News2008

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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(28/11/08) Have you been affected by TB? Join the TB Action Group (TBAG)

TB Alert is delighted to be facilitating this new UK voice for people affected by TB. On Friday 28th November at the second meeting of the network, members agreed, not only a name for the network -TB Action Group (TBAG) but also:

Who? To represent and be made up of “people affected by TB” (not TB "patients"). This is in recognition of the fact that getting through TB is not just a medical process but has potential ramifications on many other areas of a person’s life, and that TB has a large impact not only on the individual but also upon their families and loved ones.

Why? to improve TB services through the knowledge acquired through members' own personal and varied experiences.

What? three main areas of activity - awareness raising, peer support and lobbying - to compliment rather than replicate the work of TB Alert

If you or someone you know has been affected by TB and may be interested in being involved with TBAG please email Tessa Marshall, Information Officer (or call 01273 234770).
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(27/11/08) How nutrition and Tuberculosis are linked

TB incidence was 4-fold higher in people with the lowest standard of living.

95 per cent of new TB cases every year occur in developing countries.

Deficiencies of protein, vitamins and minerals have detrimental effects on the immune system.

In spite of the dramatic advances made in health care in the past decades, it is hard to believe that tuberculosis (TB) kills three people every two minutes in India. Mycobacterium tuberculosis is one of the oldest infectious agents known to mankind.

While infection occurs in 50 per cent of people, an enigma of this disease is why and how the majority (90 per cent) of people is able to keep the bacteria under check all their lives, while in a minority, the immune system loses the battle. The clues are probably in the air we breathe and the food we eat.

Globally, 95 per cent of new TB cases every year occur in developing countries, making it an infectious disease of poverty.

Incidence of TB

While TB can and does affect people from all social classes, a survey done by the Tuberculosis Research Centre (TRC), Chennai showed that the incidence of TB was four-fold higher in people with the lowest standard of living index in the community as compared to the highest.

The determinants

The mechanism by which malnutrition predisposes to TB is an ongoing area of research but it is clear that deficiencies of protein, vitamins and minerals have detrimental effects on all arms of the immune system.

A study done in Harlem in the 1940s where family members of half the black TB patients were given vitamin and mineral supplements found that they developed TB less frequently than those in families without the supplements.

There appears to be enough evidence to suggest that improving the nutritional status of people reduces TB incidence — yet, this has never been given priority as an infection control measure.

Globally about 8.8 million new cases and 1.7 million TB related deaths occurred in 2007 — India alone accounted for one fifth of the global TB burden and 400,000 deaths.

Achieving the goal

While the core of the Revised National TB Control Program (RNTCP) will continue to be the detection and treatment by DOTS (directly observed treatment, short-course) of all TB cases in the community, improving the nutritional status of large segments of our population could help achieve the Millennium Development Goal of reducing TB incidence by 2015.

Malnutrition not only increases the risk of developing TB but also the risk of dying from it. At the individual level, smoking cessation advice and nutritional supplementation should be added to TB treatment.

Food or nutritional support during TB treatment is likely to have multiple beneficial effects — better TB treatment outcomes by improving adherence, improved quality of life and work capacity and serving as an incentive for others to seek out and use government TB diagnostic and treatment services.

While there are few clinical trials demonstrating the benefit of such interventions, operational research while providing food supplements to TB patients, particularly in the hunger hotspots in India could provide the needed evidence as well as be responsive to patient needs.

The DOTS strategy for tuberculosis was based on clinical trials done in Chennai in the 1960s and 70s — we now have the opportunity to once again lead the global fight against tuberculosis by focusing on a neglected area of infectious disease control.

DR. SOUMYA SWAMINATHAN
TUBERCULOSIS RESEARCH CENTRE, CHENNAI.

As reported in The Hindu, to view this article on The Hindu website please click here.
id: 27/11/08nutrition

(20/11/08) TB resources - Presentations available for download

On the 20th November 2008 a TB Conference was held in Manchester at Manchester Royal Infirmary Postgraduate Education Centre.

Please visit the publications page on our website by following this link to download the presentations which took place on the day.

These presentations include;

Tuberculosis and Air Travel - Ibrahim Abubakar, MBBS, PhD, FFPH, Consultant Epidemiologist, Centre for Infections, Colindale, London

Organising a TB Service - the results of BTS Surveys - Dr Marc Lipman, Royal Free Hospital, London

TB in prisons - Dr Sohail Ashraf, Consultant in Health Protection, Cumbria and Lancashire Health Protection Unit

Extreme drug resistant TB (XDRTB) - Professor Peter Davies, Liverpool

The history of Tuberculosis treatment - Dr C C Evans MD. FRCP. FRCPI.

TB commissioning and the TB toolkit - Dr Marko Petrovic, Consultant in Communicable Disease Control, HPA NW Region

The Current Status of Interferon-Gamma Release Assays (IGRA’s) - Professor Peter Ormerod, Royal Blackburn Hospital and Lancashire Postgraduate Medical School

and

IT’S AN ENVIRONMENTAL MYCOBACTERIUM. What do I do...?

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(20/11/08) Eli Lilly wins recognition for work against TB

Eli Lilly and the International Council of Nurses (ICN) have been recognised for their joint work in combating tuberculosis (TB).

They were awarded a corporate citizenship prize at the US Chamber of Commerce Business Civic Leadership Centre's 9th annual dinner.

A new online voting system decided on the prize-winners, with Lilly and the ICN gaining credit for their actions against the rising global threat of multidrug-resistant strains of the disease (MDR-TB).

"Stopping MDR-TB is not about a single action - it's about a series of joint initiatives that improve survival for some of the world's most vulnerable ... patients," said John Lechleiter, the company's president and chief executive officer.

Dave Benton, chief executive officer of the ICN, stressed that nurses represent the world's "front-line resource" in the fight against a number of deadly global pandemics.

Meanwhile Eli Lilly employees and retirees have made a significant donation to charity, the company has announced.

As a result of their efforts, president and chief executive officer of the drugs giant John Lechleiter presented an $11.1 million (£7.5 million) cheque to the United Way of Central Indiana.

As reported by Hays Pharma, to read the article click here.

Related websites:
Eli Lilly and Company
Hays Pharma

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(12/11/08) "Europe failing to respond to global TB threat" - MSF report

Medecins Sans Frontieres report reveals insufficient and badly designed funding for research.

MSF Press Release, Brussels:

New analysis from international medical humanitarian organisation Médecins Sans Frontières (MSF) shows how the European Commission is failing to pay its fair share towards discovering and developing new tuberculosis (TB) vaccines, diagnostics and treatments.

MSF is calling on the European Commission to increase its funding five fold into research for medical tools to fight TB in the face of a global epidemic that claims 1.7 million lives a year.

"Because the tests and drugs we use today aren't anything like effective enough, MSF teams responding to the epidemic in Africa and Asia are faced with an almost impossible task," said Dr. Tido von Schoen-Angerer, Director of MSF's Campaign for Access to Essential Medicines. "We desperately need new vaccines, drugs and diagnostics for TB. This will only happen with more research."

This is ever more urgent given TB's rapid spread among people living with HIV and the rise of drug-resistant strains of the disease which do not respond to many of the commonly used treatments.

On a global scale, around 1.45 billion euros needs to be spent on TB research and development (R&D). MSF estimates that the European Union's (EU) fair contribution would be 409 million euros a year. But MSF's report shows that the European Commission spent a mere 18.7 million euros on TB R&D in 2007.

"Europe's responsibility here is clear," said Dr. von Schoen-Angerer. "Countries right on Europe's doorstep - and even within the European Union - are struggling against resistant strains of the disease. But the research budgets remain pitifully low. Tuberculosis is knocking loudly on the door, but the European Commission is playing deaf."

And member states are not making up the shortfall. An earlier MSF analysis found that Germany, the EU's largest economy, was only contributing 7.5 million euros in 2007. "The European Commission cannot pass the buck on to the member states and vice versa", said Dr. von Schoen-Angerer.

MSF's analysis also shows how the European Commission (EC) funding is badly tailored to suit the needs of developers of vaccines, drugs and tests. The EC largely ignores new alternatives to the traditional patent-based research model, such as non-profit partnerships and prize funds. By eliminating the need for high drug prices to recover research and development costs, these innovative approaches could overcome the neglect of research into diseases that do not attract sufficient investment from industry, such as tuberculosis.

While it focuses on TB, MSF's analysis also looked at other diseases: in 2007, only 17.1 million euros were spent on research and development for malaria. Not a single euro went into research for other neglected tropical diseases such as Leishmaniasis or Chagas, although these affect millions of people in developing countries.

MSF treats almost 30,000 people with tuberculosis in 39 countries worldwide.

To read this press release at MSF.org click here

To read the report;
"Cough up for TB! The Underfunding of Research for Tuberculosis and Other Neglected Diseases by the European Commission" click here.

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(30/10/08) "Tuberculosis in the UK" - the Health Protection Agency's 2008 annual report

"Tuberculosis in the UK" - The HPA's 2008 annual report on Tuberculosis in the UK

This report provides an update on current trends in Tuberculosis in the UK, using surveillance data for cases reported in 2006. In addition, it also highlights the research and development of work carried out by the Health Protection Agency since its inception in 2003.

To view the report electronically follow this link to it on the HPA website.

Related websites:
The Health Protection Agency

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(20/10/08) Successful trial of a candidate vaccine to prevent TB among HIV-infected patients

The Union announces a successful trial of a TB candidate vaccine to prevent tuberculosis among HIV-infected patients.

Paris, 20 October, 2008 – The International Union Against Tuberculosis and Lung Disease (The Union), an international organisation established in 1920 to fight TB and promote lung health worldwide, today announces the successful results of a TB candidate-vaccine trial for HIV-infected patients.

As a fact, Tuberculosis and HIV are inextricably intertwined since the risk of developing tuberculosis in persons carrying HIV is a lifetime risk. HIV infection greatly increases the risk of active tuberculosis in persons who carry the mycobacterium tuberculosis. Today, one in five HIV-infected persons who have a very severely weakened immune system, can develop active TB within a 12-month period, this being an extraordinarily high risk.

Investigators from Dartmouth Medical School (DMS) in the United States and from Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania reported in Paris at the 39th Union World Conference on Lung Health of The Union on the successful trial of a new vaccine against tuberculosis. The researchers described a placebo-controlled seven year efficacy trial among 2000 HIV-infected subjects, showing that those who received the vaccine had a reduced rate of tuberculosis.

The study called “DarDar study” was conducted in Dar es Salaam, Tanzania under the direction of Drs. Lillian Mtei and Kisali Pallangyo of MUHAS.

Dr. Pallangyo declared, "This is a very encouraging development in the global efforts aimed at improving the lives of millions of people co-infected with HIV and mycobacterium tuberculosis, a common problem in sub-Saharan Africa. The research has also demonstrated that international collaboration between industrialized and developing countries in addressing an international problem can be done successfully."

Dr. Ford von Reyn, Professor of Medicine at DMS in New Hampshire and Principal Investigator of the study added, “Because tuberculosis is the most common cause of death among persons with HIV in most resource-limited areas of the world, our research group was focused on developing an improved TB vaccine specifically for patients with HIV infection. We are delighted that the vaccine was shown to be effective.”

The study which started in 2001 was sponsored by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health (US). The vaccine, now known as Mycobacterium vaccae, is an inactivated whole cell vaccine and was given to study volunteers in a five dose series over a period of 12 months. Subjects were then followed every three months to detect cases of tuberculosis. Tuberculosis researchers and representatives from tuberculosis programs around the world attended the scientific presentation in Paris today and were enthusiastic about the possibility of a new approach to preventing tuberculosis in patients with HIV-TB co-infection.

Dr. Nils Billo, Executive Director of The Union, also commented: “Today over 14 million people are co-infected with HIV-TB and a large proportion of this community will develop active tuberculosis if there are no effective interventions. HIV associated to TB is a potentially lethal disease and ways to prevent this from occurring are very much awaited. Therefore, an announcement of a potential vaccine to prevent TB in HIV-infected persons is most exciting and promising for HIV-infected patients”.

About The Union

The International Union Against Tuberculosis and Lung Disease, known as The Union, is the only international voluntary scientific organisation with partners in all regions providing a neutral platform to fight TB, HIV, asthma, tobacco and lung disease. The Union was established in 1920 as a federation of national associations, and today provides direct field assistance to over 75 countries, conducts clinical trials and organises international conferences and training courses. It also publishes The International Journal of Tuberculosis and Lung Disease (IJTLD), which is the reference for clinical research and epidemiological studies on tuberculosis. Among its international initiatives, it manages the grants programme for the Bloomberg Initiative to Reduce Tobacco Use, as well as the FIDELIS Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB, and many others.

Related websites:

The International Union Against Tuberculosis and Lung Disease

To view or print the press release click here.

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(15/10/08) Ancient bones show Tuberculosis is older than previously thought

Human tuberculosis may be 3,000 years older than previously thought, say researchers who analyzed DNA from 9,000-year-old human bones found off the coast of Israel.

"Examining ancient human remains for the markers of TB is very important because it helps to aid our understanding of prehistoric tuberculosis and how it evolved," said the study's lead author Dr. Mark Spigelman, of London's University College.

"This then helps us improve our understanding of modern TB and how we might develop more effective treatments."

Tuberculosis is caused by Mycobacterium tuberculosis bacteria that commonly attack the lungs, which killed an estimated 1.7 million people worldwide in 2006, according to the World Health Organization.

People who develop TB can often be cured provided that proper medical treatment is available. Rare but new drug-resistant strains require more potent and expensive medications that have more serious side effects.

In Wednesday's issue of the journal PLoS One, Spigelman and his colleagues described the bones, thought to be a mother and baby, that were found submerged in a 9,000-year-old Neolithic village off the coast of Haifa.

To read to full report go to CBCNews.ca

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(05/10/08) Global photo exhibition to highlight XDR-TB

The emergence of a devastating drug-resistant strain means that tuberculosis now kills more of us than malaria. Award-winning photographer James Nachtwey travelled from Siberian prisons to Cambodian clinics to document the battle against this 'virtually untreatable' and deadliest of diseases.

TED, a New York-based organisation that brings together leading scientists, thinkers and designers committed to social change, begins exhibiting Nachtweys's photographs in galleries in public spaces on seven continents, from Times Square in New York to Antarctica this weekend. The brainchild of Chris Anderson, a former magazine entrepreneur, TED grants $100,000 to three outstanding people each year and gives them 'one wish to change the world'. Nachtwey's was to use his skills as a photojournalist to raise global awareness of 'extensively drug resistant tuberculosis' (XDR-TB for short) and in the process demonstrate the power of news photography in the digital age.

With TED's funding, Nachtwey travelled to countries as diverse as Cambodia, Siberia, Rwanda and India, documenting the depredations of XDR-TB and the efforts of governments and NGOs to pioneer new treatment programmes that may arrest the disease's progression. On Friday, TED unveiled a slide show of more than 50 of Nachtwey's images at the Lincoln Center in New York and the National Theatre in London. Over the next few weeks the same photographs will be shown on outdoor screens in 50 cities worldwide and on the internet as part of a multimedia campaign that aims to harness the power of the web and 'viral marketing' techniques. At the same time the UK think-tank Demos will exhibit Nachtwey's photographs in a gallery in Brick Lane, east London, renamed the Emergency Room.

The Emergency Room runs from 7th to 22th October at the Bacon Street Project in Bethnal Green.

More details are at theemergencyroom.org, and further details of the project are at tedprize.org/nachtwey.

Details of Nachtwey's slide show are on www.xdrtb.org.

Read Mark Honigsbaum's full article in 'The Observer'

Read the text of Peter Moszynski's article for BMJ News

Related articles:

'Tuberculosis: An Ancient Disease Continues to Thrive' by Alice Park, read it online at TIME
'Technology, Entertainment, Design' conference website

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(04/10/08) Global exhibition on XDR-TB - article by Peter Moszynsky in BMJ

An international multimedia campaign is being launched this week to draw attention to the growing problem of drug resistant tuberculosis.

Centred on the work of the Pulitzer prize winning photojournalist James Nachtwey, and funded by an award from the annual "Technology, Entertainment, Design" conference (www.ted.com), the campaign is being launched simultaneously on 3 October in public spaces on seven continents, from Times Square in New York to Antarctica. In London the pictures are being projected onto the flytower of the National Theatre and also feature in a static exhibition, entitled The Emergency Room, in Bethnal Green, east London.

Mr Nachtwey told the BMJ: "This is a man made catastrophe, resulting from too few resources being allocated for the proper diagnosis and treatment [of tuberculosis] in developing countries."

He continued: "Photographers go to the extreme edges of human experience to show people what’s going on. They believe that your opinions and your influence matter. They aim their pictures at your best instincts: generosity, a sense of right and wrong, the ability and the willingness to identify with others, the refusal to accept the unacceptable."

Joanne Carter, executive director of Results USA, the medical advocacy group supporting the campaign, said: "We hope that the visibility achieved by the global unveiling of these photos will underscore the danger of underfunding and lack of global attention to TB programmes, spur people around the world to demand action, and spur world leaders to act.

"MDR-TB [multidrug resistant tuberculosis] and XDR-TB [extensively drug resistant tuberculosis] are markers of our decades of neglect of tuberculosis—neglect of fully funding and implementing current best practices for treating TB and neglect of investing in development of new and better tools.

"So, right now, increasing public and policymaker awareness, and increasing the public demand for greater action, is one of the best weapons in stopping the spread of drug resistant TB."

She believes that multidrug resistant and extensively drug resistant tuberculosis have "the potential to undo the last decade of progress," both in fighting tuberculosis and in fighting AIDS.

She said, "We are seeing the spread of a deadly, difficult to treat airborne infectious disease that, if not stopped, will make TB far more difficult and expensive to treat. WHO’s MDR report last February reported half a million new cases of MDR-TB each year. And with TB being the biggest killer of people with AIDS, we are literally facing a situation of people now living with HIV (thanks to antiretrovirals) but dying of TB.

"It’s within our power to stop it. A big part of what’s needed is public demand for action." Governments "cannot sit back and watch the deadly trajectory of this epidemic the way they did for so many years in the AIDS epidemic," she added.

As reported by Peter Moszynski for BMJ News

The Emergency Room runs from 7th to 22th October at the Bacon Street Project in Bethnal Green.

More details are at theemergencyroom.org, and further details of the project are at tedprize.org/nachtwey.

Related websites:
'Technology, Entertainment, Design' conference website

id: 4/10/08Peter

(23/09/08) Unified strategy needed to beat big killers

Significant strides have been made in tackling three of the world's deadliest diseases - HIV/Aids, TB and malaria. But co-infection could pose a threat to further progress.

It would be difficult to overstate the global burden of HIV/Aids, tuberculosis (TB) and malaria. Together they account for more than six million deaths per year. Each disease alone poses a huge enough challenge to the developing countries where they are endemic, but co-infection is common, presenting even greater challenges to public health systems and international infection control efforts. Yet despite growing awareness of the overlap of these three diseases, efforts to integrate the fight against them have to date largely been piecemeal.

In recent years, significant progress has been made in tackling each disease, with signs that numbers of new infections are levelling off. The number of new cases of malaria per capita has been falling globally since 2003; new HIV infections fell by 300,000 between 2004-07 to 2.7m; while the latest World Health Organisation (WHO) figures show incidence of TB falling by up to 6% in 66 of 93 countries surveyed.

But there are growing fears that co-infection could halt this progress. In 2006, of the 9.2 million new cases of TB and the 1.7 million deaths caused by the disease, 700,000 cases and 200,000 deaths were in HIV-positive people. In 2005, 11% of TB deaths were caused by HIV. The rise of drug-resistant TB poses another threat, with co-infection making HIV more complex to treat. Mike Mandelbaum, chief executive of British charity TB Alert, which works in the UK and overseas, says: "In sub-Saharan Africa, 70% of TB patients are HIV positive. But mostly the conditions are being dealt with separately. There were calls for a joint approach to co-infection even five years ago but little progress has been made on the ground."

There is also growing awareness of the interaction of malaria and HIV, with infection with one disease increasing the susceptibility to infection with the other. The Medicine Sans Frontiers (MSF) international malaria working group says that, because HIV suppresses the immune system, even where malaria transmission is stable, those infected with the virus face a higher risk of symptomatic malaria infection.

Competition for funding

Historically, failure to join up efforts to tackle all three disease has been due partly to competition for funding. Over the past 20 years, efforts to tackle HIV/Aids have gained much greater donations. The launch of the UN's Global Fund to fight Aids, TB and malaria in 2001 has helped redress this, although 60% of its grants go on fighting Aids. Globally, TB funding rose to $3.3bn (£1.86bn) this year from under $1bn in 2002. Funding for malaria has risen tenfold over the last decade to $1.3bn (£733m) this year, with major donors including the US Presidential Initiative, which has pledged $1.2bn (£677m) over five years.

The Global Fund has only managed to raise half of the $7-10bn (£3-6bn) per year that former UN secretary general Kofi Annan said would be needed to tackle the three diseases. But Dr Christoph Benn, the fund's cluster director for partnership, communications and resource mobilisation, says its impact has been huge. "We have about $20bn (£11.3bn) in pledges, including long-term pledges. For the first two years, donations pledged amounted to just $800m (£451m) a year, now we're at $3.5bn (£1.9bn)."

Among donors, Britain is the second largest after the US in the fight against HIV and Aids. Dfid says it will be "spending £6bn up to 2015 to improve health programmes including HIV and Aids, in addition to the £1bn committed to the Global Fund."

Professor Awa Marie Coll-Seck, executive director of the Roll Back Malaria partnership, says: "If the Global Fund had just been an Aids fund we'd be in a very different situation now. There's still not enough money - we need $3bn (£1.7bn) a year - but coming from such a low figure it's a very important achievement. And there is a big rise in funding for malaria in the next round of Global Fund grants."

At the international level there is growing coordination of the fight against the three diseases. At the International Aids conference in Mexico in August, Roll Back Malaria backed a campaign to get insecticide-treated bed nets distributed freely for people living with HIV and Aids. This June also saw the first HIV/TB global leaders forum at the UN headquarters. The Stop TB Partnership's global drug facility, Unitaid - an international facility for purchasing drugs to combat HIV, malaria and TB - the WHO and the Foundation for Innovative New Diagnostics pledged to accelerate efforts to control drug-resistant TB with funding for new treatment in 54 countries and new labs in up to 16 countries.

In Andhra Pradesh in India, TB Alert India has worked with the Rural Institute for Social Education, a highly experienced non-governmental organisation (NGO) based in Tirupati in the south of the state, to form a coalition of 36 community-based organisations to deliver health programmes alongside their existing support services. Over the next five years these organisations aim to provide health education and patient support to more than 5.5 million people.

TB Alert's Mandelbaum says: "This will involve not just TB but also HIV and malaria. The outcomes will be more prevention of disease, earlier detection and improved completion of courses of treatment, which is the key to preventing drug-resistant TB."

Some doubt the millennium development goal targets to extend malaria treatment and prevention measures, such as insecticide-treated bed nets, may be achieved by 2015. But on this, growing partnership between aid agencies and the private sector has led to spectacular progress. The Japanese Sumitomo Chemical Company and Tanzania's A-to-Z Textile Mills have opened several factories in Africa producing mosquito nets, which are sold through the WHO, Unicef, the UN High Commissioner for Refugees and local NGOs. A second factory is under construction in Nigeria - due to open in March 2009 - which Sumitomo's executive director, Shigenori Tsuda, says will raise production from the current 10m nets a year to 20m./Roll Back Malaria's Coll-Seck says: "All countries are now ready to scale up their mosquito net coverage. In 2005, Ethiopia had around 5% coverage for long-lasting nets. But in the past 18 months it has been able to distribute around 20m nets - and this is a poor country."

As reported by David Batty for The Guardian
id: 23/09/08Mike

(17/09/08) Remains of fourth century TB victim found

YORK, England -- Scientists say a skeleton discovered in a shallow grave at the University of York might be that of one of Britain's earliest victims of tuberculosis.

Researchers said radiocarbon dating suggests the man, between 26 and 35 years old, died during the fourth century.

A detailed analysis of the skeleton revealed the likely cause of death was TB that affected the man's spine and pelvis. Scientists said it was possible he contracted the disease as a child from infected meat or milk. The TB was then dormant until adulthood, when its secondary phase became active.

"This was a remarkable find and detailed study of this skeleton will provide us with important clues about the emergence of tuberculosis in late-Roman Britain," said Cath Neal of the University's Department of Archaeology.

Archaeologists unearthed the skeleton close to the perimeter of the remains of a late Roman masonry building discovered on the site that is, close to the route of an old Roman road.

The burial site is on part of the campus that will not be built upon and school officials are developing plans for community archaeology and education visits once the research is completed.

As reported by UPI.com
id: 170908fourthcentury

(15/09/08) Experts say TB drug development is at critical stage

Consortiums and high levels of partnership are key to finding new drugs and diagnostic tools needed in TB, as is continuous funding, experts at a recent TB symposium in Maputo, Mozambique have said.

The experts further agreed that there is also increasing partnership between clinical part of TB and research.

“Clinical part is now increasingly informing trials and the two arm are learning from each other”, they said.

Prof Clifton E. Barry, head of TB research section at the department of health and human services, National Institute of Health said, although there are complains about the many number of consortiums and partnerships in TB and which together eat into the time medical professionals are supposed to be attending to patients in the field, “these are necessary”, he said.

He said this is necessary considering that many of the countries in sub-Saharan Africa most affected by the diseases the world is trying to fight have only a 30 to 50 percent capacity to do what millennium development goals say need to be done and it is through these various partnerships and consortiums that the few available capacity could be enhanced and new cadre of scientists build up.

He said this important for Africa especially given that TB by and large is still a neglected disease and ceased to be a public health issue in the West despite its recent re-mergence.

Agreeing, Prof Douglas Young, head of the division of Microbacterial research, National Institute of Research, UK, and professor at the Imperial College said for anything to be done in the region, these alliances are needed.

“It is through these alliances that we are able to engage with each at various levels and things are moving---in a bid to bridge the over 15 years that TB was treated as a low key issue”, he said.

He sees the next decade as a crucial period for TB research. He said the recent Global Plan to Stop TB 2006-2015 sets out a comprehensive agenda for optimal use of existing strategies for disease control, while at the same time highlighting the limitations of current tools.

The Global Plan includes a realistic assessment of the size and cost of the research effort required to develop new diagnostics, drugs and vaccines for TB. Innovative discovery research will be crucial to the success of this effort and there is need to bring together two communities---biologists and industry.

There are formidable biological challenges underlying the development of effective new tools, and TB research has to take advantage of the ideas and technologies of cutting edge science to confront these.

Prof Marcel Tanner, Director Swiss Tropical Institute said the TB drug development is a complex process and requires more than money.

He said settings need to be right so as to quicken process and there is need to develop appropriate laboratories, upgrade the few that are found in Africa and link them with each other for ease of sharing information.

Prof Alex Walker, an epidemiology professor at Havard said the task at hand is too big and consortiums are needed adding that although sub-Saharan Africa still does not have a needed number of scientists, thanks to consortiums, there are more than there used to be some years ago.

This requires funding---lots of it. Prof Clifton conceded that funding for TB has improved and is better than four years ago. But current funding can only support work on TB to Phase 2.

Clifton said money needed for Phase one and two is available thanks to funding from the Bill and Melinda Gates Foundation among others but asked who is to fund the critical stage—Phase 3.

According to Prof Paul L. Herling, head of corporate research at the Novartis International, funding for phase 3, the clinical trial phase is urgently needed.

He proposes a new model that could see funding for TB and other neglected diseases ravaging most of sub-Saharan Africa solved.

Herling’s model applies to areas where a large medical need exists but where no commercial returns can be expected and addresses the fact that the largest part of the cost of medicines’ research and development is due to the failed projects.

He said while the historic funding has built a portfolio that is moving towards clinical trials and led to current molecules in pipeline, future needs are estimated at over USD10 billion to help move these pipelines into clinical trials and hope to come up with effective TB drugs that are effective, simple and short as to increase adherence and hence curb resistant-strains TB.

Prof Herling said the biggest challenge now facing the TB community is the fact that portfolios are fragmented across players –even in key diseases.

But said the portfolio management challenges are still less well recognized among the product development partners.

However, there is a broad support for continuing to work through these partnerships. He said prioritization of funding across diseases is going to be necessary, even in a scenario with sufficient funding and acknowledged that this is politically sensitive area as some donors are hesitant to delegate this responsibility.

The model he envisages is to create a major pool of funds by mechanisms similar to GlobalFund, GAVI, International Finance Facility fed by Governments, both of developed and developing world (latter must contribute as they are responsible for the health of their citizens ), charities (Welcome, BMGF, others).

He said major problem might not be finding money but how to make it efficiently available to entities discovering and developing medicines for neglected diseases.

He proposed that to go about the problem, there is need to establish a portfolio management committee nominated by fundersbut fulfilling stringent professional criteria.

Their task would be to evaluate submitted projects and fund the selected ones to the next decision point in development (phase transitions), monitor the progress and make funding decisions for next phases as well decide development strategy.

This is identical to the process currently used in Pharma, the same decision criteria (scientific, technical feasibility, medical need, target product profile etc.) should be used with the exception of commercial viability.

He acknowledged that this draft of a model might be sufficiently attractive to Pharma companies as some of them have already shown their interest to contribute to the access to medicines problem and does not threaten the IP protection essential for innovation.

He suggested that this model might be combined with others such as advanced market commitments, for late stage developments e.g a vaccine amd medicines in late Phase 3 clinical trials.

As reported at Africa Science News Service
id: 150908critical

(15/09/08) Genetic 'revamp' of old tuberculosis vaccine shows promise

German researchers have used genetic engineering to breathe new life into an old tuberculosis vaccine. The newly developed vaccine, VPM1002, is based on the Bacillus Calmette-Guérin (BCG) vaccine, which was created in 1921. BCG is one of the most commonly used vaccines worldwide but is now frequently ineffective. The promising new vaccine has reached the clinical trials stage and, it is hoped, will be ready for worldwide use in the next 10 years.

Tuberculosis (TB) is a disease that primarily affects the lungs. It is transmitted easily when people live in very close proximity to one another, and is very widespread in developing countries. According to the World Health Organization, nearly one third of the world's population has been exposed to the tuberculosis pathogen; approximately eight million people contract the illness and two million people die of it every year.

Most people who contract TB do not develop full-blown symptoms; 90% of people who have been exposed to the pathogen experience what is known as a latent infection. However, one in ten of these latent infections progress to the active form of the disease, and people who are not treated have only a 50% chance of survival. TB is the leading cause of death among people infected with HIV.

TB treatment includes isolation (to break the chain of transmission) and therapy with several types of antibiotics over the course of at least six months. Resistance to antibiotics is a growing concern, and the increasing occurrence of multi-drug-resistance has been quite alarming. Vaccination programmes are pivotal for prevention, and the development of new and more effective vaccines is of ever-increasing importance.

VPM1002 is based on the BCG vaccine, which was developed at the Pasteur Institute in France and is currently given to approximately 85% of infants in 172 countries. While it is very effective in preventing TB in children, its efficacy is widely variable in adolescents and adults (ranging from 0 to 80%).

Professor Stefan Kaufmann, Director of Germany's Max Planck Institute for Infection Biology, led the team of researchers that genetically modified the BCG to create VPM1002. Leander Grode, who now heads the project at Vakzine Projekt Management GmbH (VPM), explains, 'The weakened vaccine was genetically modified in such a way to ensure that it is no longer able to hide from the human immune system and even stimulates the body's own defences.' To make this happen, a gene from a different bacterium, Listeria, was inserted into the vaccine.

In the new scenario, the vaccine bacteria are taken up by the scavenger cells of the human immune system (macrophages) and end up in their digestion chambers, called phagosomes. The genetically engineered modification allows the vaccine bacteria to escape from the phagosomes; they are then present in the middle of the immune cell. Dr Grode explains, 'This alarms the rest of the immune system, which is then armed to repel real tuberculosis pathogens.'

VPM1002 stimulates the human immune system to prevent infection by the most common TB pathogen, Mycobacterium tuberculosis. The vaccine has proven successful in animal models, and human trials are now underway. Testing the vaccine for safety and long-term effects will take up to 10 years.

The basic research for VPM1002 was undertaken by Professor Kaufmann's team at the Max Planck Institute. The vaccine was licensed to VPN, a public-private partnership between the German Federal Ministry for Education and Research and the Helmholtz Centre for Infection Research, in 2004.

Read this story at Cordis News

Other reports on this story:
MedIndia.com
Science Daily

id: 15/09/08german

(15/09/08) ‘Dangerous Synergy’ of Crack and Infectious Tuberculosis

Research funded by health authorities in England indicates crack cocaine users are significantly more likely to be infected with resistant forms of tuberculosis than are other users of hard drugs -- a worrisome finding given the rise in London's crack users, according to the authors, whose study is published in the September 2008 issue of CDC's Emerging Infectious Diseases journal.

The paper "Crack Cocaine and Infectious Tuberculosis" was written by Alistair Story of London's Health Protection Agency, Graham Bothamley of Homerton Hospitals National Health Service Foundation Trust in London, and Andrew Hayward of the University College London Centre for Infectious Disease Epidemiology in London.

"Our study suggests a dangerous synergy between TB and crack cocaine," they concluded. "Users may experience addiction-related problems that complicate access to healthcare and aggravate transmission, possibly aggravated by a biological driver that may increase susceptibility to infection and progression to infectious disease."

Habitual smokers of crack cocaine inflicts lung damage, resulting in intensive coughing, shortness of breath, shortness of breath, and exacerbation of asthma, the authors say. They analyzed clinical and social data collected by case managers for all TB patients ages 15-60 undergoing treatment in London on July 1, 2003, then used univariate analyses to compare the characteristics of crack users, other hard drug users, and those not known to use drugs. TB patients who used crack cocaine were mostly 20-49 years old, and 86 percent of them were smear positive versus 36 percent of patients who were not known to use drugs, they wrote. The risk for smear-positive disease was 2.4 times higher in crack users than for other drug users and the highest among groups studied.

Read this story at Occupational Health and Safety online

Related websites:
Emerging Infectious Diseases Journal
Health Protection Agency
id: 15/09/08crack

(14/09/08) Scientists crack secrets of TB bug

Scientists have cracked the secret of how the tuberculosis bug survives and spreads inside the lungs.

They hope the discovery will lead to new ways of fighting TB, which causes more deaths worldwide than any other potentially curable infection.

Mycobacterium tuberculosis invades immune system cells in the lungs and keeps them alive to function as temporary incubators.

The bacteria multiply within the macrophage white blood cells and then burst out to infect other cells.

Normally a biological "fail-safe" mechanism would destroy the infected cells, wiping out the invading bacteria at the same time and triggering an immune response.

But M. tuberculosis prevents this kind of planned "cell suicide", called apoptosis, from taking place, scientists have learned.

Instead the cells die an unnatural form of death called necrosis, which allows the replicated infectious bacteria to escape and evade the immune system.

Experts hope the research, published in the journal Nature Immunology, will help them develop new drugs to stop the TB bug spreading.

The US study led by Dr Heinz Remold, from Harvard Medical School in Boston, showed that the bacteria blocked a key mechanism essential for cell suicide.

Around nine million new cases of TB and almost two million deaths are reported around the world each year. In the UK there are about 8,500 infections each year. Of these, around 8% are drug resistant strains.

As reported by the Press Association

id: 140908bug

(01/09/08) Images to Stop TB: Photo contest launched by Stop TB Partnership

The Stop TB Partnership has launched a photo competition to obtain outstanding photos depicting tuberculosis (TB) prevention and treatment and community activity to raise awareness about it.

Entries can be sent in till 30 October 2008.

Please click here for more information on the competition and how to enter.

Related websites:
Stop TB Partnership
id: 01/09/08photo

(25/08/08) Drug Resistant TB can be treated with agressive treatment

Harvard researchers suggests that extensively drug resistant or XDR Tuberculosis can be treated effectively with aggressive therapy.

XDR- TB is linked with high death rates and is thought to account for at least 7 percent of cases of the infection throughout the world.

According to the latest study published in the journal The Lancet, in spite of the fears that extensively drug resistant is untreatable, researchers suggests that a cure is possible with a combination of at least 5 medications.

Lead author of the study, Dr. Salmaan Keshavjee, a doctor at Harvard Medical School in Boston, Massachusetts said, "While early studies suggested that XDR TB is untreatable, our report indicates that while it may be difficult, it is possible to treat these patients through the use of aggressive regimens."

"A cure rate of 48.3 percent is promising in a disease that has been touted as untreatable,” Dr. Salmaan said.

Dr. Keshavjee and colleagues conducted the tests at prisons in Tomsk, Russia, where drug-resistant tuberculosis is widespread. The researchers looked at the 608 patients with MDR-TB, a strain of the disease that is resistant to the most commonly used treatments isoniazid and rifampin. 5 percent or 29 patients had XDR-TB, where the strains also don't respond to fluoroquinolone and injectable antibiotics including amikacin, kanamycin or capreomycin.

The researchers reported that they were successful in treating nearly 50 percent of the patients with XDR-TB and 66.7% of the other patients were cured.

British Lung Foundation’s spokesperson, Dr John Moore-Gillon says that the sad news is that we have extensively drug resistant tuberculosis in the first place.

He said, "The reason we have the problem is inadequate control of TB. This treatment is extremely labour and resource intensive and has to be done within extremely well structured TB programmes.”

Adding further he said, "It's a very important paper showing it's possible to deal with XDR-TB but it's very expensive."

Though, treatment for MDR-TB costs tens of thousands but when it comes to treatment for XDR-TB it's "much more than that" Dr Gillon said.

Nearly 1 in 3 people in world are infected with dormant TB bacteria. Only when the bacteria becomes active do people become ill. TB generally is found in people with weak immune systems, such as those who are HIV+, of older age or on certain medication. It is an airborne bacteria which often infects the lungs.

TB is treatable, but if not managed properly can mutate into drug-resistant strains. Nearly 2 billion people of the world's population may be infected with Mycobacterium tuberculosis, the bug that causes tuberculosis.

Every year, the UK reports nearly 50 to 70 cases of multi-drug resistant (MDR) TB. XDR-TB, a strain which is resistant to 3 or more of the 6 classes of second line drugs was first found in the South Africa in the HIV/AIDS population.

According to the World Health Organization, approximately 8 million people throughout the world develop active tuberculosis and almost 2 million die every year. XDR TB has so far been confirmed in the US, Canada and another 45 countries world wide.

As reported by Abby Kapoor for themedguru.com

Related websites:

The Lancet.com

Follow the links below to read related stories:

BBC
Insidemedicine.ca
Bloomberg.com

id: 250808XDR

(12/08/08) 1% of HIV-Positive People Worldwide Have Been Tested for TB

About 1% of HIV-Positive People Worldwide Have Been Tested for TB, Report Says

Only 1% of people living with HIV/AIDS worldwide have been screened for tuberculosis, according to a report recently released by the coalition Advocacy To Control TB Internationally, or ACTION, Reuters reports. The report, which is based on World Health Organization statistics, was released Thursday at the XVII International AIDS Conference in Mexico City.

According to the report, of the 33 million HIV-positive people worldwide, only 314,394 have been tested for TB, and of those screened, more than one in four were found to have active TB (Shankar, Reuters, 8/8). People living with HIV are 50 times more likely than HIV-negative people to develop TB, and without proper treatment, 90% typically will die within months, according to WHO data. None of the world's three largest HIV/AIDS donors -- the Global Fund To Fight AIDS, Tuberculosis and Malaria; the President's Emergency Plan for AIDS Relief; and the World Bank -- requires mandatory TB testing for HIV-positive individuals (IRIN/PlusNews, 8/8).

Researchers from ACTION at the AIDS conference said the low TB screening rate is "unacceptable." The group recommended universal TB screening for HIV-positive individuals, along with access to the three "I"s: intensified TB case detection, infection control and isoniazid preventive therapy. According to Jim Yong Kim, chief of the Division of Social Medicine and Health Inequalities at Harvard Medical School, screening tests for TB are inexpensive compared with the cost of antiretroviral drugs. Kim added that an integrated approach is necessary to address HIV/TB coinfection (Reuters, 8/8). Advocates at the AIDS conference also called on global leaders to commit to universal access to high quality HIV/TB care by 2015 (ACTION release, 8/7).

According to Kim, the initial pressure to deal with HIV/AIDS led to HIV services developing separately from TB services. "But now the focus needs breadth," Kim said, adding that people living with HIV need a "full range of public health services, including TB care." Kim noted that TB diagnosis tools may be outdated but that HIV programs could perform better even with existing TB diagnostic technology. "TB is a very curable disease," Kim said, adding that even extensively drug-resistant TB can be treated, according to a study conducted in Peru. "It is a crime for people with access to [antiretrovirals] to continue to die from TB," Kim said. Vuyiseka Dubula, secretary general of South Africa's Treatment Action Campaign, added that "[i]gnoring TB screening and care undermines all the gains made in HIV treatment," (IRIN/PlusNews, 8/8). According to Michel Sidibe, assistant secretary general and deputy executive director of UNAIDS, TB is a "preventable plague inside a devastating epidemic" (Reuters, 8/8).

In an effort to address HIV/TB coinfection, several HIV/AIDS and TB advocacy groups at the AIDS conference collected more than 10,000 postcards signed by people affected by HIV/AIDS and TB. The postcards will be sent to heads of the Global Fund, PEPFAR and the World Bank, as well as to the ministers of health in four countries -- Botswana, Kenya, Nigeria and South Africa -- with high HIV and TB burdens (ACTION release, 8/7).

Kaiser Daily HIV / AIDS Report available on Kaisernetwork.org

Read the report:
'The 1% Scandal: Living with HIV, Dying of TB' by ACTION, Advocacy to Control TB Internationally here.

Other reports of this story:
Reuters

Related websites:
ACTION, Advocacy to Control TB Internationally
WHO, World Health Organisation

id: 1208081%

(11/08/08) New TB test grabs limelight at AIDS conference

A new TB diagnostic test said to provide more reliable information more quickly was a highlight of last week’s international AIDS conference in Mexico following its global launch in July.

Developed by Inverness Medical Innovations, a leading provider of near-patient diagnostics, monitoring and health management solutions, the Clearview TB ELISA was featured at AIDS 2008 and is claimed to provide a much needed aid in the diagnosis of Mycobacterium tuberculosis (TB) in TB/HIV co-infected patients.

In 2007, approximately 33m people were living with HIV infection and due to their compromised immune status, more than one third were co-infected with TB. TB, therefore, is a leading cause of death in this patient group, creating a real need for reliable TB diagnostics.

Enabling treatment decisions to be made on the same day, the Clearview TB Elisa test allows for more effective patient health management and helps to mitigate the risk of further transmission to a highly vulnerable population.

The test has shown strong performance in detecting TB in those co-infected with HIV, by using antibodies specific to the antigen lipoarabinomannan (LAM).

Elevated levels of the LAM antigen within the urine of TB/HIV co-infected patients provides a specific and reliable diagnostic target. Clinical data shows that, while microscopy methods detect TB in these TB/HIV co-infected patients, at rates as low as 20%, targeting the LAM antigen using the Clearview TB ELISA can produce detection rates of 80%.

Ron Zwanziger, Inverness’ CEO said: “Introduction of the Clearview TB ELISA is an important first step in making available much-needed diagnostic tools to address the TB epidemic where the need is greatest. We are working hard to build support for its widespread adoption.”

As reported on Medical Laboratory World

Other reports of this story:
The Wall Street Journal

Related websites:
Inverness Medical Innovations

id: 110808limelight

(02/08/08) Anglican Communion Discuss Global TB/HIV Co-epidemic

Anglican Communion Discuss Global TB/HIV Co-epidemic at Lambeth Conference

On Monday 28 July, advocacy organisation RESULTS UK held a panel-led seminar on the co-epidemic of tuberculosis (TB) and HIV/AIDS at the Lambeth Conference in Canterbury. The Lambeth Conference takes place once every ten years and provides a forum for debate on key issues affecting the Anglican Communion.

The session, "The Deadly Co-epidemic of Tuberculosis (TB) and HIV/AIDS", coincided with two major themes of the 2008 Lambeth Conference; HIV/AIDS and the Millennium Development Goals. It was chaired by the Most Reverend Thabo Makgoba, Archbishop of Cape Town who called upon his colleagues to look at how churches can help halt the spread of these diseases.

Presentations on the state of the global TB/HIV co-epidemic and the role of faith-based organisations (FBOs) in tackling the epidemics were given by Dr.Hailyesus Getahun, Head of TB/HIV at the World Health Organisation, Kenyan TB/HIV patient advocate Lucy Chesire and Dr. Kingsley Moghalu, Head of Global Partnerships at the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Dr. Getahun explained that less than one per cent of people living with HIV worldwide are being screened for TB despite the fact that TB is the leading killer of people living with HIV. Lucy Chesire, who shared her personal experience of living with both diseases, called upon the Anglican Community and other churches to help reduce stigma and to provide integrated support for patients with HIV and TB.

Dr. Moghalu noted that only five per cent of Global Fund grants are being implemented by FBOs and that this figure should be much higher given the position that such organisations are in to influence change and to reach those in greatest need. The Global Fund's ninth funding round will be launched later in the year and provides and opportunity for the Anglican Community to submit proposals.

Participants agreed that the session should be a starting point for further collaboration between the Anglican Communion, civil society and international organisations to address these diseases of poverty.

Read the article at HealthDev.net
id: 02/08/08anglican

(29/07/08) Mass campaign needed to control TB in India

A national mass campaign, similar to the polio eradication campaign, should be launched to control the spread of tuberculosis, said Shashidar Buggi, director of the State-run SDS Tuberculosis (TB) Sanatorium and Rajiv Gandhi Institute of Chest Diseases (RGICD) Hospital in Bangalore on Saturday.

He was addressing nursing students at an orientation programme on the Revised National Tuberculosis Control Programme (RNTCP) jointly organised by Karnataka State Tuberculosis Association and SDS TB Sanatorium and RGICD Hospital at the School of Nursing in Bowring and Lady Curzon Hospital.

Pointing out that one person died of TB every 90 seconds, Dr. Buggi said India had three-fourths of the TB cases in the world.

“Although TB is the most common communicable disease, we have not been able to control it because of ignorance, lack of cooperation from the patients and their family members and misconceptions about the disease.

There is a need to launch a mass campaign similar to the polio campaign to control TB,” he said.

Long treatment

“It is unfortunate that even after the introduction of the RNTC programme, the disease prevails in the country. This disease requires long treatment (a minimum of six months).

But patients discontinue medication once they start feeling better. These are the ones who pose a serious threat of cross infection at home and community,” Dr. Buggi said.

S.S. Revadi, Senior Specialist at the hospital, said there was no need to admit a patient as soon as he tested positive.

“We have noticed that the family members are eager to get the patient admitted in a hospital as soon as they come to know that the person has TB.

But that is not required all the time. The patient can be treated effectively without being admitted to a hospital with cooperation from the family members,” he said.

While most people suffered from pulmonary (respiratory) TB, infections could even lead to tuberculosis of brain, eye and skin.

In fact, younger people were more affected by TB nowadays, he added.

As reported in The Hindu
id: 290708campaign

(25/07/08) Figo scores a goal against tuberculosis in new comic book

International football star Luìs Figo is now the captain of a different kind of team -- the Stop Tuberculosis Team -- whose players come alive on the pages of a newly released comic book. In Luìs Figo and the World Tuberculosis Cup, Figo's fellow players are teen-aged girls and boys. Together they win a match against a team of tuberculosis germs.

The comic book, which seeks to teach children and teens about tuberculosis and how to prevent it, was launched yesterday in Lisbon by Dr Jorge Sampaio, the UN Secretary-General Secretary's Special Envoy to Stop TB and the former President of Portugal. "We hope this comic book, with its thrilling narrative and images, will convince young people all over the world that in the game of life, we are facing a tough match against TB. But it is a match they can win, along with their families and friends," Dr Sampaio said.

In a statement released on the occasion of the launch Figo urged young people everywhere to take the comic book's messages seriously. "Tuberculosis is a killer, and I want all of you to stay safe from it. I am passing the ball to you -- you can help reach the goal of stopping tuberculosis," he said.

Designed by artist Rod Espinosa with a script provided by the Stop TB Partnership, the comic book is the product of a global competition launched in January 2008. An international jury of cartoon experts, together with representatives from UN organizations, selected Mr Espinosa's design proposal among 22 entries.

"The Stop TB Partnership has a vision: that today's young people will see tuberculosis eliminated in their lifetimes. We believe this comic book will spur them to take up this challenge as their own," said Dr Marcos Espinal, the Partnership's Executive Secretary.

Read the press release here

id: 250708figo

(25/07/08) TB posing 'major challenges' to HIV treatment

Health experts are urging the inclusion of tuberculosis prevention programs in HIV treatment and care, as TB is a major cause of death among HIV patients.

Dr Diane V. Havlir, of the University of California, San Francisco, and colleagues examined interactions between HIV and TB for HIV care programs and the framework for HIV programs to incorporate TB activities, and global progress in implementation.

"As HIV care expands further, there is both an opportunity and necessity for incorporation of TB control activities into these programs," wrote the authors.

"Tuberculosis programs simply do not have the capacity to provide ongoing TB screening, prevention, and treatment for millions of individuals receiving HIV care," they added.

The authors said that TB poses numerous challenges to HIV treatment/including drug-resistance, difficulty in diagnosis and treatment in HIV-infected persons and complications from drug interactions. "Finding and treating TB cases, administering antiretroviral therapy (ART) and isoniazid preventive therapy [IPT; an antibacterial drug], and infection control are critical activities to incorporate into HIV care programs, the first chronic care models to emerge in many developing countries.

"Because patients with HIV are at risk for TB throughout life, activities should be ongoing in pediatric and adult ART clinics, pre-ART clinics (keeping relatively healthy patients engaged in care), and maternal health programs," said the authors. The authors suggested several approaches that would help in reducing the TB mortality rate in HIV patients.

The first approach TB Intensified Case Finding includes both active identification of TB among patients with HIV in care and screening their household members for active TB. This can prove to be the most effective TB control measure.

Then comes treating Individuals with active TB. The authors suggested expansion of a care model whereby TB is treated by HIV programs. HIV care staff is trained to diagnose and treat a wide array of infections associated with HIV disease.

Allowing Isoniazid Preventive Therapy administration, which in some countries is either against national policy or impossible because of the stringent requirements for the exclusion of TB before IPT initiation would also help in reducing deaths.

Antiretroviral Therapy is one of the most powerful weapons against TB. The earlier ART is initiated, the lesser is the TB risk. TB Infection Control is one of the most challenging areas. Implementation of measures in both outpatient and inpatient health care facilities that will reduce the risk of TB transmission and protect health care workers is a challenge. TB infection control guidelines exist but are rarely implemented.

It is essential to recording and reporting TB infections. Standardized recording and reporting formats in accordance with national TB and AIDS control guidelines should be used.

Lastly, Joint HIV/TB Planning, the authors suggest that successful implementation of TB interventions in HIV services requires effective communication, coordination, and collaboration with TB control programs.

"HIV care programs must take a bold approach to TB prevention, diagnosis, and treatment to successfully address the catastrophic and intersecting epidemics of HIV and TB," said the authors. The report appears in the July 23/30 issue of JAMA.

As reported at Oneindia

Read other related HIV/TB stories:

African Science News Service
Kaisernetwork.org
China View

id: 25/07/08HIVTB

(23/07/08) Joint venture to develop advanced TB vaccine

The University of Oxford and Emergent BioSolutions Inc. (NYSE:EBS) announced today that they have formed a joint venture, The Oxford-Emergent Tuberculosis Consortium Ltd. (the “Consortium”), to further develop MVA85A, the world’s most clinically advanced vaccine candidate for the prevention of tuberculosis.

The University of Oxford, through its technology transfer office, Isis Innovation Limited, has exclusively licensed the MVA85A tuberculosis vaccine candidate and related technology to the Consortium.

The Consortium will work with the Aeras Global TB Vaccine Foundation to evaluate the efficacy of MVA85A in infants in a Phase IIb clinical trial anticipated to begin in 2009. The trial will take place at a clinical trial site developed by Aeras and the University of Cape Town’s South African Tuberculosis Vaccine Initiative (SATVI) in Worcester, South Africa. The Consortium has secured £8 million (approximately $16 million) from The Wellcome Trust and the Aeras Global TB Vaccine Foundation to fund this Phase IIb trial. Under agreements with the Consortium, Emergent BioSolutions has the rights to commercialize the MVA85A vaccine. The Aeras Global TB Vaccine Foundation will have distribution rights in the developing world to ensure availability and access to the vaccine to those who need it.

The MVA85A vaccine candidate is designed to work in tandem with the Bacille Calmette Guerin vaccine (BCG), which is currently the only available vaccine against tuberculosis. BCG is administered to infants throughout the developing world and in certain countries in the developed world. However, BCG provides only variable protection against pulmonary tuberculosis and is not effective in adults.

The MVA85A vaccine candidate is intended to augment the response of T-cells already primed by the BCG vaccine. Clinical trials to date have demonstrated consistently high cellular immune responses in those who received the MVA85A vaccine candidate following vaccination with BCG. The MVA85A vaccine has been awarded orphan drug status by EMEA and is the most clinically advanced of a new generation of tuberculosis vaccine candidates.

The MVA85A vaccine was originally developed at the University of Oxford by Dr. Helen McShane, a Wellcome Trust Senior Clinical Research Fellow, working with Dr. Sarah Gilbert and Professor Adrian Hill, a Wellcome Trust Principal Research Fellow. Further funding has been provided by the European Community's fifth and sixth Framework Programmes and the Medical Research Council (MRC), a UK organization dedicated to promoting the balanced development of medical and related biological research in the UK.

“I am excited by the prospect of further development of this promising vaccine candidate,” said Dr. McShane of the University’s Jenner Institute. “Curbing tuberculosis is a pressing global health priority, and if achieved could save the lives of millions. We at Oxford have selected Emergent BioSolutions as our commercial partner given their vaccine development experience and dedication to bringing lifesaving