Tuberculosis

Infection and transmission

Tuberculosis (TB) is a contagious disease. Like the common cold, it spreads through the air.
Only people who are sick with TB in their lungs are infectious. When infectious people cough,
sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A person needs only to
inhale a small number of these to be infected.

Left untreated, each person with active TB disease will infect on average between 10 and 15
people every year. But people infected with TB bacilli will not
Related links
necessarily become sick with the disease. The immune system
"walls off" the TB bacilli which, protected by a thick waxy coat,
WHO report on Multidrug and
can lie dormant for years. When someone's immune system is
extensively drug-resistant
weakened, the chances of becoming sick are greater.
tuberculosis (M/XDR-TB)
 Someone in the world is newly infected with TB bacilli
Global tuberculosis control
every second.
 Overall, one-third of the world's population is currently More on tuberculosis
infected with the TB bacillus.
 5-10% of people who are infected with TB bacilli (but
who are not infected with HIV) become sick or infectious at some time during their life.
People with HIV and TB infection are much more likely to develop TB.

Global and regional incidence

WHO estimates that the largest number of new TB cases in 2008 occurred in the South-East Asia
Region, which accounted for 34% of incident cases globally. However, the estimated incidence
rate in sub-Saharan Africa is nearly twice that of the South-East Asia Region with over 350 cases
per 100 000 population.

An estimated 1.3 million people died from TB in 2008. The highest number of deaths was in the
South-East Asia Region, while the highest mortality per capita was in the Africa Region.

In 2008, the estimated per capita TB incidence was stable or falling in all six WHO regions.
However, the slow decline in incidence rates per capita is offset by population growth.
Consequently, the number of new cases arising each year is still increasing globally in the WHO
regions of Africa, the Eastern Mediterranean and South-East Asia.

Estimated TB incidence, prevalence and mortality, 2008

Incidence1 Prevalence 2 Mortality

WHO region no. in % of rate per no. in rate per no. in rate per
thousands global 100 000 thousands 100 000 thousands 100 000
 Incidence1 Prevalence 2 Mortality
total pop3 pop pop
Africa 2 828 30% 351 3 809 473 385 48
The Americas 282 3% 31 221 24 29 3
Eastern
675 7% 115 929 159 115 20
Mediterranean
Europe 425 5% 48 322 36 55 6
South-East Asia 3 213 34% 183 3 805 216 477 27
Western Pacific 1 946 21% 109 2 007 112 261 15
Global total 9 369 100% 139 11 093 164 1 322 20
1
Incidence is the number of new cases arising during a defined period.
2
Prevalence is the number of cases (new and previously occuring) that exists at a given point in
time.
3
Pop indicates population.

HIV and TB

HIV and TB form a lethal combination, each speeding the other's progress. HIV weakens the
immune system. Someone who is HIV-positive and infected with TB bacilli is many times more
likely to become sick with TB than someone infected with TB bacilli who is HIV-negative. TB is
a leading cause of death among people who are HIV-positive. In Africa, HIV is the single most
important factor contributing to the increase in the incidence of TB since 1990.

WHO and its international partners have formed the TB/HIV Working Group, which develops
global policy on the control of HIV-related TB and advises on how those fighting against TB and
HIV can work together to tackle this lethal combination. The interim policy on collaborative
TB/HIV activities describes steps to create mechanisms of collaboration between TB and
HIV/AIDS programmes, to reduce the burden of TB among people and reducing the burden of
HIV among TB patients.

Drug-resistant TB

Until 50 years ago, there were no medicines to cure TB. Now, strains that are resistant to a single
drug have been documented in every country surveyed; what is more, strains of TB resistant to
all major anti-TB drugs have emerged. Drug-resistant TB is caused by inconsistent or partial
treatment, when patients do not take all their medicines regularly for the required period because
they start to feel better, because doctors and health workers prescribe the wrong treatment
regimens, or because the drug supply is unreliable. A particularly dangerous form of drug-
resistant TB is multidrug-resistant TB (MDR-TB), which is defined as the disease caused by TB
bacilli resistant to at least isoniazid and rifampicin, the two most powerful anti-TB drugs. Rates
of MDR-TB are high in some countries, especially in the former Soviet Union, and threaten TB
control efforts.

While drug-resistant TB is generally treatable, it requires extensive chemotherapy (up to two

years of treatment) with second-line anti-TB drugs which are more costly than first-line drugs,
and which produce adverse drug reactions that are more severe, though manageable. Quality
assured second-line anti-TB drugs are available at reduced prices for projects approved by the
Green Light Committee.

The emergence of extensively drug-resistant (XDR) TB, particularly in settings where many TB
patients are also infected with HIV, poses a serious threat to TB control, and confirms the urgent
need to strengthen basic TB control and to apply the new WHO guidelines for the programmatic
management of drug-resistant TB.

The Stop TB Strategy, the Global Plan to Stop TB, 2006–2015 and targets for TB
control

In 2006, WHO launched the new Stop TB Strategy. The core of this strategy is DOTS, the TB
control approach launched by WHO in 1995. Since its launch, 36 million patients have been
treated under DOTS-based services. The new six-point strategy builds on this success, while
recognizing the key challenges of TB/HIV and MDR-TB. It also responds to access, equity and
quality constraints, and adopts evidence-based innovations in engaging with private health-care
providers, empowering affected people and communities, to help strengthen health systems and
promote research.

The six components of the Stop TB Strategy are:

 Pursue high-quality DOTS expansion and enhancement. Making high-quality services

widely available and accessible to all those who need them, including the poorest and
most vulnerable, requires DOTS expansion to even the remotest areas.
 Addressing TB/HIV, MDR-TB and the needs of poor and vulnerable populations.
Addressing TB/HIV, MDR-TB and the needs of poor and vulnerable populations requires
much greater action and input than DOTS implementation and is essential to achieving
the targets set for 2015, including the United Nations Millennium Development Goal
relating to TB (Goal 6; Target 8).
 Contribute to health system strengthening based on primary health care. National
TB control programmes must contribute to overall strategies to advance financing,
planning, management, information and supply systems and innovative service delivery
scale-up.
 Engage all care providers. TB patients seek care from a wide array of public, private,
corporate and voluntary health-care providers. To be able to reach all patients and ensure
that they receive high-quality care, all types of health-care providers need to be engaged.
 Empower people with TB, and communities through partnership. Community TB
care projects have shown how people and communities can undertake some essential TB
control tasks. These networks can mobilize civil societies and also ensure political
support and long-term sustainability for TB control programmes.
 Enable and promote research. While current tools can control TB, improved practices
and elimination will depend on new diagnostics, drugs and vaccines.
The strategy is being implemented as described in The Global Plan to Stop TB, 2006-2015. The
Global Plan is a comprehensive assessment of the action and resources needed to implement the
Stop TB Strategy and to achieve the following targets:

 Millennium Development Goal (MDG) 6, Target 8: Halt and begin to reverse the
incidence of TB by 2015;
 Targets linked to the MDGs and endorsed by the Stop TB Partnership:
o by 2005: detect at least 70% of new sputum smear-positive TB cases and cure at
least 85% of these cases;
o by 2015: reduce TB prevalence and death rates by 50% relative to 1990;
o by 2050: eliminate TB as a public health problem (1 case per million population).

Progress towards targets

In 2008, an estimated 62% of new smear-positive cases were treated under DOTS – just short of
the 70% target.

The treatment success in the 2007 DOTS campaign was 86% overall, surpassing the 85% target
for the first time. The treatment success target was met by 13 of the 22 high-burden countries.
However, the regional average cure rates in the African, American and European regions were
below 85%.

It is estimated that the global TB incidence rate peaked in 2004. Therefore, the world as a whole
is on track to achieve the MDG target of reversing the incidence of TB. The major exception to
this is the epidemiological subregion of African countries with low HIV prevalence. Six
epidemiological sub-regions (Central Europe, Eastern Europe, Eastern Mediterranean, high-
income countries, Latin America and the Western Pacific) have already achieved the target of
halving the 1990 prevalence rate. Four epidemiological sub-regions (Central Europe, high-
income countries, Latin America and the Western Pacific) have already achieved the target of
halving the 1990 mortality rate.
DoH urges 6 habits to fight dengue

Philippine Daily Inquirer

First Posted 02:05:00 09/06/2010

Filed Under: Dengue, Diseases, Health treatment

MANILA, Philippines—Six new habits that health officials have laid out may help dengue patients
fight the mosquito-borne virus even in the comfort of their homes.

The Department of Health (DoH) is promoting the D.E.N.G.U.E strategy to decongest hospitals
which have thousands of dengue patients, whose conditions can be managed at home.

“Instead of confining patients in a hospital facility, parents and caregivers can practice the
D.E.N.G.U.E. strategy,” Health Secretary Enrique Ona said in a statement.

The six measures the DoH is encouraging patients, their parents and caretakers to adopt are the
following:

Daily monitor the patient’s status; encourage intake of oral fluids like oresol (oral rehydration
solution), water and juices; note any warning signs of dengue; give paracetamol to the patient,
not aspirin as it induces bleeding; use mosquito nets; and early consultation with doctors for any
warning signs.

The health agency has formulated the new strategy to educate the public on home treatment for
mild dengue cases, Ona said.

Upsurge in cases

The upsurge in the number of dengue cases has left hospitals across the country struggling to
accommodate patients seeking medical treatment despite limited beds.

The DoH has monitored 62,503 dengue cases from January to Aug. 21, mainly in Western
Visayas, Calabarzon, Central Mindanao and Eastern Visayas.

The virus, delivered by a bite from the Aedes aegypti mosquito, has so far claimed the lives of
465 Filipinos.

In just a span of a week—from Aug. 14 to Aug. 21—the health department registered 7,844
dengue cases nationwide. But last week, the DoH assured the public that the government was
still capable of managing the problem.

Health and local officials in Santiago City and Tuguegarao City in Isabela province have
declared a dengue outbreak.
In Santiago City, health officials said dengue cases had risen to 83, 27 of which were recorded in
the last two weeks.

Dr. Romanchito Edgar Bayang, assistant city health officer, said a 15-year-old boy who died on
Thursday was the first dengue fatality in Santiago City.

In Cagayan province, the city council of Tuguegarao expressed alarm over the 323 dengue cases,
including one fatality, reported in the city from January to Aug. 31.

The council planned to reactivate anti-dengue brigades in villages and to ask Mayor Delfin Ting
to require all government workers to observe the “four-o’clock habit,” an hour that would be
devoted to cleaning potential breeding and nesting areas of dengue-carrying mosquitoes.

Capiz

Health officials in Roxas City on Saturday reported that dengue cases in Capiz province were
dropping.

From 235 cases reported on Aug. 15-21, the number dropped to 178 on Aug. 22-28, said Yre
Altavas, officer in charge of the Capiz epidemiological surveillance and response unit.

With the cleanliness drive and reward system for the cleanest villages, local government and
health officials said they hoped that dengue cases would continue to drop in the coming weeks.

Capiz Gov. Victor Tanco has announced that assistance will be given to indigent patients.

For its part, the city government of Roxas led by Mayor Angle Alan Celino will give cash
incentives to the cleanest villages that stay dengue-free for two months.

In Negros Oriental, August proved to be the most deadly month for dengue as the mosquito-
borne killer claimed four lives in the province.

But Negros Oriental is luckier than other dengue-stricken provinces in the Visayas as it has not
breached the one-thousand mark.

Pacholo Alcantara, surveillance officer of the provincial health team office of the Department of
Health, said that as of Sept. 3, there have been 773 dengue cases recorded throughout the
province.

But Dr. Felix Sy, head of the Metropolitan Health Team covering the towns of San Jose, Sibulan,
Bacong, Valencia, Dauin and the city of Dumaguete, said the total cases this year were lower
than last year’s figure for the same period.

While the figures for Negros Oriental were in the triple digits, the neighboring province of
Negros Occidental had four-digit figures, earning it the distinction of having the biggest number
of dengue cases throughout the country.
Negros Occidental recorded 4,087 cases from January to Aug. 21, or an increase of 416 percent
over last year. It recorded 24 deaths. Reports from Jocelyn R. Uy in Manila; Villamor Visaya
Jr., Inquirer Northern Luzon; Felipe V. Celino and Alex Pal, Inquirer Visayas