27th March 2017
Problems are continuing in South Africa with people having incurable TB. In January 2017 there was a report of a prospective study that had been carried out looking at the outcomes for people who effectively had incurable TB, sometimes referred to as totally drug resistant TB or extremely drug resistant TB. The study followed for six years a group of 273 patients who either had XDR-TB or who had effectively incurable TB. It was found that 74% had unfavourable outcomes such as treatment failure of death.
Not only were there unfavourable outcomes for the people themselves, butt it appears that these people also spread virtually incurable TB to other people. This was because some of these peope were highly infectious at the time that they were discharged from hospital into the care of their families in the community. Discharging patients with incurable XDR TB is a major concern among doctors.
“We are sitting on a ticking time bomb and if we continue in this way we will have a disaster on our hands” Keertan Dheda, Professor of Medicine, University of Cape Town.
16th February 2017
Researchers at the CROI conference taking place in Seattle have reported that they have treated people with XDR TB for just six months with a new combination of TB drugs. At the end of the six months most people no longer had detectable bacteria in their body.
The researchers used a combination of drugs, bedaquiline, pretomanid and linezolid. This combination is known as Nix-TB.
See also Treatment of drug resistant TB
19th January 2017
A new study in South Africa also suggests that XDR TB is being transmitted from person to person rather than being caused by inadequate treatment.
In South Africa where the new study was done there has been a 10 fold increase in the number of extensively drug-resistant cases in the past decade. One in 36,000 are now infected.
For many years, there was this thought that maybe drug-resistant TB strains might not be able to be transmitted as efficiently as regular TB strains. Dr Neel R. Gandhi of Emory University’s Rollins School of Public Health.
31 clusters of the disease were found, the largest of which accounted for 84 percent of the 404 patients studied. Living with someone with TB accounted for most of the acquired cases, although the disease was also spread in the workplace (representing 13 percent of cases) or in other community settings such as a church, bar, beauty salon or prison (accounting for 8 percent of cases).
See also Drug Resistant TB in South Africa
2nd December 2016
A new study has shown that MDR-TB strains in Shanghai are mainly being transmitted from person to person, and that often these strains are becoming more resistant as they spread. It has been commonly believed that most MDR-TB results from inadequate treatment but the findings of this study suggest that there is evidence of transmission of MDR-TB at the population level.
Overall the researchers found that 367 of the 7,892 patients (5%) had MDR-TB, and that transmission of MDR strains accounted for 73% of MDR-TB cases overall. Residential communities and related public facilities were the most common transmission settings.
See also TB in China
1st November 2016
Despite receiving 300 doses of bedaquiline from USAID, India has enrolled a mere 36 patients
Six months after the launch of the new TB drug bedaquiline, the Indian government has enrolled a mere 36 patients. India has received a donation of 300 doses from the United States Agency for International Development, with another batch of 300 doses to be donated next year. Bedaquiline is particularly used for the treatment of drug resistant TB.
“India has been really remiss with its bedaquiline program. Since it was announced only a handful of patients have been enrolled. For a country as advanced as India, with thousands of patients who would benefit from new drugs, this glacial pace is really disappointing”, said Jennifer J Furin, Lecturer on Global Health and Social Medicine at Harvard Medical School.
19th November 2016
Tens of thousands of British babies may have been left at risk of tuberculosis because of a global shortage of vaccine.
Babies born in east London, parts of the West Midlans and other areas with large overseas populations, and where there is a high risk of the disease, may not have been given the vaccine since Public Health England ran out of supplies in June.
Dr Helen Fletcher , a TB specialist at the London School of Hygiene and Tropical Medicine, said the disease spread slowly, so it could be “years before we see the impact” of the shortage. She added that “This crisis has been a long time coming. BCG vaccination in the UK is a mess”.
22nd October 2016
The World Health Organisation’s report for this year, the Global TB Report 2016 says that the spread of the disease is greater than previously estimated, and that global efforts to beat it are falling far short of what is needed.
Although the overall number of TB deaths has continued to fall, new data shows that 50 percent more cases exist in India than previously thought.
Based on WHO estimates, some 480,000 people contracted multi-drug resistant TB in 2015, more than half of them in India, China and Russia. And most people who have multi-drug resistant TB are not getting proper treatment.
11th October 2016
Kenya has become the first country in the world to roll out nationwide child friendly TB drugs. The improved treatment was first announced at a conference in South Africa last year, and it has taken a quite a while for the drugs to become available.
The new drugs should improve survival rates for children with TB, because the new tablets are much easier to take. They don’t have to be cut up or crushed to get the right dose. However, there are still issues about cost because although the drugs are free, the chest x-ray used to diagnose TB is not free.
See also TB Treatment for Children
7th September 2016
In August 2016 a new study suggested that the number of TB cases in India could be vastly under reported. This is primarily because so many people choose to have their health care from private health care providers rather than from government facilities. To estimate the number of cases of TB in the private sector, the researchers calculated the nationwide sales of TB drugs across the private sector and then used these figures to calculate the number of TB cases. This suggested that there might have been as many as 2.2 million TB cases treated in the private sector in 2014, two to three times higher than current estimates.
The research team included researchers from Imperial College London, members of the government RNTCP program and other researchers. Dr Nimalan Arinaminpathy lead author of the research said that:
“we have had little idea of the true scale of the problem in India .. This is because many patients in India use the private healthcare system as opposed to the state system. Most cases of TB seen in the private healthcare system are not reported to public health officials.”
See also TB in India
11th August 2016
Several months ago it was announced that bedaquiline treatment to treat XDR-TB would soon be available funded by the Indian government. But it is only now that the government’s RNTCP has finally provided bedaquiline TB treatment for the first patient in Mumbai. It is expected that the treatment will be provided for just 100 patients. Previously Chennai and Guwahati have been the only places to provide government funded bedaquiline. The drug needs to be used with extreme caution to prevent drug resistance developing.
3rd August 2016
Pyrazinamide and the fluoroquinolones are essential antituberculosis drugs in new rifampicin sparing regimens. But little information is available about the extent of resistance to these drugs at the population level.
An analysis of population based surveys from a number of countries was carried out, to investigate resistance to pyrazinamide and the fluoroquinolones among patients with TB. In all settings pyrazinamide resistance was significantly associated with rifampicin resistance. High levels of ofloxacin resistance were detected in Pakistan, but resistance to moxifloxacin and gatifloxacin was low in all countries.
The authors call for a rethink of surveillance needs so that better data are available to understand levels of resistance. Without this information the risk remains high of introducing ineffective regimens that are not curative and might amplify development of drug resistance.
Source: Zignol M, et al. www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30190-6/abstract
21st July 2016
The Praja Foundation, a non-governmental organisation (NGO) has reported that the number of TB deaths reported by the Brihanmumbai Municipal Corporation’s (BMC) TB control unit has been up to six times less than the actual figures. On the basis of an analysis of death certificates between 2011 and 2015 the NGO found that there were 34,914 TB related deaths during this period. The BMC TB control unit reported only 6,838 deaths during the same period.
25th June 2016
A study reported in the Lancet Infectious Diseases, and carried out by Sheffield University, Imperial College London & the World Health Organisation, has estimated that 2 million children are infected with drug resistant TB, requiring the treatment every year of up to 25,000 cases of MDR TB in children. More than 850,000 children are estimated to develop TB each year.
See also TB in Children
In South Africa a national survey of medicine shortages found that drug availability in 2015 was similar to what it had been in 2014. Nearly a quarter of health clinics had HIV antiretroviral and TB medicine outages in the previous three months. 20% of clinics reported that they had HIV antiretroviral and TB medicine outages on the day of contact, and 10% of clinics had important vaccine and medicine outages that day.
Mpumalanga (58% of clinics), Gauteng (39%) and Free Staate (36%) provinces had the highest reports of HIV antiretroviral and TB drug shortages. Shortages of TB medication and HIV antiretroviral medication are of particular concern, as the treatment requires a strict regimen to be effective. Disruptions increase the chance of patients’ infections becoming resistant to the drugs and failing to work.
Source: www.groundup.org.za www.groundup.org.za/article/survey-finds-massive-medicine-shortages-clinics/
9th June 2016
The preliminary findings of an ongoing nationwide TB prevalence survey, shows that Tuberculosis infections in Kenya are ‘higher than thought’ with 81,457 Kenyans having been infected last year. The head of the TB department in the Ministry of Health says that the infections demand an intensive TB testing and swift treatment to curb the contagious disease that killed 10,000 Kenyans last year.
One in three Kenyans has latent TB which is not contagious.
Source: www.allafrica.com Kenya: TB Infections in Kenya ‘Higher Than Thought’, Health Ministry Says
20th May 2016
A huge backlog of more than 100,000 infants who have not received the BCG vaccine to protect against TB will have built up by the time supplies become available again. The Irish health minister confirmed that it will now be early 2017 before the BCG vaccine can be administered to all newborns.
A European shortage of the vaccine since April last year means around 70,000 babies have had to be put on hold for the vaccine.
Source: Independent.IE 100,000 babies lose out due to lack of TB jab
19th May 2016
Access is dwindling for many older, off-patent, essential drugs as companies use a new strategy to acquire therapies in niche markets where there are few or no alternatives, and then jack up the price. Seven TB drugs, rifapentine, rifabutin, pyrazinamide, capreomycin, streptomycin, aminosalicyclic acid and ethionamide are at risk of being affected by this type of policy.
Jeremy Greene, associate professor of medicine and the history of medicine at John Hopkins School of Medicine in Baltimore, Maryland said that he was not surprised by the names on the list. Tuberculosis is still prevalent in the United States, but we tend to think of it as happening in other places, so the competition for drugs has dwindled.
Source: Medscape Multispecialty 17 essential drugs at risk for price boost, analysts say