CALIFORNIA: TB Cases Fall in All but One Valley County
Barbara Anderson
Fresno Bee (03.18.10) - Friday, March 19, 2010
On Thursday, the California Department of Public Health (CDPH) released new data showing the state recorded 2,472
active TB cases in 2009, down from 2,695 cases in 2008. State health officials said the TB rate went from 7 cases per 100,000 residents in 2008
to 6.4 last year, the lowest on record.
"We have come a long way in our struggle to eliminate TB, and we can be proud of our aggressive efforts to
control the disease," said CDPH's Dr. Mark Horton.
According to officials, three-quarters of TB cases statewide were among foreign-born individuals. Yet even in
this population, officials noted a significant decline in cases, from 279 in 2008 to 176 in 2009, among persons who had been in the United
States for less than one year.
Dr. Kenneth Bird, TB control officer for Fresno County, said the drop in TB statewide could be due to lower
immigration rates. Better health screenings of immigrants prior to their arrival in the United States also have contributed to the decline, he
said.
In the central San Joaquin Valley region, all but one county, Merced, posted a decline in TB cases last year.
Merced County logged 11 active cases in 2009, up from five in 2008.
"When the numbers are relatively small, any increase or decrease is more pronounced," said Richard Rios, public
information officer for Merced County's Department of Public Health. "It's important to recognize prevention measures are an ongoing necessity.
And we feel this increase is not due to any lull in our prevention and control measures."
UNITED STATES: Johnson Urges More Hepatitis Funding
Bob Keefe
Atlanta Journal-Constitution (03.17.10) - Friday, March 19, 2010
A bipartisan bill introduced by US Rep. Mike Honda (D-Calif.) and co-sponsored by Rep. Hank Johnson (D-Ga.) and
more than 30 others seeks to boost federal funding for hepatitis research and awareness efforts from roughly $21 million to $90 million.
The National Viral Hepatitis Roundtable (NVHR) estimates 5 million Americans are infected with hepatitis B or C.
Blacks and Asian Americans are most affected, and the disease is particularly prevalent in the South. The virus is most commonly spread today
via intravenous drug use, though it can also be transmitted from mother to child and contact with infected blood. Hepatitis is known as a
"silent killer" since many who are infected are unaware they have the virus.
While hepatitis prevalence is growing, federal funding for CDC's hepatitis programs has declined over the past
decade, said Lorren Sandt of NVHR. "It [CDC's hepatitis division] is so grossly under-funded that people are dying needlessly every year,"
Sandt said.
In December, Johnson announced his battle with hepatitis C. "Who knows how I contracted it?" the Georgia
congressman said Tuesday at a news conference. "You can put your hand up and swear on the Bible that you've never used intravenous drugs or got
a blood transfusion and people will still think, 'OK, he's not being truthful.' The fact is, it could've happened anywhere."
Johnson was declared virus-free in January 2009 after months of aggressive treatment. However, he is still
recovering from the disease and the side effects of treatment.
The bill faces an uphill battle, given Congress' focus on other issues and federal and state funding shortfalls.
The measure is currently stalled in committee. Sandt said passing it should be a priority, noting the cost of hepatitis treatment could more
than triple to $85 billion by 2024.
INTERNATIONAL NEWS
GLOBAL: Multidrug-Resistant TB a Serious Global Threat: WHO
Agence France Presse (03.18.10) - Friday, March 19, 2010
The World Health Organization's latest report on multidrug-resistant tuberculosis (MDR TB) documents the highest
proportion of such cases ever, at about 5 percent. Roughly 440,000 people worldwide had MDR TB in 2008 and a third of them died, out of the 9.4
million new TB infections annually, WHO said.
"We confirm in that report that MDR TB is really a serious threat to global health. We estimated approximately
half a million cases every year. And only a small proportion of them, 7 percent, get a diagnosis and treatment," co-author Matteo Zignol said
Thursday.
Nearly half the MDR TB cases are estimated to have occurred in China and India, WHO said. In northwestern Russia,
one-quarter of all TB cases were found to be drug resistant, a proportion never seen before, the report found.
Fifty-eight countries have reported the deadliest form of the disease - extensively drug-resistant TB (XDR TB).
"XDR TB is virtually untreatable. In the best hands, the cure rate is above 60 percent. In the vast majority of cases, there is nothing to
offer," co-author Ernesto Jaramillo told journalists.
Drug resistance is fueled by stopping treatment before a course of antibiotics has been completed and by poor-
quality medicines, the report said.
The authors said there is an urgent need to improve diagnostic capabilities. In Africa, just two laboratories are
certified to diagnose XDR TB, the report noted. "Still in many, many countries, there is not yet capacity for diagnosing and treating [MDR
TB]," said Zignol. "So these people continue to spread the infection before they die. That's why the response to MDR TB has to be prioritized -
because it's not enough to do good basic control."
UNITED KINGDOM: UK Tuberculosis Cases Rise by 5.5 Percent
Beverley Rouse, Press Association
The Independent (London) (03.16.10) - Friday, March 19, 2010
On Tuesday, the Health Protection Agency announced that TB cases in the United Kingdom rose by 5.5 percent in
2009, according to preliminary data. That is the largest increase in cases since the 9.4 percent jump in 2005, said Ibrahim Abubakar, a TB
expert at HPA.
"This increase shows that we must remain vigilant in our fight against TB," Abubakar said. "This is an entirely
preventable and curable infection, but it can be fatal if prompt diagnosis and treatment are not given."
More than a third of the 9,153 cases were in London (3,476), and the West Midlands had 1,035. Case numbers did
not change significantly from 2008 in either region.
The largest increases were in Wales, rising 31.7 percent in one year to 220 cases, and in the South West, where
cases rose 25.8 percent to 337. Increases topped 10 percent in the East Midlands, North West and South East. However, cases declined by 28.8
percent to 42 in Northern Ireland last year.
"Although some progress is being made, the consistent increase in the number of cases of TB in the UK means our
efforts to control the disease must be strengthened," said Maria Zambon, director of HPA's center for infections. "Both health professionals
and the general public alike must remain vigilant if we are to eradicate this major global killer infection."
In May, HPA will launch a nationwide TB strain-typing service to help understand how the disease is spreading.
The data will be used to identify those at risk, determine the allocation of public health resources, and improve diagnosis and
treatment.
CANADA: British Columbia Officials Seek to Boost HPV Vaccinations in Girls
Pamela Fayerman
Vancouver Sun (03.17.10) - Friday, March 19, 2010
More than two years after its launch, British Columbia's human papillomavirus (HPV) vaccination program has
achieved 62 percent uptake among grade-six and -nine girls. That is second only to Quebec, where uptake is 80 percent - a goal B.C. officials
are hoping to achieve with a ramped-up campaign.
French-language media in Quebec did not carry as many anti-vaccine stories or focus on controversies, peers there
told Dr. Gina Ogilvie, B.C. Center for Disease Control (BCCDC)'s associate director of STD prevention and control. As a result, many parents in
Quebec were not persuaded to refuse the vaccine for their child.
To increase uptake, BCCDC plans to boost HPV vaccine awareness among health professionals so they can share
information about the three-shot series with parents. According to a survey conducted for the agency, some parents were concerned that they
lacked enough information about the vaccine, worried about its safety, and wished to wait until their daughters were older.
"The vaccine has, in my mind, an excellent safety profile with a 0.01 percent adverse-event rate," Ogilvie said.
Only one girl had an adverse reaction, an allergic response, and she was briefly hospitalized for observation.
About 50,000 girls have received the vaccine in the province, with more than 120,000 doses administered; some
girls have not yet had all three shots. The province pays for the vaccine, which prevents four types of HPV that are responsible for about 70
percent of cervical cancer cases and 90 percent of genital warts.
MEDICAL NEWS
SOUTHEAST ASIA: An Algorithm for Tuberculosis Screening and Diagnosis in People with HIV
Kevin P. Cain, MD; Kimberly D. McCarthy, MM; Charles M. Heilig, PhD; Patama Monkongdee, MSc; Theerawit Tasaneeyapan, MSc; Nong Kanara,
MD; Michael E. Kimerling, MD, MPH; Phalkun Chheng, MD, MPH; Sopheak Thai, MD; Borann Sar, MD, PhD; Praphan Phanuphak, MD, PhD; Nipat
Teeratakulpisarn, MD; Nittaya Phanuphak, MD; Nguyen Huy Dung, MD; Hoang Thi Quy, MD; Le Hung Thai, MD; Jay K. Varma, MD
New England Journal of Medicine Vol. 362; No. 8: P. 707-716 (02.25.10) - Friday, March 19, 2010
Tuberculosis is a leading cause of death among adults with HIV. In some countries, up to 50 percent of these
patients die during TB treatment, usually within two months of the TB diagnosis. Delayed diagnosis is probably a significant contributor to
high mortality, an international team of researchers noted in this collaborative study.
While TB screening is recommended for those with HIV to facilitate antiretroviral and isoniazid preventive
therapy, there are no internationally accepted, evidence-based guidelines for optimal screening. Nonetheless, screening for chronic cough is
common.
In the current study, researchers consecutively enrolled 1,748 HIV patients from eight outpatient clinics in
Cambodia, Thailand, and Vietnam, irrespective of evidence or absence of TB symptoms. Median CD4+ T-lymphocyte count was 242 per cubic
millimeter; interquartile range 82-396. Three samples of sputum and one each of urine, stool, blood, and lymph-node aspirate (for those with
lymphadenopathy) were obtained for mycobacterial culture. The team compared the characteristics of patients diagnosed with TB (on the basis of
one or more culture-positive specimens) with TB-free patients to derive an algorithm for screening and diagnosis.
TB was diagnosed in 267 (15 percent) patients. Cough of two to three weeks duration in the preceding four weeks
had a sensitivity of 22-33 percent for detecting TB. Cough of any duration, fever of any duration, or night sweats lasting three or more weeks
in the preceding four weeks was 93 percent sensitive and 36 percent specific for TB. TB diagnosis was ruled out for the 1,199 patients with any
symptoms with the help of a combination of two sputum-negative smears, normal chest radiograph, and CD4+ cell count of 350 or more per cubic
millimeter. A positive diagnosis could be made for only 113 patients (9 percent) who had one or more positive sputum smears; mycobacterial
culture was required for most other patients.
"In persons with HIV infection, screening for tuberculosis should include asking questions about a combination of
symptoms rather than only about chronic cough," the authors concluded. "It is likely that antiretroviral therapy and isoniazid preventive
therapy can be started safely in people whose screening for all three symptoms is negative, whereas diagnosis in most others will require
mycobacterial culture."
NEWS BRIEFS
HAWAII: Homeless TB Patient Being Treated in Honolulu
Associated Press (03.18.10) - Friday, March 19, 2010
On Wednesday, the state Attorney General's Office filed paperwork in Circuit Court seeking authority to
quarantine a homeless man diagnosed with a highly contagious form of TB. In a declaration, the state Department of Health's Dr. Glenn Wasserman
said the man was treated in February at The Queen's Medical Center before being transferred to Leahi Hospital in Honolulu. Against medical
advice, the patient left the hospital on March 9 but later returned. To prevent the man from flying to the Big Island, the department contacted
CDC, which activated its federal "Do Not Board" authority in coordination with the Department of Homeland Security. The patient continues to
receive treatment in isolation at Leahi.
SINGAPORE: Singapore's Tuberculosis Cases Lower in 2009
Xinhua News Agency (03.19.10) - Friday, March 19, 2010
Singapore's Health Ministry on Friday reported that the city-state recorded 1,442 TB cases last year, down 0.6
percent from the 1,451 cases logged in 2008. According to local radio 938 Live, the ministry said Singapore's emphasis on treatment compliance
through the national TB control program contributes to a low incidence of TB. Older persons and men continue to account for a significant
portion of new cases.
INDONESIA: Tuberculosis Kills over 100,000 People Annually in Indonesia
Xinhua News Agency (03.19.10) - Friday, March 19, 2010
Indonesia sees more than 500,000 new TB cases annually, and the disease kills 100,000 people a year, the Health
Ministry reported Friday. "Tuberculosis is still a deadly disease in Indonesia," said Iwan Muljono, a ministry director, according to the
Antara news agency. Poverty and a lack of resources to tackle the disease are among reasons it continues to spread, he said.
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