this activation requires sufficient levels of vitamin D to be effective.

Researchers next tested serum taken from blood samples in healthy humans, both with and without sufficient levels of vitamin D. They found that the immune response was not triggered in the serum with lower vitamin D levels, as is found in many African Americans. But, when adequate vitamin D was added to this deficient serum, the immune response was effectively activated.

Scientists found that there was an 85 percent reduction of colony-forming tuberculosis bacteria in human macrophage cells that were effectively treated with interferon-g in the presence of sufficient vitamin D.

“Over the centuries, vitamin D has intrinsically been used to treat tuberculosis. Sanatoriums dedicated to tuberculosis patients were traditionally placed in sunny locations that seemed to help patients — but no one knew why this worked,” said the study’s first author, Dr. Mario Fabri, who conducted the research at UCLA and is currently a member of the department of dermatology at the University of Cologne in Germany. “Our findings suggest that increasing vitamin D levels through supplementation may improve the immune response to infections such as tuberculosis.”

The team noted that vitamin D may help both innate and adaptive immunity, two systems that work synergistically together to fight infections.

Previous research by the team found that vitamin D played a key role in the production of a molecule called cathelicidin, which helps the innate immune system kill the tuberculosis bacteria. Humans are born with innate immunity, which is the preprogrammed part of the immune system.

The current research findings demonstrate that vitamin D is also critical for the action of T cells, key players in adaptive immunity, a highly specialized system that humans acquire over time as they encounter different pathogens.

“The findings of our previous research with innate immunity provided us with a new opportunity to take a look at the effects and role of vitamin D with acquired immunity, both critical systems of human defense,” said senior investigator Dr. Robert Modlin, UCLA’s Klein Professor of Dermatology and chief of dermatology at the David Geffen School or Medicine at UCLA.

Surprisingly, researchers found that although both the innate and acquired immune systems start out by using different receptors to trigger a complex chain reaction in infected cells to kill the tuberculosis bacteria, both converge early on to follow the same pathway that utilizes vitamin D.

Specifically, in the current study, researchers discovered that T cells released interferon-g, which not only activated the infected cells called macrophages to generate cathelicidin and other proteins to kill tuberculosis but, like a honing device, also ensured that these proteins were delivered to the compartment of the cell where the bacteria resides. The cells then gobbled up the infectious areas containing bacteria.

“These current findings provide the first credible mechanistic explanation for how vitamin D critically contributes to acquired T cell immunity that protects us from infections, particularly tuberculosis,” said Modlin, who also serves as vice chair for cutaneous medicine and dermatological research at UCLA and is a distinguished professor of medicine and microbiology, and of immunology and molecular genetics.

Researchers also noted that this is the first study to demonstrate that the protein interferon-g activates cells to kill the tuberculosis bacteria.

“The role of interferon-g has been speculated for years in numerous studies, but previous research didn’t take into account that sufficient vitamin D was needed to help interferon-g trigger an effective immune response,” said study author Dr. John Adams, a professor of orthopaedic surgery at UCLA’s Geffen School of Medicine. “Now we understand better how this chain reaction works.”

According to the team, the findings are also important because they show that this unique pathway to fight tuberculosis cannot be studied in a mouse model. Mice, as nocturnal animals, are not exposed to the sun enough to absorb vitamin D; as a result, the pathway they use to kill tuberculosis is entirely different from humans.

Fabri noted that most people with tuberculosis are asymptomatic, perhaps due to successful immunological control and sufficient vitamin D to keep the infection from developing into active disease.

“At a time when drug-resistant forms of tuberculosis are emerging, understanding how to enhance natural innate and acquired immunity through vitamin D may be very helpful,” said co-author Barry Bloom, former dean of the faculty at the Harvard University School of Public Health, Harvard’s Distinguished University Service Professor, and the Jack and Joan Jacobson Professor of Public Health in the School of Public Health’s department of immunology and infectious diseases and department of global health and population.

According to researchers, the next step is to initiate clinical trials to learn whether vitamin D supplementation can enhance the body’s resistance to tuberculosis and other infections.

The study was funded by the U.S. National Institutes of Health; the Deutsche Forschungsgemeinschaft (German Research Foundation); and the Basic Science Research Program, through the National Research Foundation of Korea.

Source material reprinted from the UCLA

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In May 2011, a landmark study – HPTN 052 – showed major reductions in HIV transmission among discordant couples due to early treatment. The authors of the nine-country study concluded that earlier initiation of HIV treatment led to a 96 percent reduction in HIV transmission to the uninfected partner.

According to the government, an estimated 7.1 percent of cohabiting couples seeking voluntary counseling and testing services in the capital, Kigali, are HIV discordant. Infections within stable relationships have been identified as one of the main sources of new cases in Rwanda.

Rwanda has a successful ART program; Asiimwe said the country had achieved 93 percent coverage of people needing treatment under UN World Health Organization (WHO) guidelines, which recommend initiation of treatment at a CD4 count – a measure of immune strength – of 350 and below.

“HIV-positive people in discordant relationships will start ART regardless of their CD4 count,” said Sabin Nsanzimana, coordinator of the HIV and Sexually Transmitted Infections (STI) Care and Treatment Department at the Ministry of Health’s Centre for Treatment and Research on AIDS, Malaria, Tuberculosis and other Epidemics, TRAC Plus. “We hope to start as soon as the guidelines are approved at the senior management meeting and [endorsed by] the Ministry of Health.”

Rwanda is going ahead despite the fact that WHO has not yet released prevention guidelines for discordant couples. At an International AIDS Society conference in Rome in July, the head of WHO’s HIV/AIDS department, Gottfried Hirnschall, said the organization had delayed the release of guidelines following the HPTN 052 results.

Read more of the story here at the IRIN news service:
RWANDA: Plan to treat HIV discordant couples

“Producing effective TB vaccines requires a better understanding of the mechanisms used by Mycobacterium tuberculosis [the bacterial species that causes TB] to evade the body’s immune responses,” said senior author William Jacobs, Jr., Ph.D., professor of microbiology & immunology and of genetics at Einstein and a Howard Hughes Medical Institute investigator. He notes that the only currently used vaccine, the Bacille Calmette-Guérin (BCG) vaccine, has been notoriously inconsistent in protecting against TB.

To determine how M. tuberculosis outwits the immune response, Dr. Jacobs and his colleagues worked with a closely related species known as Mycobacterium smegmatis that is lethal to mice at high doses but does not harm people. The researchers created a version of M. smegmatis lacking a set of genes, known as ESX-3, considered crucial for evading host immunity. When high doses of the altered bacteria were infused into mice, it became clear that bacteria lacking the ESX-3genes could no longer evade their hosts’ immune system: the mice controlled and cleared the infection through a robust T-cell response—the same response a successful TB vaccine would elicit.

Science Brief thanks to EurekAlert.

Read more here:
TB vaccine candidate shows early promise

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“Microscopic analysis of sputum for TB is cheap and widely available, but misses half of all TB cases,” said David Dowdy, MD PhD, lead author of the study and assistant professor in the Department of Epidemiology at the Bloomberg School of Public Health. “TB culture, the current gold standard, requires training and equipment not available in most resource-limited settings. Serological tests are simpler and faster than culture, and are also commercially available in India, so they are an attractive option in theory. However, we found that they are not accurate enough to be useful—after accounting for missed and false-positive TB diagnoses, serological tests cost more and delivered less than either microscopy or culture. Quite simply, serological tests should not be used to diagnose active TB.”

Science Brief thanks to EurekAlert.

Read more here:
Blood tests for active TB not accurate or cost-effective

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“Our country is sorely in need of a health insurance program. The government should introduce a health insurance program like the 30 Baht scheme that Thailand adopted for poor households,” said Aung Tun Thet, former Health Ministry director-general of planning and statistics and secretary of the inter-ministerial National Health Committee from 1989-1992.

In 2001, Thailand introduced a universal coverage scheme to improve healthcare access for its poorest citizens. Low-income patients are charged 30 Baht (approximately US$1) per medical consultation. The service is free for those younger than 12, over 60, and the very poor.

Though there is no national health insurance in Myanmar, all public hospitals offer a medical cost-sharing plan – first introduced in 1993 – where patients cover medicine and laboratory fees and the state pays doctors’ fees.

Soldiers in military hospitals are exempt from paying for medicine or lab tests, and tuberculosis patients are not required to pay for drugs at a public hospital.

Read more of the story here at the IRIN news service:
MYANMAR: Call for new government to boost health spending

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Retaining cattle that test positive for TB on a farm increases the risk of spread of TB to other herds and wildlife.

To strengthen deterrents, from mid-April cattle testing positive for TB will immediately be tagged and a sample of its DNA retained by Animal Health. These samples will then be cross-checked at random, or where fraud is suspected, against the DNA of animals sent to slaughter.

Agriculture Minister Jim Paice said:

“I am absolutely appalled any farmer would deliberately break the law in this way. The vast majority of farmers with TB in their herds are doing the right thing, and it’s reprehensible that anyone should be trying to get around the tough measures that are helping to control TB in cattle. Anyone doing this sort of thing will be caught and have the book thrown at them.

“We are introducing this extra safeguard to minimize spread of this devastating disease to other herds and wildlife.”

The alleged evidence of fraud has emerged from an investigation instigated by Gloucestershire Trading Standards, which reviewed TB cattle sent to two slaughterhouses. Investigations are now ongoing there and at slaughterhouses in the South West and Midlands.

The Bovine TB Eradication Group for England (TBEG) said:

“We are appalled at this emerging evidence of TB reactor fraud, and we strongly condemn any such behavior. We urge the farming industry and the veterinary profession to continue to work together with the Government on the swift and decisive action announced today.

“We have given clear advice on what measures should be put in place quickly to tackle the problem. This suspected fraudulent behavior by a few farmers should not be allowed to unfairly damage the reputation of the responsible majority or to undermine the TB control regime.”

Source: nds.coi.gov.uk

Net News Publisher for UK News

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

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

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

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

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

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

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

Read more of the story here at the IRIN news service:
MYANMAR: Over 30 percent of TB cases going undetected

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How People Arrived Here:

myanmar tb urban areas twice as high, Myanmar tuberculosis

The possibility that the number of DR-TB cases might treble in South Africa, which has a high TB-burden, highlights the use of this new tool in relation to problems like the pricing and supply of DR-TB medication.

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

“I’m so proud to finally have this test,” said Xoliswa Harmans, a former patient with extensively drug-resistant TB (XDR-TB) and HIV, whose diagnosis in 2008 took six weeks. “It was very difficult [waiting for my results]. I was very sick. I couldn’t eat and was losing weight,” said Harmans, who now works as a TB counselor.

Unlike the previous “gold standard” test, which used a culture technique that could take six to eight weeks, this test – endorsed by the World health Organization (WHO) in December 2010 – provides results in about two hours and has a sensitivity rate of 90 percent.

Another advantage of the new test is its simplicity – it can be used by people who are not necessarily health workers because sputum sample “cartridges” are simply inserted into the machine for diagnosis.

The Ubuntu Clinic in Khayelitsha, about 32km from Cape Town, is so far the only South African clinic to use the test. The township has one of the highest national and global rates for HIV and TB. In 2009, antenatal HIV prevalence was 30 percent, and the case notification rate for TB was at least 1,500 per 100,000 people annually – one of the highest levels of TB infection in the world.

“Because of the rise of HIV, TB has become more prevalent,” said Dr Jennifer Hughes, DR-TB co-coordinator for MSF in Khayelitsha. “People with HIV are more susceptible to dying from TB, so if we can diagnose sooner we can get them on treatment sooner.”

Patients diagnosed with DR-TB are immediately eligible for ARV treatment, whereas “normal” TB patients are eligible only if their CD4 count (which measures immune system strength) falls below 350.

Read more of the story here at the IRIN news service:
SOUTH AFRICA: Quick and easy TB diagnosis puts pressure on treatment

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