Gains in tuberculosis control cited
By Mabelle Aban, Contributing Writer
Tuberculosis remains a major health problem but the country is making significant scores in the battle against the disease.
Much of the gains can be attributed to the country's adoption of the directly observed therapy, short course (DOTS) as a national strategy to fight TB, said Dr. Thelma Tupasi during the inauguration of the newly renovated building of the Philippine Society of Microbiology and Infectious Diseases (PSMID) in May.
The country adopted the DOTS strategy in 1996. By 2002, the public sector achieved its target coverage. In 2003, the Philippine Coalition Against Tuberculosis (PHILCAT) spearheaded the implementation of the Public-Private Mix DOTS (PPMD) in 70 sites around the country following receipt of a US$11.3 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria. A total of 217 PPMD projects are eyed for implementation in round five of the program.
Tupasi acknowledged the important role that PPMD plays in the country's TB control program, saying that it was instrumental in achieving the country's targets.
With PPMD, the case-detection rate jumped from 53 percent in 2001 to 71.7 percent in 2004, "and this has been maintained at 74 percent," according to Tupasi, adding that the figure may not be "ecstatic" but "really quite good" compared with those of other programs in world.
In 2001, the Tropical Disease Foundation also launched the DOTS Plus project to deal with multidrug-resistant TB (MDRTB) in accordance with World Health Organization guidelines. In 2004, this program was expanded by integrating the public sector into the existing DOTS Plus system and installing a satellite DOTS Plus clinic at the Lung Center of the Philippines.
In 2003, the country also adopted the Comprehensive Unified Policy on TB control (CUP) with the issuance by President Gloria Arroyo of Executive Order No. 187. The CUP put all TB-control protocols under one umbrella and enjoined other key government agencies and private organizations involved in TB control to carry out their respective TB-control efforts in the context of the National TB Program (NTP).
Meanwhile, the Philippine Health Insurance Corporation (PHILHEALTH) provided a benefit package for members undergoing TB treatment under the DOTS strategy, thereby ensuring sustainability of the program's implementation.
With all these efforts, the country succeeded in increasing detection rate to over 70 percent, exceeding the global target, and in bringing treatment-success rate to 88 percent, also higher than the international target of 85 percent. These also led to a drop in mortality rate from 57 per 100,000 in 2002 to 57 per 100,000 by 2005, "a significant decline in a matter of three years," said Tupasi.
With these achievements, the WHO cited the Philippines as a "success story" in TB control and management.
Tupasi said that with funds from the Global Fund, the WHO, United States Agency for International Development, Japan International Cooperation Agency, and the counterpart financing from the Philippine government, the gap in resources has narrowed until 2008.
But she stressed, "We have to be more militant. We have to really speak up and say that the government must invest more in TB, malaria, HIV control because these are not only health problems, these are developmental issues. If you make the country healthier by having healthy people, we will be more productive."
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Human antibodies neutralize H5N1
Marlowe Hood, Agence France-Presse
PARIS
Scientists in Switzerland have reproduced antibodies that can neutralize the H5N1 strain of bird flu, pointing the way to a treatment for people stricken with the deadly disease. In experiments on mice, the human antibodies-taken from individuals who survived the virus-provided near-total immunity in inoculated animals and vastly enhanced survival rates for those already infected.
"We are very confident that these data can be reproduced in humans," said Antonio Lanzavecchia, coauthor of the study and director of immune-regulation laboratory at the Institute for Research in Biomedicine.
The H5N1 bird flu has killed millions of wild and domestic fowl across the world since it first emerged in the late 1990s, and has caused 185 fatalities out of 306 known cases-most since 2003-in humans, according to the World Health Organization. Experts fear that the virus could mutate into a form easily communicable among people as happened during the great flu epidemic of 1918, which caused some 50 million fatalities.
Normal mice in Lanzavecchia's lab were injected with antibodies generated from the blood of four avian-flu survivors in Vietnam, where more than 40 people have succumbed to the disease since 2003.
The mice were then exposed to the same strains that proved so deadly in humans. The treatment provided virtually complete protection, according to the study published in PLoS Medicine.
As important, said Lanzavecchia, was the efficacy of the antibodies in neutralizing the virus in mice that had been infected as much as 72 hours earlier. The antibodies significantly reduced the amount of virus found in the lungs-by a factor of 10 to 100-and almost completely stopped it from reaching the brain or the spleen. By contrast, none of the untreated mice in a control group survived.
The development of a vaccine against a possible global H5N1 pandemic has been a major focus of scientists in the field. But relatively little attention has been devoted to antibodies, which act differently, Lanzavecchia said.
A vaccine induces a long-term or permanent immune response, but typically takes weeks or months to take effect. Vaccines are also useless to a patient once the disease has struck.
Antibodies, however, work immediately, and are relatively easy to manufacture on an industrial scale. But the protection is only likely to last a few months, he explained. This could still be critical in saving the lives of those infected, who typically seek medical help only a couple of days after flu-like symptoms appear. Antibody treatment could also immunize frontline nurses and doctors during a possible pandemic.
Because it is not possible to conduct regular clinical trials due to the lack of cases, regulators in the United States and Europe have authorized a "fast track" approval process for an antibody-based drug, said Lanzavecchia.
If a treatment shows the same results in two animal models, including one on primates, and then passes a safety analysis, it could then go to market. This process typically takes between three and four years, he said.
The research was funded by Britain's Wellcome Trust, the second largest medical research charity in the world, as well as the US National Institutes of Health and the Swiss National Science Foundation.
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Advocates vow to stamp out smoking
BANGKOK
Officials from more than 140 countries wrapped up an international tobacco-control conference in Thailand in July with a commitment to stamp out smoking in all public areas and workplaces.
Delegates to the weeklong meeting organized by the World Health Organization (WHO) to discuss ways of boosting global efforts to stop smoking unanimously agreed on a set of guidelines to help governments who are thinking of implementing a smoking ban.
"We know that secondhand smoke is deadly," said Douglas Bettcher, head of the WHO Tobacco Free Initiative. "It causes a whole range of diseases in children, and it causes cancers, it causes heart disease in adults, it causes 200,000 deaths in the workplace. The world now moves forward with a good form of globalization-the globalization of 100-percent smoke-free environments."
WHO representatives also announced that they had started talks on a new treaty to fight the illicit trade in tobacco. "This transnational phenomenon negatively affects national security and economics, as well as public and personal health in many countries," said Haik Nikogosian, head of the WHO tobacco-control secretariat. This treaty enables countries to combat the complex threats tobacco poses to human health, such as illicit trade of tobacco products, through international law."
The Framework Convention Alliance-an international alliance of hundreds of tobacco-control organizations-has estimated that illicit cigarette trade accounted for more than 10 percent of the total global trade in cigarettes in 2006.
England on July 1 became the latest place to implement a smoking ban, with smokers being asked to stop lighting up in public spaces and workplaces. Ireland was the first European country to impose a smoking ban in March 2004, and bans of varying degrees have followed in Norway, Italy, Malta, Sweden, Latvia, Lithuania, France, Finland, and Iceland.
Bans in the developing world are more patchy. Thailand does not allow smoking in air-conditioned buildings, but many entertainment venues such as bars and nightclubs are exempt.
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