March Issue of Lancet Infectious Diseases Focuses on TB Ahead of World TB Day

The March issue of the journal Lancet Infectious Diseases focuses on tuberculosis to coincide with World TB Day 2009, which is scheduled for March 24. The theme of this year's World TB Day is celebration of the lives of people affected by the disease. According to the Lancet, the lives of 14 million people with TB could be saved by 2015 if the Stop TB Partnership's treatment and control recommendations are successful. The Lancet published several articles related to TB control and treatment and challenges in fighting the disease (Lancet, March 2009). Summaries appear below.

• "Are We Really That Good at Treating Tuberculosis?": The success of TB programs is measured by treatment success rates because of the "inherent difficulty in estimating the true number of incident TB cases and therefore case detection," Helen Cox of the Macfarlane Burnet Institute for Medical Research and Public Health in Melbourne, Australia, and colleagues write in a reflection and reaction piece. According to the authors, treatment success rates in many countries "are received with skepticism among health care workers struggling with TB at the clinic level" because of the "obvious difficulties in implementing DOTS programs, maintaining program quality, and achieving adequate financing and human resources in high-TB burden settings." The authors add that many TB programs focus specifically on new sputum smear-positive cases, which "risks focusing attention" only on new TB patients. "Our failure to control TB reflects our failure to detect and cure enough cases to interrupt transmission," the authors write, adding that there is a "pressing need for appropriate performance-management tools that encompass the range of activities and outcomes performed by TB programs" (Cox et al., Lancet Infectious Diseases, March 2009).
  

• "Screening Migrants for Tuberculosis: Where Next?": More than half of new TB cases in Europe occur among foreign-born individuals and "these numbers could rise" because of "unprecedentedly high levels of global migration," Sally Hargreaves, a research fellow at Imperial College London and a senior editor for Lancet Infectious Diseases, and colleagues write in a reflection and reaction piece. Hargreaves and colleagues write that increasing rates of HIV and "overstretched" public health services have "led to calls for renewed thinking about policies" on TB screening among migrants. According to the authors, "inclusive policies that encourage greater participation in health services by hard-to-reach migrant groups" and that include TB screening and screenings for other infectious diseases, such as HIV and hepatitis, are needed. In addition, European guidelines on "standard policies for testing and treating" TB among migrants that also address latent TB should be developed and implemented, the authors write (Hargreaves et al., Lancet Infectious Diseases, March 2009).
  

• "Global Tuberculosis Control Amid the World Economic Crisis": "With many demands on political attention in a global economic downturn, will progress on tuberculosis fall behind?" Kelly Morris asks in a Lancet Infectious Diseases article. She writes that the Global Fund To Fight AIDS, Tuberculosis and Malaria and the Stop TB Partnership are facing funding deficits, adding that "investment could fall rather than increase" in the current economy. According to Morris, although DOTS implementation has improved, multi-drug resistant and extensively drug-resistant TB "are at their highest levels ever, placing a further burden on programs." In addition, progress to address HIV/TB coinfection "has been uneven because of weak health systems and the HIV epidemic." She continues that "many experts believe that the economic crisis will have a major impact on worldwide TB efforts," adding that "drug resistance may increase, with an additional negative impact from" HIV/TB coinfection. In addition, the World Bank predicts that the economic downturn could increase poverty rates, which might create conditions that facilitate the spread of TB, Morris writes. She concludes that many global health advocates "are pointing out that investment in health care can not only ameliorate the effects of recession, but could stimulate economic growth and also have positive effects on development" (Morris, Lancet Infectious Diseases, March 2009).
  

• "Moving Closer to a New Tuberculosis Vaccine": Researchers currently are conducting or preparing trials of several TB vaccine candidates, and "it seems possible that the first new TB vaccine for nearly 90 years could be available in less than a decade," Kathryn Senior writes in a Lancet Infectious Diseases article. Although the BCG vaccine "lowers childhood mortality and reduces the incidence of TB meningitis," the 87-year-old vaccine does not provide equal protection in different settings or among different populations. Senior writes that researchers "now accept that testing new vaccine candidates for TB needs to be done in various locations," adding that researchers are conducting trials of the MVA85A candidate among latent TB patients in South Africa and the United Kingdom; among patients coinfected with HIV/TB in Senegal, South Africa and the U.K.; and among children and infants in South Africa and The Gambia. In addition, the AERAS-402/Crucell Ad35, which is "[c]lose behind MVA85A in terms of clinical development," appears to have the "promising" effect of inducing high levels of cellular immunity, Senior writes. She continues that recombinant vaccines also are "producing interesting results" in clinical trials but adds that some researchers believe increased safety concerns might slow the development of an effective TB vaccine (Senior, Lancet Infectious Diseases, March 2009).