GLOBAL: "Drug-Resistant TB Spreading Around the World"
USA Today (03.05.07):: Anita Manning
Extensively drug-resistant TB (XDR-TB), first reported by CDC and the World Health Organization in March 2006, is continuing to spread. While multi-drug-resistant TB (MDR-TB) is immune to the most powerful first-line TB treatments, XDR-TB is also resistant to some second-line TB drugs, making it very difficult to treat. Health advocates say new treatments are needed.
Last August, all but one of 53 XDR-TB-infected patients in one South African province died from the disease; most were HIV co-infected. Now, the country has an estimated 600 XDR-TB cases, reaching all provinces, Karin Weyer of the South Africa Medical Research Council told last week's 14th Conference on Retroviruses and Opportunistic Infections. Among that estimated number of cases, the mortality rate is 84 percent. More than 80 percent are HIV co-infected.
Regular TB can be treated by a six-month course of antibiotics. When TB drugs are given inappropriately, or patients do not adhere to treatment, MDR-TB can arise, requiring treatment for 18 months or two years. Given enough opportunity, XDR-TB can emerge.
The Global Alliance for TB Drug Development is working with drug firms, academic institutions, and researchers to find new TB drugs, said Maria Freire, the alliance's CEO. There are some promising developments, she said, but the development of an ideal candidate - one that would attack TB in ways that circumvent drug resistance; could be taken with antiretrovirals; and would be effective within two months or less - is likely a decade or more away.
GLOBAL: "TB that Kills HIV Patients Is Spreading"
San Francisco Chronicle (02.26.06): Sabin Russell
At the Sunday start of the 14th annual Conference on Retroviruses and Opportunistic Infections in Los Angeles, researchers reported on a deadly tuberculosis strain that is killing HIV patients in South Africa and has been documented in 27 other countries.
An estimated 600 cases of extensively drug-resistant TB (XDR-TB) have been found in South African patients, of whom most were co-infected with HIV. Around 85 percent of these patients have died, researchers said.
"XDR-TB is a wake-up call," Dr. Paul Nunn, the World Health Organization's coordinator of TB control programs, told the gathering of some 3,800 leading AIDS researchers from all over the world. WHO estimates show that 27,000 people are infected with XDR-TB annually and around 16,000 of those patients die. Global awareness of XDR-TB is greatly needed "but without causing undue alarm," he said.
The international community needs to spend $650 million a year to control various strains of multidrug-resistant TB, of which XDR-TB is only the most recent and most deadly, said Nunn. XDR-TB is not only resistant to first-line treatment but also to at least two types of second-line antibiotics; and thus it is more costly to treat, he said.
Drug-resistant TB appears when first-line therapy is not properly managed. XDR-TB is likely a mutant strain that readily forms when second-line TB treatment is also poorly managed.
It is not clear how transmissible XDR-TB is. One study tested 1,694 relatives and friends of XDR-TB patients and found only 12 cases of multidrug-resistant TB and no XDR-TB cases. Another study of guinea pigs whose cages were placed in the ventilation stream from a room housing XDR-TB patients found 80 percent of the animals tested positive.
"Most public health facilities in the developing world lack airborne infection control procedures," noted Karin Weyer, director of TB research at the South African Medical Research Council.
Title: Best Practices in TB Control # 1: Working With Substance Users and Homeless Populations
Dates: 03/15/2007 - 03/15/2007
Sponsor: New Jersey Medical School Global Tuberculosis Institute.
Contact: For more information contact Bill Bower, E-mail: blb3@columbia.edu; Phone: (212) 939-8258; or access the website: www.umdnj.edu/globaltb/courses/bestpractices1.htm.
Description: Compared to the general population, TB disease and infection are more common among substance users and the homeless. This web-based seminar will explore approaches to working with these two hard-to-reach groups. Experts from the region will share hands-on experiences and practical tools that can improve case management,treatment outcomes, and contact investigations. Case presentations will be included.
Title: Best Practices in TB Control # 2: What Works Best in Low-Incidence Areas and Rural Settings
Dates: 05/16/2007 - 05/16/2007
Website: www.umdnj.edu/globaltb/courses/bestpractices2.htm.
Description: This web-based seminar will explore approaches to TB control challenges in low-incidence settings. Geographical distance and staffing can present program constraints, but some approaches work better than others. Sound TB control principles, flexibility, and a patient-centered approach are essential. Hands-on experts will explain how they are successful in these circumstances. Case presentations will be included.
GLOBAL: "Drug Resistant TB Cases Higher than Once Estimated"
Reuters (12/18/06):: Patricia Reaney
New research analyzing surveys in 79 countries revealed there are more multidrug-resistant tuberculosis (MDR-TB) infections annually than indicated by the previous estimate nearly a decade ago. MDR-TB strains are resistant to at least two of the most widely used first-line TB drugs.
"There is increasing drug resistance in some parts of the world, namely the former Soviet Union and China ," said Dr. Mario Raviglione of the World Health Organization (WHO). Together, China , Russia , and India account for half of all MDR-TB cases worldwide. "By having better data, we are able to recalculate estimates of six or seven years ago," he said.
Earlier estimates of MDR-TB infections put the annual figure at about 300,000 new cases. The more accurate estimate is 424,000 MDR-TB infections in 2004, reported researchers from WHO, CDC, and the Prince Leopold Tropical Institute in Antwerp , Belgium . The higher prevalence of MDR-TB coincides with quickly growing HIV epidemics in Eastern Europe and Asia . HIV patients are more vulnerable to opportunistic infections, with TB being a main cause of AIDS mortality.
MDR-TB rates have declined in Latvia , the United States , Hong Kong, and Cuba , the study found. But infections increased elsewhere, including Botswana and Tomsk Oblast, Russia.
MDR-TB is fueled by poor adherence to the long treatment needed to cure TB. MDR-TB is also a precursor to extremely drug-resistant TB (XDR-TB) strains, in which three or more second-line TB treatments are also not effective.
Health experts recommend improved TB control programs, especially diagnostic capabilities, where MDR-TB cases are high. Directly observed treatment strategies (DOTS), in which patient adherence to the drug regimens is monitored to ensure the entire course of treatment, is also recommended.
The full study, "Epidemiology of Anti-Tuberculosis Drug Resistance (The Global Project on Anti-Tuberculosis Drug Resistance Surveillance): An Updated Study," was published in The Lancet (2006;368(9553):2142-2154).
Title: Powering Up Political Will for TB Control: International Union Against Tuberculosis & Lung Diseases North America Region (IUATLDNAR) 11th Annual Meeting
Dates: 02/22/2007 - 02/24/2007
Sponsor: British Columbia Lung Association. American Lung Association of Metropolitan Chicago.
Contact: For more information contact Menn Biagtan, BC Lung Association,
E-mail: biagtan@bc.lung.ca; Phone: (604) 731-5864; or access the website: www.bc.lung.ca/lungdiseases/tuberculosis_iuatld.html
City: Vancouver, BC Country: Canada
Access the website: www.bc.lung.ca/pdf/11th%20Annual%20IUATLD%20Meeting%20Flyer.pdf for meeting flyer including information on registration, cost, and program details. Description: The theme of this year's conference is "Powering Up Political Will for TB Control." Attendees will have an opportunity to explore many different aspects of tuberculosis prevention and control, including the global impact of international standards, the implications and challenges of human resources, the effects of drug-resistant tuberculosis, new tools and technologies, and jurisdictional aspects of tuberculosis prevention and control. The meeting will be part of the STOP TB Canada meeting and will be joined by the Nurse's Assembly.
UNITED STATES: "Prisons, Jails Urged to Target TB"
Washington Times (06.10.06):: Joyce Howard Price Noting that tuberculosis is "particularly problematic" in US prisons and jails, federal officials have released new guidelines for TB prevention and control in correctional facilities, the first update in these recommendations since 1996.
According to researchers at CDC, incarcerated persons "with undiagnosed TB disease place other inmates and correctional staff at risk for TB, and when released, these persons also can infect persons living in surrounding communities."
The US prison population quadrupled from 1980 (500,000 inmates) to 2003 (2 million inmates), said G. Scott Earnest and other CDC epidemiologists. While 0.7 percent of the US population was incarcerated in 2003, inmates accounted for 3.2 percent of all TB cases that year.
In New York and California, the researchers wrote, TB rates among prisoners are 10 to 15 times higher than among those states' general populations. Furthermore, they said, rates of latent TB infection in prisons have been shown to be as high as 25 percent.
The authors cited a variety of reasons for prisons' higher burden of TB, including: inmates' diverse backgrounds; overcrowding; poor ventilation; HIV infection; injection drug use; and low socioeconomic status leading to poor access to medical care.
The authors noted that "detained immigrants are arriving largely from countries with a high prevalence of TB and therefore present unique challenges in the elimination of TB in the United States," and testing and treating undocumented residents can be difficult. In addition, such patients are sometimes resistant to first-line TB drugs "because of interrupted treatment received" in their home countries.
The full report, "Prevention and Control of Tuberculosis in Correctional and Detention Facilities: Recommendations from CDC," was published in Morbidity and Mortality Weekly Report (2006;55(RR09):1-44).
