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Tuberculosis May Become A Global Threat Again
Iphtashu Fitz writes "The journal Nature Medicine is due to release a report today on how highly drug-resistant strains of tuberculosis are on the verge of becoming a global epidimic. Strains of TB that are highly resistant to antibiotics are becoming increasingly prevalent in places like Russia, eastern Europe, and China, and only small changes are required to make these strains start spreading quickly. Treatment for multiple-drug-resistant strains of TB requires a carefully monitored cocktail of drugs taken for months on end, a regimin that many, especially in poorer countries are unlikely to follow to completion. The strategy used by the World Health Organization to combat TB, the "directly observed treatment, short course" or DOTS, involves using trained health workers to watch patients take their long courses of drugs, since even a little carelessness could result in TB mutating into a more drug resistant form within the patient." Oh, Alexander Fleming ? where art thou now?
This is why:
(1) If you're proscribed antibiotics, you should take them exactly as instructed; take them for the whole course, do not stop in the last couple days or when the symptoms go away;
(2) Do not attempt to "chase off" what you think might be an oncoming infection by taking a "leftover" pill or two from a previous subscription
(3) Realize that many infections are viral; do not expect or demand to be proscribed antibiotics contrary to your doctor's wishes
Doctors are now becoming very aware of bad behaviors which cause bacteria to become antibiotic-resistant, but convincing people to follow good practice is apparently harder.
My father lost his father when he was a mere 9
years old to TB. I don't understand why people
treat this as "someone elses problem" - it isn't a
SEP. It *will* bite you. You'll never have to worry about new diseases because the old ones are doing nicely...
The irony with TB is that
people think they are getting well, and stop taking
the drugs (which are making them feel ill). End result: great selection pressure to make resistant bugs).
I for one pray that we can stamp out that big disease called ignorance (hey, look at what happened in Nigeria with that dumb fuck (who cares
what religion?) and Polio). Damn. I had a friend
with scars from hell and calipers when I was a kid
and I'm a mere 45 year old. I never want to see
such things, not even in my nightmares...
Even things as simple as the commom cold are highly mobile conpared to a "few" years ago. Given air travel what it is today; a small outbreak of anything highly contagious can spell absolute disaster on a global scale. It's easy to forget people have only recently become the global travelers we now are. TB and all the others are no longer isolated to the point of initial/original concentration. Adds new meaning to "just off the jet".
Having the largest prison population in the world is a much bigger threat to America than H1B workers ever will be. Prisons are a breeding ground for communicable disease.
Personally, I hold doctors highly liable for the abuse, misuse and general over-use of antibiotics. Of course the patients are pretty damned stupid too, but I have seen cases where the doctor didn't see anything but a blood test before prescribing the antibiotics.
There are so many natural ways to inspire your own immune system to build and strengthen itself and it seems to me that for capitalistic reasons alone medical professionals do not prescribe them.
I'm not a doctor or medical expert either. But I'll say this much -- from the time I decided I was done taking pills and crap for every minor problem out there and let my body do its own healing, I have been a healthier, stronger person and I can't remember the last time I was sick... I remember what it was -- the flu -- but it was great than 5 years ago and basically, I just waited it out -- fever and headaches and agony and all. I recognize the fact that extreme situations call for the use of medicines and other modern medical techniques. But I think they are way over-used and in my opinion (guess) it's so they can way over-charge people.
Where does that statistic come from? I work in natural products biosynthesis I always thought it was much, much greater. What's the other 75%? And don't say combinatorial chemistry.
If it's "worldwide" it should be called a pandemic threat, not simply an epidemic threat.
Is it wrong to think we shoulda withheld medical technology from people incapable of using it properly so it would still work for us?
No. It would be wrong to refuse to TREAT those people, and wrong of us not to teach them the proper way to use the tech, but not wrong to think "man, we shouldn't give that kid a gun without teaching him how to shoot."
Yeah, I'm a Gen-X'er, and I know how glad I was to have an effective AIDS vaccine when I was growing up.
If the doctors are at fault, it is for bowing to the demands of ignorant, demanding patients who want antibiotics for every sniffle that little Tyffany or Brett get. I have had several co-workers who just wouldn't give up the belief that they could blast the common cold by having their pediatrician shoot up Junior with penicillin.
The Mexican practice of selling antibiotics over the counter doesn't help either. They're treated as a cure-all down there, and immigrants continue the practice.
Like the poster said, you're better off living a clean and healthy lifestyle, putting up with minor ailments, and saving antibiotics for actual bacterial infections.
Stefan
"Alright, I'm a practicing lung doctor so I've got to say a little bit."
[...]
"Using INH for a long enough duration will not cause resistence. Dead bugs can't develop resistence."
[...]
"In the grand scheme of things, TB may be getting worse worldwide, but here in the states it seems well controlled. We have a huge immigrant population, and I have seen on a couple cases of active TB over the last 5 years."
The article we're all discussing in this thread reports the incipient global TB epidemic caused by carpetbombing TB exposees with bacteriocides, which leaves the few mutants resistant to the drug to inherit their food supply: us. The principle of using a drug like INH "long enough" to kill all of the bacteria, even the more resistant mutants, depends on "long enough" being both less than the human lifetime, and humans nearly always following the long program. The biology of TB, or any other very large population fought with merely systematic techniques, allows at least a small population to survive, which can then reproduce. If large enough, that population can overcome the human immune response that resists the original infection (if the immune system hasn't been damaged too much, along with the liver damage, from the medication). Unless each bacterium is destroyed individually, systematic is all we've got, and we're dealing with statistics. The same reality applies to human behavior - highly variable across populations of millions, inevitably slopping across any thresholds. This attitude is solid biochemistry, but bad medicine. And it's the unchanging environmental factor within which TB has adapted. Without an alternative, the MDR epidemic seems inevitable, making inroads in the US more slowly, but just as inexorably as abroad.
--
make install -not war
Is. A few years ago(2001) it was found that 70% of all antibiotics in the US are fed to food-animals. Not just animals to be eaten, but animals that produce milk and eggs as well(hence my use of food-animal). If 70% of antibiotics is given to animals, the diseases have a leg-up before they hit the humans. And yes, when we eat food made with antibiotics, we do absorb some of those antibiotics, helping to created MDR's (as well as the animals creating MDR's).
What idiot modded this funny?
I know we all hate Microsoft's business practices and Bill Gates' view of OSS, but it's impossible to deny the great things his foundation has done worldwide.
Please, folks, separate the man from the business.
The global economy is a great thing until you feel it locally.
I have a friend, who is a pulmonologist in Russia. He told me that in the past doctors rarely became infected even if exposed to TB constantly. Nowadays, doctors themselves lack vitamins and put under stress in Russia. This pulmonologist was infected once, and other doctors fall ill regularly.
In theory there is no difference between theory and practice. In practice there is. - Yogi Berra
You're forgetting that the other component in drug resistant TB is availability of antibiotics. In the US, I'm fairly sure that prisons are a fairly nice source of drug resistant TB. Especially since prisoners may get on a course of drugs and stop partway through the 6-9 month course. Add in the infections in the native population and the availability of the latest antibiotics and you have a great way of incubating a drug resistant population and spreading it.
It also doesn't help that immunosupressed people (AIDS, organ transplants, etc.) can easily get infected by multiple strains increasing the possibility that different strains swap resistances.
"When you sit with a nice girl for two hours, it seems like two minutes. When you sit on a hot stove for two minutes, it
Somebody already replied that whoever moderated parent as Funny is a fucking moron.
The problem with TB is it is poor man's disease (mostly), so there is not much money in it as patients with tuberculosis have no money for so called innovative drugs. Because of that there is not much research going on new treatments of TB. This makes Mr Gates' foundation even more valuable.
OK, this guy is a blood thirsty businness shark but this doesn't mean everything he does is mean. It is better if he spends some of his enormous amounts of money on TB research than hoard it or build yet another billions of dollars worth house.
Raf
P.S. OK, as there are already more than 200 posts in this subject, probably all I've written is redundant, but what the heck...
- The CDC (U.S. center for disease control) inTrends in Tuberculosis --- United States, 1998--2003 states
- Khaled Mohammed Abu Khadra's thesis abstract (Ph.D. thesis?)
(the thesis itself was not directly linked), but the abstract gave hard numbers of preventive vaccination (vaccination prior to exposure) for the BCG vaccine in Jordan.
The last paragraph of the abstract reads:
- However, vaccines appear to become less effective after widespread usage (try googling on Ineffective TB vaccine), so they may be ineffective after all (a BBC Article gives 70% effectiveness ratings).
- Potential Public Health Impact of New Tuberculosis Vaccines by Ziv E, Daley CL and Blower, S.
describes the outcome of a mathematical epidemiological model of Tuberculosis, which appears to indicate that vaccination
AFTER exposure (post exposure) is likely to be more effective than pre-exposure vaccination at preventing disease (the authors make an interesting point that disease prevention is more important than preventing infection).
I wasn't able to directly refute the claims, and I suspect some of them may be true given the information turned up."During 2003, a total of 14,871 tuberculosis (TB) cases (5.1 cases per 100,000 population) were reported in the United States."
While Eurosurveillance in 2002 reports on data (which may have been gathered in 2000) at Tuberculosis control in Europe needs expanded DOTS, linked HIV/TB control, and improved surveillance reports:
"In most countries of western Europe, reported TB incidence is below 15 per 100 000 and continues to decrease slowly. In central Europe, reported TB incidence ranges from 20 to 40 per 100 000 and is decreasing in most countries. TB incidence is much higher in Bosnia-Herzegovina (65/100 000) and Romania (124/100 000), where it has increased significantly in recent years. In eastern Europe, a further increase in reported incidence was observed in 2000 to an overall 89/100 000, a 56% increase since 1995. In countries providing representative data, the overall levels of drug resistance at the beginning of treatment remained low both in Western and Central Europe (less than 1% of patients never previously treated had primary multidrug resistance) and remained extremely high in the Baltic states (9-12%)."
So the U.S. may have a lower rate of TB than western europe, and definitely has a lower rate than central or eastern Europe. However, I was not able to find a supporting reference for the U.S. having the lowest Rate of infection.
"The overall vaccine effectiveness was 88% ; 85% for pulmonary TB and 95% for Extra-pulmonary TB. The vaccine was more effective (92%) when given shortly after birth, compared to 62% when given at school age."
Sorry, I don't want to drag this off-topic into another screed about the evils of extended copyright, but it is mildly relevant.
My grandfather was a well-respected medical researcher. The works that he developed his fortune and reputation have been superceded, but toward the "mature" part of his career in the 1930's he did a lot of work on tuberculosis especially with animal tests on cattle. The articles my grandfather wrote are still under copyright. He's been dead for decades, and tuberculosis has been a non-issue for most Americans for years. Now that a more vicious strain of TB is starting to emerge, I find it disturbing that this material is still illegal to share.
If you can't see what I'm talking about, look at the two-digit year rollover problem framed in the media as Y2K. All of the research into the causes, identifications, and solutions to the "millenium bug" will remain under copyright for close to 90 years under current copyright law. Imagine though that copyright was extended yet again and these works weren't public domain until AFTER the next two digit rollover in 2100.
Just as people have already started to build two-digit years into databases again, so have people given up on many practices that might minimize the spread of TB. Some people can't even identify these practices or understand why they're at issue.
I realize that the research into Y2K and bovine tuberculosis isn't "gone" that it's still around under lease, but it seems that having only the choice of paying for out-of-date information on a tangential problem or recreating the works someone else did is a waste of resources (money or time) that could be better applied toward whatever problem is causing researchers to look back on these old issues.
I'm thinking about digging into my grandfather's work papers (what's left anyway) and trying to digitize some of his data, notes, and private letters on the subject of bovine TB. Some of this data probably can't be collected today because of regulations on animal testing that didn't exist in the 1930's. I know full well that it would be irrelevant to the current threat of drug resistant tuberculosis strains, but it might let some researchers or problem-solvers keep their money and time focused where the real problem is rather than paying/recreating old research.
While I'm not against people making money from their research and creative works, the length of time that this stuff remains under protection is absurd. The money made either for my family or the publishers trailed off to nothing decades ago. The potential monteary profit of his work is far outweighed by my own interests in not becoming a victim of a drug-resistant version of this affliction. The benefit of this work today is only as part of a contextual frame or foundation for research into other communicable diseases.