Tuberculosis is still out on a rampage, claiming around two million lives a year, especially in the developing world, despite concerned efforts to fight the disease. And while the disease in the majority of cases is curable, in California where notified cases of TB decreased by 33 percent from 1994 to 2003, "the proportion of multidrug-resistant cases has not decreased but remains steady," according to a study in the Journal of the American Medical Association (JAMA).

    "Tuberculosis continues its 3,000-year history of decimation," said Dr. Catherine DeAngelis, an editor of JAMA.

    Around nine million new cases of tuberculosis are registered annually, especially in developing countries, said DeAngelis.

    In 1991, World Health Organization put the figure at eight million cases a year, and set out a goal of a 50-percent reduction in TB incidence and mortality by 2015 from 1990. Around 80 percent of the new cases are focused on 23 countries, more than half of them in Bangladesh, China, India, Indonesia, and Nigeria, according to one of the JAMA studies.

    Christopher Dye of the WHO, a coauthor of the study, said that worldwide cases were growing at the rate of one percent a year in 2003. He believes the trend can be reversed by cutting transmission of the infection in countries where incidence is very high.

    In addition to treatment with antibiotics, strategies to reduce the disease include putting in place a system of regular supply of medication, combined with governments having the political will to combat the scourge.

    The WHO programs established by countries in the 1990s aimed to improve detection and treatment rates from 70 percent to 85 percent, and to reduce overall incidence by at least two percent a year.

    Disappointing progress globally meant that annual targets for the incidence of TB had to be eased to six percent from five percent, aiming for a reduction by half in cases by 2015, the authors said.

    Medical authorities state that it is hard to tackle TB efficiently in Africa and eastern European countries because of the high incidence of AIDS, with many cases of resistance to traditional treatment among patients.

    Drug resistance is due to not taking a course of antibiotics all the way through, seen in some treatments earlier on, said Dr Reuben Granich of the Centers for Disease Control and Prevention (CDC). To recover from TB, the patient must take antibiotics for a period of six to nine months, he said, noting that multiple resistance to medication is absolutely a man-made phenomenon and may be avoided.

    In California, meanwhile, the cost of treating resistant strains of TB has grown from US$28,000 to US$1.2 million per patient, he said. AFP

 

---

 

Polio defies eradication

 

WASHINGTON

A momentous campaign appears likely to miss a target to drive polio from earth by the end of 2005, health officials said, as the disease fought a stubborn last stand in Asia and Africa.

    But a "miracle" victory over a crippling virus that blighted the lives of millions remains in reach after a 200-nation campaign which experts have dubbed humanity's greatest-ever public health drive.

    An outbreak of polio in Nigeria in 2003, which has now spread to 16 countries including Indonesia, where there are six cases and Yemen with more than 60 infections, has frustrated the bid to eradicate polio.

    Asia, site this year of a blitz to immunize millions of children at rail stations, bazaars and schools, is close to being polio-free, but the disease lingers in remote African communities less than six months to deadline.

    "Looking at the epidemiological evidence, we are optimistic that Asia will achieve that goal," said Oliver Rosenbauer, of the World Health Organization's polio-eradication unit in Geneva. "In Africa, it is probably more challenging ... to stop it there by the end of this year is technically feasible, but probably we are going to see poliovirus transmission into 2006."

AFP

    The rainy season in Asia and Africa, peak time for polio transmission, is crucial.

    "We won't know how really feasible that deadline looks until later in the year," said Claire Hajaj of UNICEF's antipolio unit in New York. "It is possible to stop polio in Asia very quickly ... Africa will definitely be more of a challenge to stop polio by the end of the year."

    Polio is a virus that can cripple or paralyze patients and even cause death. It can attack anyone, but most of the afflicted are younger than five years old.

    A huge immunization sweep in more than 20 African countries in May sent health officials sounding optimistic that it could be as successful as previous campaigns, which all but snuffed out polio in the continent.

    Though new cases of polio, possibly transmitted from Nigeria by Muslims during the annual pilgrimage to Mecca are a "setback," they can be controlled by mass-immunization drives, experts said. The main battle is being fought in six nations where polio is endemic: India, Pakistan, Afghanistan, Nigeria, Niger, and Egypt.

    "Those are the areas where the virus lives. Those are the areas that are going to export the virus," said Rosenbauer.

    After an 18-year campaign worth US$3 billion started by Rotary International, which includes United Nations agencies, governments, and health authorities, polio hangs on only in remote areas that have escaped prior immunization drives.

    The Nigerian outbreak took hold after wild rumors circulated that doses of polio vaccine could cause AIDS, or were part of a US-led anti-Muslim plot.

    Immunization resumed last year after a diplomatic offensive that saw interventions by former US secretary of state Colin Powell and Nigerian President Olusegun Obasanjo. The World Bank granted Nigeria US$51.7 million in May to assist its fight against the disease.

    Andrew Natsios, chief of the US Agency for International Development, said "the victory is not yet won, but we are close."

    Dr. Julie Gerberding, head of the US Centers for Disease Control and Prevention, a leading light in the US end of the war on polio, said the campaign had "almost accomplished a miracle."

    More than 99 percent of global polio cases have been snuffed out, dipping from 350,000 in 1988 to 1,300 in 2004. By the end of 2005, five million people who would otherwise have been paralyzed will be walking.

    The world will only be certified "polio-free" if no new cases are detected for three years, under surveillance from an independent verification body. AFP

 

---

 

Asia still lacks flu-pandemic plan

 

SINGAPORE

Many countries in the Asia-Pacific region have yet to draw up firm plans to fight a potential flu pandemic, with poorer countries posing the greatest risk to the international community.

    Experts fear the H5N1 bird-flu virus could mutate into a form easily passed from person to person, creating a powerful new strain of influenza that could catch governments off guard and kill millions of people worldwide.

    The World Health Organization said only seven Asian governments have approved plans to fight a flu pandemic, even though 60 people have died of bird flu in Asia since 2003.

    "Areas where we currently see a great deal of H5N1 activity--Southeast Asian countries like Thailand, Vietnam, and Cambodia--loom large on our surveillance screen," said Bob Dietz, a WHO press officer. "But the reality is H5N1 activity in a certain place does not mean that we will see a pandemic start there. It could start anywhere. And as always, poorer nations are more vulnerable to disease than wealthier ones."

    The Washington Post reported on August 6 that US scientists have tested a vaccine that appears effective against H5N1 but more tests are needed, and whether enough can be produced to meet demand remains an issue.

AFP

    The big concern is that H5N1 would mingle with the ordinary flu virus, perhaps in someone who is suffering from influenza, or with an intermediary animal such as the pig, which can harbor both avian and human flu viruses. That way, a mass killer could emerge: a virus that is both lethal and contagious.

    Asia was hit hard by the SARS epidemic in 2003. SARS was first detected in southern China in late 2002 and spread by travelers globally to infect over 8,000 people, leaving nearly 800 dead. The epidemic raised awareness about the need for cross-border cooperation, but preparations for bird flu remain uneven across the region.

    Singapore is one of the few countries that have put pandemic plans in place despite having virtually no agricultural sector. The health ministry said that, although there was no vaccine available, it had already begun buying oseltamivir (Tamiflu), a drug used to treat type A influenza.

    China claims to have developed two new vaccines that it says are fully capable of stopping the spread of H5N1, giving it enough cover if a pandemic breaks out. Other than claiming to have vaccines, China has never made public how much it has stockpiled nor its plans to immunize birds and humans should a pandemic break out.

    Vietnam has only two major centers for treating people affected by bird flu, the Institute of Tropical Diseases in Hanoi and a similar facility in the southern economic capital, Ho Chi Minh City. Internationally accepted tests to confirm whether suspected human cases of bird flu are positive are only done at two laboratories, one in each city.

    Dr. Hans Troedsson, WHO representative in Vietnam, said a pandemic would be "horrendous" for the country, which might suffer hundreds of thousands of deaths.

    In Thailand, public-health authorities are relying on a US$116-million emergency plan approved by the cabinet in January.

    Under the plan, Thailand must stockpile 150,000 doses of Tamiflu, based on expectations of a minimum 50,000 to 60,000 people infected, and up to one million people in the worst-case scenario.

    Hong Kong health authorities meanwhile have stockpiled 3.7 million capsules of the antiviral.

    Indonesia's Health minister Siti Fadillah Supari said the government had imposed firm measures to prevent a pandemic. In South Korea, health authorities said they had been increasing their inventory of flu vaccines but declined to reveal the amount stockpiled.

    In Japan, once an avian-flu outbreak is confirmed, authorities kill all birds at affected farms with the bodies either incinerated or disinfected with chemicals. Authorities shut down affected farms for thorough disinfection and ban human traffic to and from the farms. The government also imposes a three-week ban on the transport of birds, their meat, and eggs from farms within 30 kilometers of an outbreak. AFP