Utah Valley Global Health Group

A blog about global health for those living in Utah Valley and their friends.

Archive for the ‘Tuberculosis’ Category

World Tuberculosis Day

Posted by chads on March 24, 2007

Today is World Tuberculosis Day. The following was also published as an editorial in yesterday’s edition of the newspaper Deseret News.

Asian Bird Flu has received a large amount of news coverage in recent months. While news of the potential of this disease is frightening, a current global health emergency deserves at least as much attention: extremely drug-resistant tuberculosis (XDR-TB). Tuberculosis takes the lives of almost 2 million people every year, despite the fact that it can be treated for a mere $16 per person, per year. Tomorrow, March 24, is World TB Day, and action must be taken to control this deadly disease.

Tuberculosis, a bacterial disease that often affects the lungs, is almost as old as mankind. Egyptian mummies have shown signs of the disease, and, unfortunately, it has played a significant role in Utah history. Many pioneers suffered and died young from what was then known as “consumption.” Brigham Young was 14 when his mother died – from tuberculosis.
Fortunately, TB is no longer a significant public health problem in Utah. In 2005, there were only 29 cases in the entire state (4 in Utah county) – and all of those patients received the treatment that they needed. The disease is both preventable and treatable, so well-implemented programs are nearly always effective.

Because tuberculosis takes months to treat with multiple medications, treatment programs must be well-planned out, based on scientific evidence, and consistently implemented. Partially treated TB has led to a public health nightmare in developing countries. The bacteria has become resistant to one or more of the medications, and, at times, impossible to treat. This super-resistant strain is passed on to other people before it takes the life of its victim, creating a global public health emergency.

South Africa is currently dealing with an outbreak of what public health officials have called “extremely drug resistant” TB (XDR-TB). This strain of TB is the direct result of the poor TB control noted above. XDR-TB killed 52 of 53 patients in a reported outbreak — half of them within 16 days. XDR-TB is spreading in southern Africa and has been detected in at least 28 countries on 5 continents — including the U.S.

Worse, because of the deadly synergy between HIV/AIDS and TB, XDR-TB threatens to roll back progress in the fight against the AIDS pandemic.

Global problems such as the current tuberculosis crisis often leave us feeling paralyzed. It is easy to feel that these are people in far-away lands with problems too large to solve, and think that there is little that we can do. In this age of globalization with frequent international travel, however, drug-resistant tuberculosis has the potential to affect all of us. And there are definite steps that we can all take to make a difference:

1. Support legislation that will control tuberculosis in a long-term, sustained fashion. A “Global Plan to Stop TB” was recently launched (www.stoptb.org/globalplan). Contact your Congressman and senators, and urge them to support the United States’ share of support in 2008: $400 million in bilateral aid for TB efforts, and $1.4 billion for the Global Fund to Fight AIDS, TB and Malaria.

2. Get involved locally. A small group of interested citizens has recently been organized in Utah County to stay informed and involved in global health issues. We meet monthly for RESULTS (www.results.org) meetings, and have occasional social get-togethers. The next one will be on April 7. See http://www.globalhealth.wordpress.com for details, updates, and discussion.

Archbishop Desmond Tutu recently spoke of the risk of “turning back the clock to a time before TB drugs even existed.” The choice is clear: we can either take the steps necessary to save millions of lives, or live with the consequences of inaction.

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RESULTS, XDR-TB, and emergencies

Posted by chads on March 11, 2007

We had our monthly RESULTS meeting and teleconference on March 10. The thrust of the discussion was on obtaining funding for “extremely drug resistant tuberculosis”, or XDR-TB. The WHO explains:

MDR-TB (Multidrug Resistant TB) describes strains of tuberculosis that are resistant to at least the two main first-line TB drugs – isoniazid and rifampicin. XDR-TB, or Extensive Drug Resistant TB (also referred to as Extreme Drug Resistance) is MDR-TB that is also resistant to three or more of the six classes of second-line drugs.

The folks at RESULTS urge us to push our elected officials for additional funding for XDR-TB in the “Emergency Defense Supplemental”:

Please continue to urge Congress to support an emergency infusion of resources to help address the XDR-TB (extremely drug resistant TB) emergency. (The continuing resolution did not contain bilateral TB funding in it.) XDR-TB has a very high mortality rate, is especially deadly for those with HIV/AIDS, and threatens to undermine AIDS and TB treatment in southern Africa. The U.S. is also quickly facing the dangers of XDR-TB. When the president sent his Emergency Defense Supplemental request to Congress it contained monies for Avian Flu, which is a theoretical emergency. XDR TB is a REAL emergency.

I wholeheartedly agree with this plea for fundingwith a passion. Well, sorta. The need for a comprehensive response to tuberculosis is, in my mind, indisputable. And the public health crisis that barely treatable (and sometimes untreatable) XDR TB presents is unacceptable.

I have mixed feelings, however, about calling this an emergency. You see, public health officials and clinicians have known for many, many years that TB was becoming resistant to many drugs, and that it had the potential to become a public health emergency. XDR TB exists because of our failure to respond properly to TB; a failure to strengthen the health system. The WHO continues:

Resistance to anti-TB drugs in populations is a phenomenon that occurs primarily due to poorly managed TB care. Problems include incorrect drug prescribing practices by providers, poor quality drugs or erratic supply of drugs, and also patient non-adherence.

Screaming “emergency” is an effective fund-raising tool, though it more often that not comes in unpredictable spurts. It seems to me that such sporadic responses lead in the long term to corruption, dependence, and lack of preparedness for the next “emergency.” Those suffering from diseases like tuberculosis desperately need a health system that is strong, flexible, and promotes evidence-based health interventions.

So, I’ll support this Emergency Defense Supplemental funding for XDR-TB. Because something has to be done. But there has to be more of a focus on health systems strengthening.

Posted in Health Systems, RESULTS, Tuberculosis | Leave a Comment »