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TB cases declining

WHO

By ROY C. MABASA October 12, 2011, 8:48pm MANILA, Philippines The World Health Organization (WHO), in a data released recently, revealed that for the first time the number of people falling ill with tuberculosis (TB) each year worldwide is declining. However, while the 2011 Global Tuberculosis Control Report showed that the number of people who fell ill with TB dropped to 8.8 million in 2010, after peaking at 9 million in 2005, United Nations Secretary-General Ban Ki-moon warned that current progress is at risk due to under-funding. TB usually attacks the lungs but can also affect other parts of the body. It is spread through the air when people who have an active mycobacteria infection cough, sneeze, or otherwise transmit their saliva through the air. Most infections in humans result in an asymptomatic, latent infection, and about one in ten latent infections eventually progresses to active disease, which, if left untreated, kills more than 50 percent of those infected. The WHO report found that TB deaths fell to 1.4 million in 2010, after reaching 1.8 million in 2003. It showed that the TB death rate dropped 40 percent between 1990 and 2010, and all regions, except Africa, are on track to achieve a 50 percent decline in mortality by 2015. In the Philippines, a significant drop in the incidence of TB was also recorded. From at least 400,000 cases in 1990 to 260,000 in 2010. Success in treatment of TB in the country also improved from only 60 percent 11 years ago to 89 percent last year. WHO said much of the progress reported today is the result of expanded efforts in large countries where the burden of TB is estimated to have been declining for much of the last decade after a peak linked to the HIV epidemic. However, the report stressed that current progress is at risk from under-funding, especially efforts to combat multi-drug-resistant TB (MDR-TB), a form of the disease that fails to respond to standard first-line drugs. While the share of domestic funding allocated to TB rose to 86 percent worldwide for 2012, most low-income countries still rely heavily on external funding.

Anti-TB drive launched


Published : Sunday, August 28, 2011 00:00 Article Views : 1,139 Written by : LEA BELTRAN HEALTHNEWS ASSOCIATE EDITOR

TUBERCULOSIS, or TB, infects 75 Filipinos every day and is the sixth leading killer disease in the country. Worldwide, the Philippines is the 22nd country with the highest number of TB cases while it is second only to China in Asia. In response to this, Chevron committed $5 million to fight TB in the Philippines as the first corporate champion of The Global Fund to Fight AIDS, TB and Malaria. Since then, almost 8,175 service deliverers have been educated in providing quality TB services. More than 6,144 health care providers were trained in community care and treatment for Multi-Drug Resistant (MDR) TB were provided to about 1,778 patients who were no longer responding to first line anti-TB drugs. MDR treatment costs more than P200,000 for at least 18 months of treatment. Chevron Philippines Inc. (CPI), recently launched its Labanan ang TB Para Tsuper Healthy anti-Tuberculosis (TB) awareness campaign in Manila highlighted by the unveiling of the Anti-TB bus which will make the round of the city s public transport terminals to conduct on-board seminars about TB. The awareness drive aims to provide public transport drivers, their families, and commuters with accurate information about TB symptoms, prevention, and cure. According to Evangeline Rafanan, director of the Manila City Health Office, tuberculosis can be prevented and treated if diagnosed early. We are very lucky to have a partner with Chevron that will help us eradicate the increasing tuberculosis cases in Manila, added Rafanan. Meanwhile, Zeny Maranan, president of Federation of Jeepjney Operators and Drivers Association of the Philippines (FEJODAP), is thankful that this campaign was launched. Maranan said, Marami po kaming mga ka-myembro na bumabyahe kahit na masama ang pakiramdam dahil kailangang kumita para sa pamilya. Ngayon po ay may katuwang na kami para maiwasan ang pagkakasakit ang pagkawala ng kinikita ng aming mga kasama. [We have a lot of member-drivers who work despite bad health condition because they need to earn for their family. Now, we have a partner that will help us prevent the disease and cost our job.] Besides the TB Helpline number, Chevron will also be providing flyers, posters and hold audio-visual presentations for wide dissemination. Through its Anti-TB Helpline 381-1010, the campaign established a link between the public and free TB treatment facilities such as Directly Observed Treatment, Short-course (DOTS) centers. People who call the helpline are directed to the DOTS center nearest their residence for assistance. Dean Gilbert, area business manager of Chevron Global Lubricants, said The Caltex TB awareness campaign is founded on the belief that the best assistance we can give is by empowering people with the right information. By knowing the difference between what is fact and fiction, the fight against TB is already half won. By encouraging our valued customers such as the public transport drivers to know the symptoms of the disease and encourage everyone they know to get an early check up, we believe we can stop the spread of Tuberculosis. According to Cherry Ramos of Chevron, this campaign had its pilot site in Makati in 2010 were 1,800 PUJ drivers and their families were engaged. It is being replicated in Manila, this time targeting 2,500 public transport drivers, in partnership with the Manila City Health office and FEJODAP.

DOH ties up with private sector for TB control program in Ilocos Norte
Written by Cristina Arzadon

LAOAG CITY (August 18) The Department of Health (DOH) has enlisted private support for the national governments tuberculosis (TB) control program through an advocacy symposium for non-health care providers. The forum, set on August 23 at the Northview Hotel here, will gather together a multi-sectoral group for capacity building process that the Philippine Coalition against Tuberculosis (PhilCat) will provide. The PhilCat is a non-government organization and a sub-recipient of a grant of the Philippine Business for Social Progress from the Global Fund to fight AIDS, tuberculosis and malaria. Founded in 1994, the PhilCat partnered with the DOH to lead collective efforts in TB control. Dr. Walberg Samonte, provincial health officer, said public and private collaboration is vital to achieve a successful control program. The program targets an increase in case detection and cure rates by engaging the private sector in our program implementation, he said. Samonte said Philcat was tasked primarily to organize and install the Provincial Coordinating Council for Public-Private Mix Dots (PCC-PPMD) in 44 provinces across the country to boost the governments national tuberculosis program. Both PhilCat and the DOH enlisted Ilocos Norte in 2010 as one of the expansion sites for the programs implementation. In its report during the first health summit in June, the provincial health office said TB occupies the 10th slot in the leading causes of deaths in Ilocos Norte. Samonte said the province was found to be poor in TB case detection and exhibited a low detection rate. The provincial government had set in place intervention measures including the accreditation of rural health units as TB DOTS centers. As of June this year, the PHO has accredited 91.3 percent or 21 of 23 RHUs as TB DOTS centers. (PIA Ilocos Norte)

Source: http://www.ilocossentinel.com/story/doh-ties-up-with-private-sector-for-tb-controlprogram-in-ilocos-norte.html

DOH warns of ongoing transmission of drugresistant tuberculosis


PUBLISHED ON NOV 24, 2010 |

By LILITA BALANE Tuberculosis, among other communicable and preventable diseases, continues to ail thousands of Filipinos and threatens to afflict more with the emergence of a variety that is resistant to drugs. Based on government statistics, chronic tuberculosis has slid on the list of leading causes of illnesses and deaths in the country. From 5th among the top causes of diseases in 2000, it ranked 7th in 2008. And from 27,351 deaths in 2001, the government recorded only 26,588 deaths from TB in 2005. But according to the health department, the campaign and treatment against TB might be hampered by the evolution of multi-drug resistant (MDR) types. Then another problem would be the MDR-TB. Its not yet being talked about until 2007. It is 1.5 to 2.1 among the new cases, so there is now an ongoing transmission, National Disease Prevention and Control medical specialist Anna Marie Celina Garfin told reporters recently at a seminar on public health issues organized by Newsbreak and the Pharmaceuticals and Healthcare Association of the Philippines. The Philippines remains 9th among the 27 countries with the highest number of MDR cases globally. About 4% of the new TB cases and 21% of the previously treated cases in the country are MDR. These prevalence rates are high compared to the global average rates of 1.2% and 7.1%, respectively. TB is a contagious bacterial infection that primarily affects the lungs. TB patients usually go to their local hospitals and undergo a free six-month, directly-observed treatment short-course (DOTS), which includes the intake of antibiotics like rifampicin and isoniazid. In case a patient misses treatment sessions or healthcare workers fail to properly administer the therapy, a common TB can turn into an MDR. An MDR-TB means extending a patients treatment to up to 2 years, using second-line drugs that induce more side effects, and additional expense both for the government and the patient, Garfin explained.

Anti-TB drugs are free at the local health centers, but with new cases of MDR-TB, the government is obliged to shoulder expensive second-line drugs and provide extra incentives in the form of cash or food packages, to ensure that TB patients will complete the DOTS. Garfin estimated that an MDR-TB patient would need P400,000 for his or her treatment. Aside from the 150,000 common TB cases it has treated, the government has also detected and treated at least 15,500 MDR-TB cases. There were, however, 257,317 total TB cases reported in 2008, requiring the government to find and cure the remaining 107,317 patients. The Department of Health (DOH) is still optimistic that the Philippines will meet its Millennium Development Goal to halt or reverse the incidence, prevalence, and deaths from TB. Garfin said that the Philippines has 77% TB detection rate, which is above 70% target by 2015. From 31 deaths per 100,000 population in 2005, DOH expects that the country could reduce TB mortality rate to 19 deaths. At present the DOH TB program is partnering with other government agencies and private groups to localize the implementation of DOTS, to seek additional budget for the TB program, and to reduce out-of- pocket expenses by expanding the coverage of health and social insurance in the treatment of TB.

Control and Prevention of Tuberculosis in the Philippines I. The Clinician and his Role in the Control of Tuberculosis

An extensive discussion on the Current State of Tuberculosis in the Philippines is included in the first chapter of this document. Three important players have been identified as key components to achieve control of tuberculosis in the country: the Patient, the Health Provider, and the National TB Program. Although the rates of case detection and treatment success have improved in the last few years, particularly in the public sector, there remain many several obstacles to be hurdled for adequate TB control. Being a clinical practice guideline, this chapter on Control and Prevention of Tuberculosis in the Philippines is written having in mind the health provider as a professional seeing patients with TB in his everyday clinical practice with other multiple tasks in our society. Thus the focus of recommendations is not possible solutions to problems of the national TB program. Instead it will be directed in helping each and every practicing physician, whether in government or in the private sector, whether in the rural or urban areas or in teaching institutions to coordinate individual efforts to the improvement of care of each and every TB patient for the common good. II. Outline of Issues on Control and Prevention A. How can physicians contribute to the control and prevention of TB in the Philippines? B. How helpful is active case finding in detecting other individuals infected with TB? C. How useful is the tuberculin skin testing in the diagnosis of tuberculosis? D. Do we manage latent tuberculosis? E. What is the role of vaccination in the prevention of TB? F. What are the infection control measures appropriate for TB in the hospital setting? III. Recommendations for the Control and Prevention of Tuberculosis in the Philippines How can physicians contribute to the control and prevention of TB in the Philippines? The control and prevention of tuberculosis in a high-burden country such as in the Philippines can be achieved primarily by correct management of each and every case of active and infectious TB disease through DOTS. Clinicians should employ best practices in the diagnosis and treatment of TB as outlined in this clinical practice guideline within the context of a directly observed treatment short course (DOTS) program. How helpful is active case finding in detecting other individuals infected with TB? As an extension of the DOTS strategy, active case finding in family members and close contacts of patients with tuberculosis can facilitate reduction in the morbidity and mortality attributed to the disease. Summary of Evidence Strategies to promote active case findings in the family members and the close contacts of TB patients have yet to be formulated in the local setting. But this will be a helpful tool, as it can lead to earlier detection and immediate treatment of active cases, resulting in decreased morbidity and mortality rates. Four active case finding strategies were evaluated in a study with the goal of expanding the WHO tuberculosis control program. The study showed one twelve year cycle of active case finding based on a symptomatic

screen could reduce the number of new cases of tuberculosis between 1998 and 2050 by 17 million, and the number of deaths by 7 million.

Social support offered by families has been identified with positive health seeking behavior and treatment adherence. How useful is the tuberculin skin test in the diagnosis of TB? In the general population, the tuberculin skin test (TST) is not useful for detecting tuberculosis infection. TST is recommended for asymptomatic individuals with an increased risk for tuberculosis and are likely to benefit from treatment of latent tuberculosis infection (LTBI). Summary of Evidence A major concern of TB prevention strategies is the identification of asymptomatic M. tuberculosis infection. Presently, only the tuberculin skin test (TST) administered by the Mantoux method is recommended for detecting asymptomatic tuberculosis despite its low pooled sensitivity (60% at 95% CI; range 38% - 82%) and pooled specificity (78% at 95% CI; range 59% - 97%). Test sensitivity approaching 100% if it is administered in patients with latent tuberculosis infections and normal immune responses. However, false positive reactions from non-tuberculous mycobacteria may complicate readings. Currently, no other diagnostic test has been found to accurately identify TB infection among asymptomatic individuals. A method known as the multiple-puncture technique has been cited, but was found to have even poorer sensitivities and specificities compared to the Mantoux test; it is thus not recommended even for children or infants. The Mantoux technique is the intradermal injection of tuberculin, the most widely used of which is purified protein derivative (PPD) from cultures of Mycobacterium tuberculosis. The size of the Mantoux reaction is correlated with future risk of tuberculosis 124 development, but no correlation between the sizes for current active disease has been established. The recommended cut-off for a positive tuberculin skin test among Filipinos is 8 mm.

An initial two-step tuberculin skin test has been recommended for high-risk individuals (e.g. health care workers, employees in health care facilities, and residents of nursing homes). This two-step technique is recommended when there is a need to determine a true baseline reading. The second injection step is made when the initial test reads negative; this is administered a week after the first test. The two-step tuberculin skin testing is also recommended for individuals who are candidates for serial testing as part of surveillance programs, for example, health care workers who are in contact with people with active disease. The procedure is also advocated for individuals who intend to travel to places with a high incidence of tuberculosis infection.

Other uses for the tuberculin skin test include monitoring recent converters in institutions

where TB outbreaks are common, and screening immunosuppressed patients and other high-risk groups. Monitoring recent converters in institutions like hospitals, prisons, homeless shelters, workplaces, schools and other areas where people repeatedly congregate (bars, clubhouses) allows reductions in morbidity as the TB infection usually initiated in these places frequently progress to active cases.

Performing TST on HIV/AIDS victims, patients with diabetes mellitus, persons undergoing regular dialysis, and other high-risk immunosuppressive individuals has been proven cost-effective and has been recommended by the American Academy of Pediatrics (AAP), the Advisory Committee for Elimination of Tuberculosis of the Centers for Disease Control, and the American Thoracic Society (ATS). For a more extensive discussion of the tuberculin skin testing, please refer to the recently released statements of the PCCP Council on Tuberculosis Guideline on Tuberculin Skin Testing in Adult Filipinos Do we manage latent tuberculosis? At this time, the treatment of patients with LTBI is not a priority in the Philippines. While TB remains uncontrolled, resources must be focused on the source case. If and when targets have been achieved and sustained, strategies can then be shifted from control to elimination. Summary of Evidence At present, the focus of management remains on the susceptible infected individual. For high-risk groups, i.e., those who are likely to have progression of active disease, chemoprophylaxis or treatment of Latent TB Infection (LTBI) may be needed, as recommended by the American Thoracic Society, American Academy of Pediatrics, the Advisory Committee for Elimination of TB of the Center for Disease Control and Prevention, and the Philippine Guidelines on Periodic Health Examination. These high risk groups include childhood contacts of active cases of TB, and persons with positive TST and risk factors for TB: diabetics on immunosuppressive treatment, patients on hemodialysis presenting with fibrotic lesions, health care workers who convert from negative to positive, and patients with HIV infection. However, emphasis should be placed on adequate screening, close monitoring and observation, and appropriate treatment once these patients show signs of active disease.

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