Wednesday, January 28, 2009

An Update on Tuberculosis: a more deadly disease than ever

Tuberculosis (TB, TBC) is one of the deadliest diseases in the world and has had a resurgence lately. It kills worldwide roughly 2 million people a year, compared with the 1 million killed by malaria.

TB is a communicable disease of humans and animals, primarily affecting the lungs, caused by a slow growing bacteria microorganism, of the bacillus group.

Clinical trials are now being done around the world to find effective vaccines against the world's three worst infectious disease killers: AIDS, TB, and Malaria. Research is also being done to develope a vaccine for the rampant Hepatitis C Virus. Visceral leishmaniasis (black fever, leishmaniasis involving the internal organs of the body), the world's second most common parasite killer (folowing malaria) also is the focus of new and better treatments.

Promising phase II trials were completed in Kenya and Tanzania for two malaria vaccines. They were published last month and presented at the American Society of Tropical Medicine and Hygiene meeting in New Orleans. Multicenter phase III efficacy (effectiveness) trials should begin early this year, after approval by national regulatory agencies and ethics committees. The vaccines reduced the incidence of illness caused by the malaria parasite by 53% over 8 months and by 65% over 6 months in the two phase II studies.

The cure for TB, using medication, can cost as little as $20, since the medicines are primarily oral and generic (not expensive brand-name drugs). By comparison there is no cure yet for AIDS, and medical treatment can be relativelely expensive.

One third of the world's population is infected with the TB germ. TB germs can live in a person without making the person sick, but often the organisms eventually break away and spread, causing illness. Each year almost 9 million people in the world do become sick with the TB disease. It must be made clear that TB infection is not the same as TB disease. In the U.S. the majority of cases are now in the foreign born.

TB is also the leading killer worldwide of those who have AIDS, the two diseases being a very lethal combination.

About 5% (1 in 20) of the 9 million yearly new cases worldwide are resistant to multiple drugs that are used to treat TB, the highest percentage ever. TB resistant to the two first-line drugs, isoniazide and rifampin, is labelled MDR-TB (multidrug-resistant TB). TB resistant to both first-line and second-line drugs (XDR-TB or extensively-resistant TB) is virtually untreatable and very deadly. XDR-TB carries a 25% mortality within one year, even in the U.S. The dreaded XDR-TB has been found in over 45 countries.

A 2008 WHO report indicates an alarming slowing in the progress of detecting new cases, probably because TB budgets remain flat in most countries of the world. Another problem is that there has been only 25 labs in all of Africa capable of detecting resistant TB (MDR-TB), and 19 of these are in South Africa.

Although there are no quick fixes, there are ways to improve the TB problem:

1. The TB drug resistance problem needs a head-on assault by international partnerships, which include different sectors of society.

2. Governments, pharmaceutical companies, churches, and other NGO's (non-government organizations) can provide free or subsidized access to treatment at a local level in hard-hit areas of the world, or even on a more global scale. Otherwise gains made in resistant TB, as well as in AIDS, treatment, may be lost.

3. HIV positive patients should routinely be tested for TB.

4. Strict adherance to treatment guidelines must be followed, in order to prevent emergence of resistant strains of the TB bacteria (and the HIV virus).

5. TB patients should be separated to reduce the risk of transmission to others.


WHO (World Health Organization)- WHO Stop TB Department (website for XDR-TB)

CDC (Center for Disease Control and Prevention

TB Education and Training Resources (American Medical News, April 14, 2008) (Global Fund to Fight AIDS, TB, and Malaria) (Save the Children)


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