Win­ning the war against TB

Financial Mirror (Cyprus) - - FRONT PAGE -

ex­ten­sively drug-re­sis­tant TB (XDR-TB), have also ap­peared.

Given the enor­mous eco­nomic bur­den and wide­spread hu­man suf­fer­ing caused by TB, a com­pre­hen­sive ef­fort to tackle the dis­ease is ur­gently needed. In a se­ries of ar­ti­cles in the Bri­tish med­i­cal jour­nal The Lancet, Sal­maan Ke­shav­jee, a pro­fes­sor of global health and so­cial medicine at Har­vard Med­i­cal School, out­lined a strat­egy for de­feat­ing it. Ke­shav­jee and a group of TB sci­en­tists, clin­i­cians, and ad­vo­cates from gov­ern­men­tal and non­govern­men­tal or­gan­i­sa­tions, hos­pi­tals, and uni­ver­si­ties set them­selves the goal of bring­ing TB’s death toll to zero – and out­lined the mea­sures needed to achieve it.

The first step is to ramp up dat­a­col­lec­tion ef­forts. TB epi­demics, like those of other in­fec­tious dis­eases, vary by ge­og­ra­phy; as re­sult, erad­i­ca­tion ef­forts need to be cus­tom­ized to lo­cal con­di­tions. Lo­cal TB pro­grams need to make bet­ter use of ex­ist­ing data, ex­pand rou­tine col­lec­tion, mod­ern­ize data-stor­age sys­tems, and de­velop the an­a­lyt­i­cal in­fra­struc­ture needed to mea­sure the ef­fects of lo­cal in­ter­ven­tions. These find­ings need to be made avail­able within the coun­try where data were col­lected, and the lessons learned must be shared with neigh­bour­ing coun­tries and re­gions.

More­over, health-care work­ers must ex­pand ef­forts to pre­vent new in­fec­tions and quickly treat fresh cases. By ac­tively seek­ing out vic­tims and treat­ing them quickly, so that they are no longer in­fec­tious, the chain of TB trans­mis­sion can be bro­ken. This strat­egy has been proven ef­fec­tive by em­pir­i­cal eval­u­a­tion and math­e­mat­i­cal mod­el­ling.

At the same time, ef­forts must be made to con­trol the seedbeds of the dis­ease, the la­tent in­fec­tions that are the source of vir­tu­ally all new cases of ac­tive TB. My­cobac­terium tu­ber­cu­lo­sis, the bac­te­ria that causes the dis­ease, can lay dor­mant for long pe­ri­ods, dur­ing which the vic­tim shows no symp­toms of hav­ing been in­fected. Tar­get­ing TB at this stage would stop the bac­te­ria’s spread and re­duce the dis­ease’s global bur­den. Rolling out pre­ven­tive ther­a­pies in at-risk pop­u­la­tions and de­vel­op­ing bet­ter di­ag­nos­tic tests to iden­tify those with asymp­to­matic in­fec­tions would help drain reser­voirs of the bac­te­ria.

De­vel­op­ing a more ef­fec­tive vac­cine would have the big­gest im­pact on the epi­demic. The Bacil­lus Cal­mette–Guérin vac­cine is given to in­fants in many parts of the world, but its ef­fi­cacy against pul­monary TB is highly vari­able. To elim­i­nate the dis­ease glob­ally, a bet­ter vac­cine would be cru­cial.

Fi­nally, any ef­fort to erad­i­cate TB must ac­knowl­edge that the dis­ease is rooted in poverty and so­cial ex­clu­sion. Since the mid­dle of the twen­ti­eth cen­tury, world­wide ef­forts to ad­dress TB have em­pha­sised bio­med­i­cal so­lu­tions and fo­cused on treat­ing out­breaks. But, be­fore the devel­op­ment of an­tibi­otics, im­prove­ments in liv­ing stan­dards had helped re­duce the im­pact of TB. In­te­grat­ing a bio­med­i­cal ap­proach with an em­pha­sis on the i mpor­tance of good nu­tri­tion, de­cent hous­ing, and hu­man wel­fare will be nec­es­sary if the dis­ease is to be brought to heel.

The global com­mu­nity must work to­gether and trans­late ex­ist­ing knowl­edge and strate­gies into ef­fec­tive pro­gram­matic in­ter­ven­tions in com­mu­ni­ties most af­flicted by TB. By de­vel­op­ing new tools – in­clud­ing rapid di­ag­nos­tics, safe and shorter treat­ment of TB in­fec­tion and dis­ease, and an ef­fi­ca­cious TB vac­cine – strength­en­ing health sys­tems, and im­prov­ing the liv­ing con­di­tions of at-risk pop­u­la­tions, we can neu­tralise one of hu­mankind’s old­est killers. Only then will we be able to con­sign TB, at long last, to the his­tory books.

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