Vaccine shows promise against TB, leading cause of death in SA

TB and HIV are concurrent epidemics in Africa interacting synergistically

THE African Union (AU) was among hundreds of organisations to commemorate World Tuberculosis Day – to draw attention to a disease the World Health Organisation has rated the top infectious killer worldwide, claiming over 4 500 lives a day.

TB is the leading cause of death in South Africa and 2014 data revealed that 8.4% of deaths nationally were attributed to the disease.

Data collected in the country in 2014 estimated that 454 000 people developed TB, while 300 000 were treated for the disease. Of those patients, only 252 000 were successfully treated and an estimated 19 500 patients were lost to follow up on.

In 2015 TB surpassed HIV as the number one infectious killer globally.

The theme of World TB Day 2018 was “Wanted: Leaders for a TB-free world”, and it focused on building commitments to end TB.

Africa accounts for more than half of the 30 high TB burden countries, over 76% of the countries with high TB/ HIV burden, and 30% of countries with a high burden of multidrug-resistant TB.

The continent’s TB treatment success rate in 2015 was at 83% among new and relapsed TB patients on treatment.

The AU said while significant progress had been made in advancing TB surveillance, diagnostics, testing and treatment, the disease remained the ninth leading cause of death worldwide and the leading cause from a single infectious agent.

“TB and HIV are concurrent epidemics in Africa interacting synergistically, and contributing to excess burden of disease on the continent.

“While significant progress has been made due to community action, shared responsibility and global solidarity, the 2017 WHO Global TB report shows that new cases and death are increasing in Africa, sending clear signals that more resources need to be allocated to respond to TB most effectively.”

The AU also said it was worrying that case notification was stagnating.

“Research shows drug resistance, including multidrug-resistant TB, has reached alarming levels with the emergence of strains virtually untreatable with existing drugs.

“Africa’s health systems remain weak by international standards and inadequate coverage and weak performance of health services limit access to high-quality tuberculosis care.

“Many private health providers are delinked from TB services provided by the public sector. There is an increase in TB associated with non-communicable diseases and risk-factors such as diabetes, tobacco-smoking, silicosis, alcohol and drug misuse, and malnutrition.”

South Africa’s first survey to assess the incidence of TB in the country was commissioned by the Department of Health in February and aims to determine the bacteriological or laboratory-confirmed prevalence of tuberculosis in South Africa.

It enrolled about 55 000 participants.

Data will be collected in 110 clusters across all nine provinces and is expected to conclude in Gauteng in November.

Results are expected to be released next year.

Researchers at the South African Tuberculosis Vaccine Initiative, UCT, the Infectious Disease Research Institute, and Aeras (a non-profit, global biotech organisation developing new TB vaccines) have released the first results from a clinical trial, reporting safety and induced immune responses of a novel tuberculosis vaccine candidate developed by scientists.

The trial in South African adults demonstrated that the vaccine was well tolerated, had an acceptable safety profile and induced a specific immune response, supporting further development and clinical testing of this novel vaccine candidate.

Lead researcher at UCT Professor Mark Hatherill said that globally about 10% of people infected with the TB bug develop TB disease over their lifetime, but a vaccine such as this could help to prevent the disease, which is spread by coughing.

“In South Africa, 50 to 80% of adults are infected with Mycobacterium tuberculosis and the incidence of TB disease is one of the highest in the world, so there is an urgent need to stop TB before it is spread,” Hatherill said.