Showing posts with label MDR-TB. Show all posts
Showing posts with label MDR-TB. Show all posts

Tuesday, March 18, 2014

ECDC/WHO: World TB Day - Focus On MDR & XDR Treatment Outcomes

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Map Credit - Tuberculosis surveillance and monitoring in Europe 2014

 

# 8386

 

Next Monday (March 24th) is World TB Day, and so for the next couple of weeks we can expect to see a flurry of reports and assessments released on the global battle against this insidious disease.  The ECDC describes this year’s campaign:

 

2014 theme: MDR TB and MDR TB treatment outcomes

For World TB Day 2014, ECDC is focusing on multidrug-resistant tuberculosis (MDR TB), particularly on MDR TB treatment and treatment outcomes.

In the EU/EEA, the treatment success rates of MDR TB patients have remained stable but at a very low level: only one in every three (34%) patients in the reporting EU/EEA countries finishes MDR TB treatment successfully. More than half die, fail treatment or default (stop taking treatment).

MDR and XDR TB patients face much longer treatment, take more drugs, suffer from more side effects and treatment costs are five times higher compared to drug-susceptible TB. Only complete and successful tuberculosis treatment helps to prevent disease transmission and development of resistant strains that lead to the development of extensively drug-resistant TB (XDR TB), which is almost impossible to treat.

Merely 7 of the 21 countries reporting have maintained a mean five-year decline in MDR notification rates and the overall MDR TB treatment success rate remains far below the 70% target defined by the Framework Action Plan to Fight Tuberculosis in the European Union.

Why is MDR TB still a public health concern?

  • TB is slowly declining but MDR and XDR TB pose a serious challenge in the attempt to eliminate TB across Europe, even though the number of reported MDR TB cases seem to decline slowly.
  • In EU, only 1 in every 3 MDR TB patients has a successful treatment outcome; more than half either die, fail treatment or default (stop taking treatment). XDR TB has even worse treatment outcomes: only 1 in 4 patients finishes treatment successfully
  • By not diagnosing and not treating patients with MDR TB early and successfully, we put their live at risk and pave the way for XDR TB
  • Only complete and successful tuberculosis treatment helps to prevent disease transmission and development of resistant strains

 

Today the ECDC and the World Health Organization released an extensive (15mb, 218 pg) PDF report on the TB situation in Europe entitled:

 

Tuberculosis surveillance and monitoring in Europe 2014

18 Mar 2014

Available as PDF in the following languages

ENGLISH

Abstract

​The sixth report launched jointly by the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe (WHO/Europe) indicates that, despite notable progress in the past decade, tuberculosis (TB) is still a public health concern in many countries across Europe. Of particular concern are the high rates of multidrug resistant (MDR) TB outside the European Union (EU)/European Economic Area (EEA). Meanwhile EU/EEA countries themselves have a significant number of TB cases among vulnerable population groups, such as people of foreign origin and prisoners.

An assessment of progress towards TB elimination for the four epidemiological indicators and eight core indicators defined in the report ‘Progressing towards TB elimination: A follow-up to the Framework Action Plan to Fight Tuberculosis in the European Union’ showed that none of the core indicators was achieved at EU/EEA level.

 

While progress has been made in reducing the overall incidence of Tuberculosis in Europe over the past decade, as the following press release indicates, the rise in MDR and XDR TB – and their dismal treatment outcomes -  has tempered any celebrations:

 

Tuberculosis cases down by 6% but only 1 in 3 MDR TB patients finishes treatment successfully

18 Mar 2014

In 2012, 68 423 cases of tuberculosis (TB)  were reported in 29 EU/EEA countries according to new data published by the European Centre for Disease Prevention and Control and the WHO Regional Office for Europe ahead of World Tuberculosis Day. This results in a notification rate of 13.5 per 100 000 population and constitutes a 6% decrease compared to 2011 (72 000 cases reported), confirming the average annual decline of 5% since 2008.

The surveillance data show that the majority of EU/EEA countries report sustained low levels of TB, which means fewer than 20 TB cases per 100 000 population. In 19 of them, the number of tuberculosis patients decreased. Rates were below 10 per 100 000 population in 18 countries and below 20 in 23 countries.

Overall, the EU/EEA countries have been – and still are – successful in the fight against TB and met the target of an average five-year decline. However, they have not yet met the set targets for successful treatment of the multidrug-resistant form of tuberculosis, MDR TB.

(Continue . . . )

Sunday, March 24, 2013

The Lancet : TB 2013

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(From the 2011 TB Progress Report)

 

# 7025

 

 

To coincide with World TB Day, The Lancet Infectious Diseases  today has published a series of six papers (and comments) on the ongoing battle against tuberculosis, and the rising tide of of multidrug resistant (MDR) and extensively drug-resistant (XDR) TB infections around the globe.

 

Roughly 1/3rd of all new TB cases fall into the MDR-TB or XDR-TB category. Just over a year ago new alarm bells began ringing when an ahead-of-print letter to the journal Clinical Infectious Diseases announced that four cases of TDR (totally drug resistant) tuberculosis had been identified in India.

 

The term TDR-TB was quickly labeled as controversial, and poorly-defined. From the January 2012 ECDC report New drug resistant form of tuberculosis reported in India.

 

Total drug resistant TB is a relative notion and depends on the local drugs available and tested on. This term/expression should either be avoided or should be defined worldwide. The World Health Organization (WHO) has internationally-endorsed treatment recommendations for the treatment of drug-susceptible, MDR-TB and XDR-TB.

 

During this time, Maryn McKenna – Flublogia’s favorite scary disease girl – wrote extensively about these developments on her Superbug Blog:

 

Totally Resistant TB: Earliest Cases in Italy

India Reports Completely Drug-Resistant TB

Totally Drug-Resistant TB: A Patient Is Missing

 

A couple of my efforts included Resistant TB: The Limits Of Surveillance & Reporting & EID Journal: Challenges To Defining TDR-TB.

 

Recently the World Health Organization released their 2012 Global Tuberculosis Report, with the following statement regarding reports of TDR-TB.

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“Totally drug-resistant TB” and developments in India in 2012


In December 2011, clinicians in Mumbai, India reported TB patients with what was termed “total drug resistance”.1 As a result of the intense public interest generated by this episode, in March 2012 WHO convened 40 experts to discuss its implications, whether current evidence makes it possible to define patterns of drug resistance beyond extensively drug resistance TB (XDR-TB) and if better guidance on appropriate treatment options for these patients was possible. While the group acknowledged that patients such as those described in Mumbai pose a formidable challenge to clinicians and public health authorities, no reliable definition beyond XDR-TB could be proposed.

 

Without having a better evidence base, no changes to the current guidelines on how to design treatment regimens for patients with broad patterns of resistance could be recommended. Improvements in the accuracy of drug susceptibility testing to certain drugs and the release of innovative new drugs will, however, change this position in future.


Since December 2011, several important measures have been taken by the Indian government. In Mumbai, laboratory and hospital facilities were improved, contact-tracing stepped up and efforts made to train staff on drug-resistant TB and infection control. Medical staff and funding were increased substantially. Access to second-line drugs was provided to eligible patients. National regulations governing private sales of anti-TB medication were strengthened. By the end of 2012, all 35 states in the country are expected to provide
programmatic management of drug-resistant TB. In May 2012, India made TB a notifiable disease and data collection on TB using a webbased system was initiated.2

 

 

Despite the academic debate over the definition (and existence) of TDR-TB, in January of this year - in  EID Journal: The Emergence Of `Totally Resistant TB’ - more evidence was presented suggesting that TDR-TB is either already here, or on its way.

 

In a similar vein, one of the articles appearing in the Lancet today called Drug-resistant tuberculosis: time for visionary political leadership, warns that:

 

WHO estimates roughly 630 000 cases of MDR tuberculosis worldwide, with great variation in the frequency of MDR tuberculosis between countries. In the past 8 years, extensively drug-resistant (XDR) tuberculosis has emerged, and has been reported in 84 countries, heralding the possibility of virtually untreatable tuberculosis.

 

While a free registration is required, these articles are available online in their entirety. Follow the links to read:

 

Tuberculosis 2013

Published March 24, 2013

Executive summary

To commemorate World TB Day 2013, The Lancet Infectious Diseases publishes a Series of papers on tuberculosis, a disease that has long plagued human beings and was declared a global emergency in 1993 by WHO. Without concerted action from political leaders, health policy makers, funders, and others, health systems worldwide are at risk of being overwhelmed by increasing numbers of patients with treatment-resistant tuberculosis.

 

As new diagnostic tests, drugs, and drug regimens become available that have the potential to radically improve the detection and management of tuberculosis, the papers in the Series explore the challenges for successful implementation of these interventions.

Comments
Tuberculosis 2013 Series

John McConnell, Sally Hargreaves

Full Text | PDF

Zero deaths from tuberculosis: progress, reality, and hope

Alimuddin Zumla, Peter Kim, Markus Maeurer,Marco Schito

Full Text | PDF

Progress and challenges in childhood tuberculosis

Ben J Marais, Stephen M Graham, Markus Maeurer,Alimuddin Zumla

Full Text | PDF

Series Papers
Advances in tuberculosis diagnostics: the Xpert MTB/RIF assay and future prospects for a point-of-care test

Stephen D Lawn, Peter Mwaba, Matthew Bates, Amy Piatek, Heather Alexander, Ben J Marais, Luis E Cuevas, Timothy D Mchugh, Lynn Zijenah,Nathan Kapata, Ibrahim Abubakar, Ruth McNerney, Michael Hoelscher, Ziad A Memish, Giovanni Battista Migliori, Peter Kim, Markus Maeurer,Marco Schito, Alimuddin Zumla

Full Text | PDF

Tuberculosis biomarkers discovery: developments, needs,and challenges

Robert S Wallis, Peter S Kim, Stewart Cole, Debra Hanna, Bruno B Andrade, Markus Maeurer, Marco Schito, Alimuddin Zumla

Full Text | PDF

Tuberculosis comorbidity with communicable and non-communicable diseases: integrating health services and control efforts

Ben Marais, Knut Lönnroth, Stephen D Lawn, Giovanni B Migliori, Peter Mwaba, Philippe Glaziou, Matthew Bates, Ruth Colagiuri, Lynn Zijenah,Soumya Swaminathan, Ziad Memish, Michel Pletschette, Michael Hoelscher, Ibrahim Abubakar, Rumina Hasan, Afia Zafar, Guiseppe Pantaleo,Gill Craig, Peter Kim, Markus Maeurer, Marco Schito, Alimuddin Zumla

Full Text | PDF

Alignment of new tuberculosis drug regimens and drug susceptibility testing: a framework for action

William A Wells, Catharina C Boehme, Frank G J Cobelens, Colleen Daniels, David Dowdy, Elizabeth Gardiner, Jan Gheuens, Peter Kim, Michael E Kimerling, Barry Kreiswirth, Christian Lienhardt, Khisi Mdluli, Madhukar Pai, Mark D Perkins, Trevor Peter, Matteo Zignol,Alimuddin Zumla, Marco Schito

Full Text | PDF

Drug-resistant tuberculosis: time for visionary political leadership

Ibrahim Abubakar, Matteo Zignol, Dennis Falzon, Mario Raviglione, Lucica Ditiu, Baroness Susan Masham, Ifedayo Adetifa, Nathan Ford,Helen Cox, Stephen D Lawn, Ben Marais, Timothy D McHugh, Peter Mwaba, Matthew Bates, Marc Lipman, Lynn Zijenah, Simon Logan,Ruth McNerney, Adam Zumla, Krishna Sarda, Payam Nahid, Michael Hoelscher, Michel Pletschette, Ziad Memish, Peter Kim, Richard Hafner,Stewart Cole, Giovanni-Battista Migliori, Markus Maeurer, Marco Schito, Alimuddin Zumla

Full Text | PDF

Engaging communities in tuberculosis research

Renaud F Boulanger, Stephanie Seidel, Erica Lessem, Lee Pyne-Mercier, Sharon D Williams, Laia Ruiz Mingote, Cherise Scott, Alicia Y Chou, James V Lavery, on behalf of the Critical Path to TB Drug Regimens' Stakeholder and Community Engagement Workgroup

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