TB News from India: January-February 2006

Health and Development Initiative-India, (www.healthinitiative.org), publishes 'TB News from India' once every two months. The objective of newsletter is to highlight issues related to Tuberculosis and HIV/AIDS control in India and enlist political, public, professional and administrative support for its cause. Health and Development Initiative-India is a not-for-profit organization and the news items have been quoted from various sources for fair use and in public interest. Reproduction of the material published is welcome provided a reference is made to the original source of the news item and TB News from India.

Editorial note:

Surveillance for TB

In the context of control of TB, as for other diseases, it is important to evaluate the current burden of disease, to know how this has been changing over time, and to
determine how it is likely to change in the future. It is also imperative to determine the effectiveness of ongoing TB control activities. An intelligent use of the available data and good understanding of the epidemiology helps design control strategies that are likely to be effective and are cost-effective too.

Revised National Tuberculosis Control Programme (RNTCP) achieved a landmark in 2005 when DOTS services were extended to all the districts of the country. On the other hand, the union government admitted that the number of HIV positive persons has peaked to cross the five million mark. A few other risk factors for TB such as poverty, spatial proximity to infectious patient due to overcrowding in urban household settings, homelessness, smoking and co-morbidities like diabetes, silicosis, and malnutrition besides HIV/AIDS continue to exist unabated. The inter-play of multiple factors both on plus and negative side calls for monitoring of the situation on a continual basis. This will help us to keep our responses timely and adequate. This brings in to focus the need to prioritize surveillance for TB to supplement RNTCP activities. National TB institutes at Chennai and Bangalore are already making inroads in operational research. It is imperative that a nationwide surveillance is implemented at the earliest so that early gains made by RNTCP can be carried forward.

BCG fails to tame TB
Times News Network, Lucknow

Tuberculosis, the deadly bacterial disease once declared as a global epidemic by the World Health Organization, is finally turning out to be an 'untamed' disease — even the contemporary and widely used BCG vaccine is falling short of expectations. The vaccine, invariably administered to children, shows up with incidents of 'occasional' ineffectiveness and thus leaving the microbiologists wondering for the need of another vaccine - may be in the coming 25 years.

"We need a vaccine which does what BCG fails to do - for reasons which we do not understand even today," declared Prof Anil Kumar Tyagi of the department of biochemistry, University of Delhi. Prof Tyagi was delivering the 9th Prof SH Zaidi Oration at the Industrial Toxicology Research Centre (ITRC) Lucknow in November 2005.

"Even if the time of 25 years when the vaccine is hoped to be developed looks long enough, we can go for a trial with vaccines in the next couple of years," he observed, informing of the trial of some five vaccines that are already underway. Adding to the suspicion of scientists over occasional ineffectiveness of the BCG vaccines is the failure of Directly Observed Treatment (DOTS), which despite having gained momentum all over the country, has not been a great success.

"If every patient completes the treatment, there are chances that the disease can be eliminated to a certain extent," Prof Tyagi said.

Read the complete story

TB vaccine developed by Oxford University granted orphan status

A tuberculosis vaccine developed by Oxford researchers has been granted orphan status by the European Commission. This status, designed to encourage the development of drugs, which are necessary but would be prohibitively expensive to develop under normal circumstances, will help bring the vaccine to human use across the developing world. Orphan status will give the vaccine, market exclusivity within the European Union, and will grant free vaccine development and regulatory advice so that the vaccine meets the requirements for human use once development has been completed.

It is the first time orphan status has been granted to a drug developed by auniversity (as opposed to a company). It is also the first potentially universal vaccine to be recommended for this status, which is usually given for treatments for rare illnesses. The status was granted by the Committee on Orphan Medicinal Products (COMP) of the European Medicines Agency (EMEA). COMP was set up to provide incentives for pharmaceutical companies to develop drugs for rare diseases, whose victims
are often referred to as ‘health orphans’ because no-one wants to go through the difficult and expensive process of developing treatments for them. Although tuberculosis is far from rare, it is mainly found in developing countries, which cannot usually afford new drugs, making a potential new vaccine unlikely to be profitable.

The vaccine, which has been developed by Dr Helen McShane and Professor Adrian Hill, in the Nuffield Department of Clinical Medicine, is designed to prevent tuberculosis in people already vaccinated by BCG. This is important because repeated vaccination with BCG has recently been shown to be ineffective in Brazilian young people.

Project manager, Trudie Lang said: ‘This status will not only help us to move forward with bringing the vaccine to people who need it, but is also a show of confidence in the importance of thevaccine, which is the product of very many years’ work.
Source:

Source: Oxford University

 

Gates visits Tambaram TB sanatorium in Tamil Nadu, commits support for developing vaccine for tuberculosis

Microsoft Chairman Bill Gates and his wife Melinda Gates visited the Tambaram TB sanatorium on the outskirts of Chennai during his two-day visit of Tamil Nadu.
The visit assumes significance as the Bill and Melinda Gates Foundation has committed huge funds to prevent spread of HIV in India. The Tambaram TB sanatorium is associated with an initiative for development of vaccine to combat AIDS. The Gates were given a tour of the hospital by doctors soon after his arrival in the Tamil Nadu capital from New Delhi. The Microsoft chief evinced keen interest on the research on developing the vaccine, hospital sources said, adding that he also met some HIV positive patients, who were being treated at the hospital.

Earlier Mr. Gates committed support to India for development of vaccines for tuberculosis and malaria. Mr. Gates, who met Union Health and Family Welfare Minister Anbumani Ramadoss in New Delhi, told reporters that the meeting was "great" and that there were "many commitments" before he left. Briefing reporters about the meeting, Mr. Ramadoss said the discussions were related to technology of vaccines and prevention concepts. "Nobody has taken up vaccine development for TB. Mr. Gates has extended support in this endeavor." The Gates Foundation was supporting groups such as Global Alliance on Vaccines and Immunization, in which the Government was a partner. India would benefit by the partnership, he said. Mr. Gates would also have discussions with the private pharmaceutical sector on vaccine
development.

Read story 1 & story 2

NARI part of world study on TB & AIDS
Anuradha Mascarenhas , Indian Express

With a whopping 14 million TB cases in India, HIV-AIDS poses another challenge: HIV-TB co infection. In fact, HIV sero-prevalence in TB patients in Pune increased almost three-fold from 10 per cent in July 199’5 to 28.8 per cent in January 2000, says a report published by the National AIDS Research Institute (NARI).

The trend, however, has stabilized in the last few years. Speaking to Newsline (Indian Express) on the occasion of World AIDS Day on December 1, Shrikant Tripathy, Deputy Director, NARI said both African and Indian settings indicate that tuberculosis is the commonest opportunistic infection in HIV infected persons.Hence, NARI, in collaboration with the National Institute of Health (NIH), USA, has embarked on an ambitious intercontinental multi-centric study to assess the pattern of opportunistic infections —like tuberculosis and others — in HIVinfected patients.

The study will be conducted in 20 centres including Pune. There are various issues that need to be looked at, says Tripathy. For instance, will HIV infected patients whose CD 4 counts are less than 300 and are on antiretroviral therapy (ART) develop TB or any other opportunistic infection? This multi-centric study may lead to some answers. In fact, NARI conducted a similar study on its own during the last three years. “We studied 300 HIV positive patients (with all types of CD4 counts) to see the pattern of opportunistic infections,” says Tripathy.

The patients who could afford the ART treatment were referred to government centres. While the results are yet to be published, initial findings show that 60 patients developed tuberculosis. Again, more studies are underway at NARI and the Talera Hospital in Chinchwad to assess the response of HIV positive and negative patients with TB to the Revised National Tuberculosis Control Programme (RNTCP) drug regimen. If 60 per cent of AIDS cases are reported to be opportunistic TB patients, then the treatment of TB among HIV-infected persons poses a new challenge to the RNTCP.


Read the complete story

Cabinet Approves Revised Tuberculosis Control Programme

The Cabinet Committee on Economic Affairs approved the extension of the ongoing World Bank assisted Revised National TB Control Programme (RNTCP) for another five years from October 1, 2005 to September 30, 2010 . The direct benefit for the project will be treatment of more than five million TB patients during the project period. Of this at least four and a half million patients would be cured. This will result in averting about one million deaths of whom half would be adults each with an economic output of at least Rs. 14,000 (US $ 312) per year would have worked on average 15 years- a national economic saving of more than Rs. 10,000 crore

The pilot phase of RNTCP was launched in 1993 gradually increasing the population covered. This helped establish technical, operational and managerial feasibility for an expanded programme. In 1997 the World Bank assisted RNTCP was launched at a project cost of Rs. 749.28 crore and included a World Bank component of Rs. 604.9 crore to cover a population of 271 million (1991 census) in 102 Short Course Chemotherapy (SCC) districts and strengthen another 203 SCC districts for introduction of the RNTCP at a later stage over a period of five years. The Project was extended up to March 2004 to cover a total population of 700 million under the revised strategy and again up to September 30, 2005 to cover a population of 730 million within the original project cost.

Sixteen thousand TB cases reported every year in Himachal Pradesh
The Tribune, Chandigarh

Around 16,000 persons come in the grip of tuberculosis (TB) in the Himachal Pradesh every year. This was stated byDr Neena Shandil, TB Officer, while addressing a workshop of privatemedical practitioners and TB and WHO experts. The patients with sputumpositive for the disease could cause harm to healthy people, he said.The workshop was held under the Revised National Tuberculosis Control Programme (RNTCP) to involve private medical practitioners to curb the disease. Around 70,000 TB patients have been cured in the state till date, said Dr Neena. TB treatment was being done free of cost. For effective treatment of the disease, health workers had been entrusted with the responsibility of ensuring the availability of medicines at all allopathic and ayurvedic health centres in the state, she said. For distributing medicines in remote areas, the participation of private practitioners, anganwari workers and NGOs had been ensured. Under the new arrangement, it was planned to provide a few private practitioners with medicines and prescribed guidelines. They would work as a link between patients and society. The medicines would be given free to the patients and the practitioners would be paid nominal charges, based on the number of patients attended to, said Dr Gupta.

Read the complete story

A new series of patient education materials on TB

The Division of Tuberculosis Elimination (DTBE), Centers for Disease Control and Prevention (CDC), has announced the release of a new series of patient education materials. The series includes the following six new materials:

Get the Facts about TB Disease: A booklet about TB transmission, treatment for TB disease, and how to communicate with family and friends about TB.
http://www.cdc.gov/nchstp/tb/pubs/pamphlets/TB_disease_EN_rev.pdf

What You Need to Know About TB Infection: A booklet on TB infection, including the TB skin test, treatment, and adherence to medication.
http://www.cdc.gov/nchstp/tb/pubs/pamphlets/TB_infection.pdf  

What You Need to Know About the TB Skin Test: A fact sheet on the basics of the TB skin test.
http://www.cdc.gov/nchstp/tb/pubs/pamphlets/TB_skin_test.pdf

Protect Your Family and Friends from TB – The TB Contact Investigation: A booklet on how to protect family and friends from TB and how to talk to a healthcare
worker during a contact investigation.
http://www.cdc.gov/nchstp/tb/pubs/pamphlets/TB_contact_investigation.pdf

Take Steps to Control TB When You Have HIV: A booklet about the importance of treating TB infection and TB disease when a person is also infected with HIV.
http://www.cdc.gov/nchstp/tb/pubs/pamphlets/TB&HIV_EN.pdf

Staying on Track with TB Medicine: A booklet about treatment and ways to adhere to medication regimens for TB infection and TB disease.
http://www.cdc.gov/nchstp/tb/pubs/pamphlets/TB_trtmnt.pdf

These materials have been developed for low-literacy audiences. Patients and representatives from the general public provided feedback on the materials throughout the development process.

Conference Announcement: AIIMS New Delhi to organize HIV/AIDS and Tuberculosis 2006 International Conference and CME

The CME to be held at All India Institute of Medical Sciences, New Delhi from 13th to 15th January 2006 will cover topics related to HIV/AIDS & TB. Experts in the field will have active interaction and conduct discussions on various topics. The CME will address the need for the development of a working knowledge of HIV in relation to TB for the health care workers. Target Audience for the CME includes Physicians, Socio-behavioral scientists, Public health experts, Medical Students and Nursing Personnel.

Contact person: Dr. Randeep Guleria, Convener: aiims_hat_2006@yahoo.com

www.healthinitiative.org
A Not-For-Profit Organization