Tuberculosis

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Status Brief
History/Origins:

Developmental Milestones/Developments to Date:

Current Assessment/State of the Field:

Problems/Challenges:

Proposals:

2008

Poltzer, Patrice, “Tuberculosis: A New Pandemic?“, CNN, November 17, 2008. http://www.cnn.com/2008/HEALTH/11/17/tb.pandemic/index.html

  1. “TB mutating into dangerous new strains for which there is no known cure”
  2. XDR-TB = a drug-resistant TB, incurable, could lead to a pandemic, airborne disease,
  3. 40,000 new cases of XDR-TB each year – WHO
  4. disease primarily affects developing nations
  5. TB is curable but if drugs not administered or used, disease can mutate into strands like XDR
  6. strong link between TB and poverty

Developing Countries, Public Health, Vaccination, Pandemic, Tuberculosis

2009

Suk, Jonathan, et.al, “Wealth, Inequality, and Tuberculosis Elimination in Europe“, EMERGING INFECTIOUS DISEASES, Volume 15, No. 11, November 2009.

  1. Europe- wealth inequality directly related to TB
  2. “decline of TB incidence in Europe preceded the advent of anti-TB drugs and coincided with rapid improvement of quality of life”
  3. “the current financial crisis could exacerbate the conditions of existing vulnerable groups as well as create new ones”

Europe, Public Health, Pandemic, Tuberculosis

2010

Jeffery Bigongiari, “FDA gives grants to fight tuberculosis“, Last accessed October 18, 2010. http://vaccinenewsdaily.com/news/216702-fda-gives-grants-to-fight-tuberculosis 2

  1. “The U.S. Food and Drug Administration on October 4 announced that it has awarded nearly $3 million to fund research that will support the diagnosis, treatment and prevention of tuberculosis.”
  2. “TB remains a major public health threat and continues to rise in prevalence globally. The FDA said that help is needed to shorten therapy and to treat drug resistant forms of the disease.”
  3. “The six projects and their research teams that FDA will grant funding to include Aeras Global TB Vaccine Foundation’s discovery of biological and immunological biomarkers for TB vaccines and the Global Alliance for TB Drug Development frozen trials for developing a repository of clinical trial specimens.”

Tuberculosis, Public Health

2011

Chan, Dr Margaret, “Combat Drug Resistance: No Action Today Means No Cure Tomorrow,” World Health Organization, April 6, 2011 http://www.who.int/mediacentre/news/statements/2011/whd_20110407/en/   Last Checked 9/5/2011

  1. “In the absence of urgent corrective and protective actions, the world is heading towards a post-antibiotic era, in which many common infections will no longer have a cure and, once again, kill unabated.”
  2. “The development of resistance is a natural biological process that will occur, sooner or later, with every drug.”
  3. “We have assumed that miracle cures will last forever, with older drugs eventually failing only to be replaced by newer, better and more powerful ones.”
  4. “For some diseases, like malaria, our options are very limited as we have only a single class of effective drugs- artemisinin-based combination therapies- with which to treat more than 200 million falciparum cases each year.”
  5. “While TB deaths are declining, in just the past year nearly half a million people developed multidrug-resistant TB, and a third of them died as a result.”
  6. “Irrational and inappropriate use of antimicrobials is by far the biggest driver of drug resistance.”
  7. “In several parts of the world, more than 50% in tonnage of all antimicrobial production is used in food-producing animals.”

Drug Resistance, WHO, Malaria, Tuberculosis

 

Gallagher, James, “Tuberculosis Relative Could Be New Vaccine”, BBC News, September 4, 2011 http://www.bbc.co.uk/news/health-14761366 Last checked 9/6/2011

  1. “It is one of the top 10 leading causes of death, according to the World Health Organization, killing 1.7 million people each year.”
  2. “The BCG vaccine has variable results. It has been shown to be between 0% and 80% effective in different parts of the world.”
  3. “There are also potential problems giving the live vaccine to some of the most at risk patients- those with HIV.”

Tuberculosis, Vaccination, Drug Resistance, WHO

 

Paddock, Catharine, “Resistant TB Spreading In Europe At Alarming Rate, WHO,” Medical News Today, September 15, 2011 http://www.medicalnewstoday.com/articles/234376.php  Last Checked 9/15/2011

  1. “Multidrug-Resistant Tuberculosis is a disease that could cause a pandemic in Western Europe and kill thousands of people if health authorities fail to tackle it properly.”
  2. “‘TB is an old disease that never went away, and now it is evolving with a vengeance.’”
  3. “Zsuzsanna Jakab said complacency has allowed the disease to resurge and it must be tackled now to avoid huge human and economic costs.”
  4. “TB is an infectious disease caused by Mycobacterium tuberculosis bacteria that gives rise to over 9 million new cases worldwide every year and nearly 2 million deaths. It is the leading cause of death among curable infectious diseases.”
  5. “WHO declared TB a global emergency in 1993.”
  6. “However, the cause for the current alarm is the rising number of cases of drug-resistant TB, or MDR-TB (multi-drug resistant TB), which develops when the first-line drugs are misused or mismanaged.”
  7. “The concern is that the resistant forms will rise to pandemic proportions unless TB control is managed properly.”
  8. “The death rate for TB is about 7%: this can rise to 50% for the resistant forms, according to WHO figures that also show cases of MDR-TB and XDR-TB are spreading at the rate of around 440,000 new cases a year worldwide.”
  9. “These resistant forms of TB are much harder and costlier to treat. It can take two years or more, and cost up to 16,000 US dollars in drugs alone per patient. If the patient needs isolation care in a hospital, then the cost is in the hundreds of thousands.”
  10. “More than 80,000 of these annual cases of resistant TB occur in WHO’s European region, which covers 53 European and Central Asian countries.”

Tuberculosis, Drug Resistance, Public Health, WHO

 

Sinha, Kounteya, “Drug resistance growing among TB patients,” The Times of India, November 15, 2011 http://timesofindia.indiatimes.com/india/Drug-resistance-growing-among-TB-patients/articleshow/10734179.cms Last Checked November 15, 2011

  1. “Drug resistance is spreading among tuberculosis (TB) patients in India.”
  2. “According to India’s revised national TB control programme (RNTCP), latest studies conducted in Maharashtra, Gujarat and Andhra Pradesh have found that around 12% to 17% of all TB re-treatment cases are drug resistant.”
  3. “Dr. Kumar told TOI, ‘At present we have only 6-7 effective drugs against TB.’”
  4. “Random and irrational use of these drugs, especially by private doctors, is making patients drug resistant.”
  5. “There have been no new TB drug classes for nearly 50 years and irrational courses to patients is leading to resistance among whatever drugs are available.”
  6. “The government has plans to put in place 43 labs to diagnose MDR-TB.”
  7. “According to Dr. Kumar, ‘most patients start treatment of TB in the private sector. The private doctors use irrational combinations to treat them making them drug resistant. They finally land up in the government treatment programme.’”
  8. “The direct and indirect cost of TB to India amounts to an estimated $23.7 billion annually.”

Tuberculosis, India, Drug Resistance, Vaccination, Public Health

 

Fox, Liam, “WHO Warns of Untreatable Tuberculosis,” ABC News, November 26, 2011 http://www.abc.net.au/news/2011-11-26/who-warns-of-untreatable-tuberculosis/3696226 Last Checked December 3, 2011

  1. “The World Health Organization is warning of the potential for an untreatable form of tuberculosis to develop on Australia’s doorstep.”
  2. “It says infections of multi-drug resistant tuberculosis (MDR TB) in Papua New Guinea’s remote south-west have reached crisis levels.”
  3. “The country’s health minister says tuberculosis is now a greater health emergency than HIV/AIDS.”
  4. “‘Children 14-years-old infected with MDR TB in a family with already five patients dying.’”
  5. “A research team from WHO found the rural health centres are rundown with very limited or no medical supplies.”
  6. “There is no TB coordinator in the region so no one is monitoring patients to ensure they stick to the lengthy treatment of drugs required to beat the disease, meaning many do not.”
  7. “WHO’s Dr. Donald Enarson says, ‘Multi-drug resistance has passed from being created from bad treatment to now being established in a community by itself and spreading among community members.’”
  8. “Local medical records show 94 people have contracted MDR TB in Western Province since 2005.”
  9. “Dr. Ernesto Jaramillo says, ‘When treatment is delivered under the current conditions which many patients are having, then it’s a matter of months or years before we have forms of TB that cannot be cured.’”

Tuberculosis, Drug Resistance, Australia, WHO

2012

Stobbe, Mike, Naqvi, Muneeza, (AP), “India reports new strain of ‘totally drug-resistant tuberculosis”, MSN.com, Jan 16, 2012. http://www.msnbc.msn.com/id/46010460/ns/health-infectious_diseases/
last checked 1/17/12

  1. ”Indian doctors have reported the country’s first cases of “totally drug-resistant tuberculosis,” a long-feared and virtually untreatable form of the killer lung disease.”
  2. ”Since 2003, patients have been documented in Italy and Iran. It has mostly been limited to impoverished areas, and has not spread widely.”
  3. ”No one expects the Indian TB strains to rapidly spread elsewhere. The airborne disease is mainly transmitted through close personal contact and isn’t nearly as contagious as the flu.”
  4. ”Indeed, most of the cases of this kind of TB were not from person-to-person infection but were mutations that occurred in poorly treated patients.”
  5. ”The World Health Organization hasn’t accepted the term and still considers the cases to be what’s now called extensively drug-resistant TB, or XDR.”
  6. ”Ordinary TB is easily cured by taking antibiotics for six to nine months. However, if that treatment is interrupted or the dose is cut down, the stubborn bacteria battle back and mutate into a tougher strain that can no longer be killed by standard drugs.”
  7. ”’These three patients had received erratic, unsupervised second-line drugs, added individually and often in incorrect doses, from multiple private practitioners,’ wrote the doctors from P.D. Hinduja National Hospital and Medical Research Center in the journal Clinical Infectious Diseases.”

Tuberculosis, Drug Resistance, India, WHO

2015

Sanchez, Jose, “Tuberculosis as a Force Health Protection Threat to the United States Military,” Military Medicine, pg. 276, 2015.

  1. “Tuberculosis (TB) is a communicable disease that poses a threat to force health protection (FHP) in the U.S. military.”
  2. “Tuberculosis is transmitted via close contact with an infected individual who is actively spreading mycobacteria through coughing. Once inhaled, the infection is established with or without a visible primary lung lesion; lymphatic and hematogenous spread usually follows within 3 weeks of infection. In 90% to 95% of healthy adults, the infection remains latent for decades; disease develops, or reactivates, in 5% to 10% of untreated infected adults, most often in the lung apex, where the ratio of ventilation to blood perfusion is highest.”
  3. “TB testing in the U.S. military should be scaled back from the universal testing approach that has been used in the past. Low-incidence settings, including the U.S. military, pose unique challenges to TB control because of declining resources and expertise, which can lead to outbreaks and resurgence of TB disease.”
  4. “There are other unique challenges to TB control in the military, including residence in congregate settings such as basic training and aboard naval vessels, and deployment or other military service in TB-endemic countries and global TB control as important FHP-enhancing elements.”
  5. “The U.S. military can move toward these goals through the measures described in this review, particularly the use of diagnostics such as NAAT and genotyping, administration of appropriate treatment without delay or deferral, implementation of the cohort review at the service and installation levels.”

Force Protection, Military, Tuberculosis