Poll - overwhelming majority New Jersey residents worry about drug resistant disease

Link

* 94% say infectious diseases like the flu, tuberculosis and SARS will pose some level of threat to the U.S. in the next few years, and 79% say Americans should worry about diseases like malaria, dengue fever and cholera that mostly affect poorer countries.

* 91% of the state’s residents are concerned about drug resistance and say it is important to conduct global health research to prevent the problem worldwide.

* 88% are concerned about U.S. troops overseas being exposed to global health diseases, and 86% say American civilians benefit from health research conducted by the U.S. military.

Lee Reichman on World TB Day 2011

Link

1. Why is it important for Americans to care about a disease like tuberculosis, which has a low rate of incidence in the U.S.?

Because more than half of the TB cases in the United States came from somewhere outside the United States. We can’t just tell the rest of the world to stay out, and Americans to stay in. We have to care about diseases that while not prevalent in the U.S., do pose a threat to our own health. The best way to control TB here is to control TB everywhere.

2. According to a Research!America poll, a majority of Americans think global health should be a top priority for Congress. (Source: National Global Health Survey, Charlton Research Company for Research!America, November 2008) What can our nation’s leaders do to best address the burden of this disease?

I think one of the main things our nation’s leaders can do is to get involved. Senator Sherrod Brown from Ohio recently introduced a resolution supporting World TB Day, and acknowledging the progress still needed to finally eliminate this disease. We need more Members of Congress to take action like Senator Brown. We have a preventable, curable disease which alone is the second leading killer among infectious diseases, and becomes the lead killer when you consider that most HIV/AIDS patients die of TB.

Canada - one in five homeless people with tuberculosis died within a year of their diagnosis

Link

CDC, World TB Day 2011 and QuantiFERON

Link

As early adopters of QuantiFERON New York have advised that

The entire afternoon session will be dedicated to the use of interferon gamma release assays.

whilst in Texas

Houston TB Control will present on the introduction and use of QuantiFERON TB blood testing in the community

Arizona and QuantiFERON

Arizona Department of Health Services TB Control Program has a presentation by Professor Douglas B. Hornick, MD titled TB Infection Control in Health Care Settings. The presentation was from the three day 2010 Infectious Disease Training & Exercise program.

Professor Hornick asks

What is the most dangerous type of TB to Health Care Workers?

The Unsuspected Case!!

Primarily unsuspected TB would have to be latent TB.  In looking at IGRA (QFT-G) for Screening Professor Hornick notes that

– Several have switched from TST to QFT-G (CDC recommendation w/ little data)
– LTBI infection rate reduced to 6-8% from 25-45%
– One institution found 3 early active pulmonary cases 

Sounds like switching to QFT was a successful move for infection control.

TB screening programme integrating CT and QuantiFERON was safe and feasible.

Link

Tuberculosis screening programme using the QuantiFERON®-TB Gold test and chest computed tomography for healthcare workers accidentally exposed to patients with tuberculosis

T. Hirama, a, , K. Hagiwaraa and M. Kanazawaa
a Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
Received 10 June 2010;  accepted 15 November 2010.  Available online 12 February 2011.

Summary

Healthcare workers (HCWs) have an increased incidence of tuberculosis (TB). Periodic and as-needed screenings of HCWs exposed to patients with TB are important. We integrated chest computed tomography (CT) and the QuantiFERON®-TB Gold (QFT-G) test into our TB screening programme for HCWs. First, contacts were tested using the QFT-G test. Those positive for the QFT-G test were investigated by CT and classified as having active, latent (LTBI), or old TB. Between April 2005 and April 2010, 11 patients who had not been diagnosed with active TB on admission were found to have the disease. A total of 512 close or high risk contacts were identified, and underwent screening. Out of those, 34 (6.64%) were QFT-G positive, whereas 478 (93.36%) were negative. Of the 34 QFT-G-positive HCWs, four had CT findings compatible with active TB and received multidrug treatment; 24 showed no findings of active TB and received isoniazid for six months. All completed their regimens without any adverse effects.

The TB screening programme integrating CT and the QFT-G test was safe and feasible. The efficacy of the programme needs to be confirmed by large scale clinical trials.

Mini-Symposium / Clinical Application of QFT

−−−−−−−− The 85th Annual Meeting Mini-Symposium−−−−−−−−
 

THE CLINICAL APPLICATION OF QuantiFERON TB-2G : ITS USEFULNESS AND LIMITATIONS
 

Chairpersons : 1Shigeki SATO and 2Hideaki NAGAI

Abstract

QuantiFERON TB-2G (QFT) is widely used in clinical settings for the identification of tuberculosis infection because of its high level of utility. It is well known that QFT stimulates peripheral blood lymphocytes in vitro by means of M.tuberculosis-specific protein, and that infection is identified by measuring the interferon-γ released. Interpretation of QFT results is therefore difficult in immunosuppressed subjects in whom the function of immunocompetent cells, including lymphocytes, is suppressed, making it difficult for them to produce interferon-γ.

There is a high incidence of tuberculosis among hemodialysis patients. It has been conjectured that the use of powerful immunosuppressive agents following kidney transplantation results in a high risk of tuberculosis. How QFT results change immediately following kidney transplantation is an extremely interesting question. In recent years, an increasing number of institutions have been using TNF-α inhibitors to treat rheumatoid arthritis patients. Is QTF useful for identifying whether patients have latent tuberculosis infection before the administration of anti-TNF antibodies? In particular, many rheumatoid arthritis patients may have been given methotrexate or glucocorticoids, which suppress the immune system, prior to the administration of TNF-α inhibitors, possibly making it difficult to interpret the QFT results. We must be aware of this limitation when performing QFT on immunosuppressed patients. It is also important that we understand the clinical parameters influencing QFT results（such as lymphocyte counts). The morbidity rate of tuberculosis is high among healthcare workers, particularly nurses. A number of studies have reported that QFT is useful in hospital infection control for tuberculosis, but the effectiveness of QFT for monitoring the health of healthcare workers is still not fully understood.

In this symposium, we will debate how far QFT can be used and the extent of its usefulness under exceptional circumstances.

----------------

1. How do we manage kidney transplant recipients with latent tuberculosis infection? : Norihiko GOTO (Transplant Surgery, Nagoya Daini Red Cross Hospital)

It is unclear whether QuantiFERON®-second generation (QFT-2G) is useful for diagnostic screening and follow up of latent tuberculosis infection (LTBI) in immunosuppressed kidney transplant (KTx) recipients. The QFT-2G assay that included response to mitogen stimulation was performed before and 6 months after KTx. Non responder was 0 (0％) at baseline, 3 (3％) at 6 months. Response to mitogen stimulation was 9.7±5.3 IU/mL at baseline vs. 10.4±5.0 IU/mL at 6 months after KTx (p＝0.29). QFT-2G is a useful screening test for LTBI and active tuberculosis (TB) even during maintenance of immunosuppression of KTx.

----------------  

 

2. QuantiFERON-TB Gold in Japanese rheumatoid arthritis patients for assessing latent tuberculosis infection prior treatment of anti-tumor necrosis factor antibody: Shogo BANNO (Division of Rheumatology and Nephrology, Department of Internal Medicine, Aichi Medical School of Medicine)

To determine the positive rate of LTBI in RA patients using the QFT-2G test, we divided RA patients into two groups: with or without old TB findings by chest CT. With a cutoff level set at 0.35 IU/ml, the positive rate of QFT-2G in LTBI was detected only 5.8％, when setting cutoff at 0.1 IU/ml (lower cutoff level), 23.1％ was detected in LTBI patients. The positive TST results were significantly increased in non-LTBI patients compared than in LTBI patients. The QFT-2G test was not affected by the treatment of MTX, and the incidence of indeterminate result was low. The QFT-2G was useful compared to TST before administration of TNF inhibitors in RA patients, because of superior specificity of QFT-2G.

----------------  

3. Clinical parameters that influence the sensitivity of T-cell assays: Haruyuki ARIGA (National Hospital Organization Tokyo National Hospital)

The detection of tuberculosis (TB) infection in compromised hosts is essential for TB control, but T cell assay might be influenced by the degree of cell-mediated immunosuppression.  The relationship between immunocompetence and specific interferon (IFN)-γ response in whole blood QuantiFERONTB Gold (QFT) is uncertain. Immune-related clinical indicators associated with the degree of antigen-specific IFN-γ production were analysed using a large immunologically-unselected population with obvious TB infection. The absolute number of blood lymphocyte in TB patients was significantly associated with specific IFN-γ production in a linear regression model.   

Sensitivity of 2 IFN-γ Release Assays, QFT and ELISPOT, partly depends on peripheral lymphocyte counts. At low lymphocyte count conditions, ELISPOT assay is superior to whole blood QFT for detecting tuberculosis infection.

----------------  

 

4.QuantiFERON TB-2G among staffs in the hospitals of Nationao Hospital Organization: Susumu OGURI, Chihiro NISHIO, Kensuke SUMI, Masayoshi MINAGUCHI, Tomomasa TSUBOI, Atuo SATOU, Osamu TOKUNAGA, Takeshi MIYAMOMAE, Takuya KURASAWA (National Hospital Organization Minami-Kyoto National Hospital)

Purpose To investigate the infection rate of tuberculosis among staffs working in the hospitals of NHO.

Method Questionnaires were sent to the hospitals and the responses were analyzed.

Result Among the staffs working in the hospitals with tuberculosis wards, positive rate of QuantiFERON TB-2G was 6.9％, probable positive rate was 5.6％. On the other hand, among the staffs working in the hospitals without tuberculosis wards, positive rate was 4.4％, probable positive rate was 3.9％.

Conclusion It is necessary to monitor the infection rate among hospital staffs.

---------------- 

ANALYSIS OF USEFULNESS OF A WHOLE BLOOD INTERFERON GAMMA ASSAY (QuantiFERON®TB-2G) FOR DIAGNOSING ACTIVE TUBERCULOSIS IN IMMUNOCOMPROMISED PATIENTS

1. Akihiro ITO, 2. Kimihide TADA, 2. Hiroshi OOTERA, 2. Toshiyasu SAKURAI and 3. Hironobu IWASAKI

Abstract

Purpose Recently, there have been many reports that QuantiFERON® TB-2G (QFT-2G) is useful for diagnosing active tuberculosis. However, it remains controversial whether QFT-2G is useful for diagnosing active tuberculosis in immunocompromised patients as well as immunocompetent ones. Therefore, we analyzed whether QFT-2G sensitivity is decreased in immunocompromised patients compared with that in immunocompetent patients and what factors affect the QFT-2G sensitivity.

Subjects and methods The subjects consisted of 159 patients (105 males, 54 females; age 64.0 years [14_91]) who were diagnosed with active tuberculosis and underwent the QFT-2G test in Nishi Kobe Medical Center between July, 2006 and December, 2008. We analyzed these patients with regard to age, sex, white blood cell count in peripheral blood (WBC), lymphocyte count in peripheral blood (Lym), serum total protein, serum albumin, and QFT-2G sensitivity, and compared the findings between immunocompetent and immunocompromised patients.

Immunocompromised patients consisted of those with diabetes mellitus, malignant disease, chronic renal failure, systemic steroid administration and AIDS. To test significance of differences, we used Mann-Whitney test for categorical variables, and t test for continuous variables.

Results One hundred fifty one patients had pulmonary tuberculosis (including 8 with bronchial tuberculosis), 11 tuberculous pleurisy, 2 miliary tuberculosis, 2 intestinal tuberculosis, 1 tuberculous lymphadenitis, 1 tuberculosis of the hip joint, and 1 tuberculosis of the vertebra (there was some overlap among cases). In the entire patient group, positive QFT-2G results were detected in 125 (78.6％). In the immunocompetent and immunocompromised patients, positive results were seen in 82 (78.8％) and 43 (78.2％), respectively; these proportions were not significantly different (p＝1.00). In all patients, Lym was significantly lower in patients with intermediate, negative or indeterminate QFT-2G results than in QFT-2G-positive patients (p＜0.001).

Conclusion In our analysis, QFT-2G sensitivity did not significantly differ between immunocompetent and immunocompromised patients. Therefore, it is considered that QFT-2G is useful for diagnosing active tuberculosis in immunocompromised as well as immunocompetent patients.

1. Kurashiki Central Hospital,
2. Nishi Kobe Medical Center,
3. Internal Medicine, Akashi Ninju Hospital
Correspondence to: Akihiro Ito, Department of Respiratory Medicine, Kurashiki Central Hospital, 1_1_1, Miwa, Kurashikishi, Okayama 710_8602 Japan.

Who is Dr. Gail Cassell?

Dr. Gail Cassell has a list of achievements as long as your arm and can be considered an expert on TB.

In their tweets AERAS refer to Dr. Gail Cassel

<10% of new MDR-TB cases are treated each year G Cassell  

MDR-TB grossly underestimated, Gail Cassell

It takes MONTHS to diagnose untreatable TB - who is exposed while they wait?

Exactly, if a person has contact with a drug resistant case of TB they could be infected with drug resistant strain of TB. So how many infections are a latent form of drug resistant TB? Back to @aerasglobaltb

1/3 world's pop latently infected w TB; 1 in 10 will become sick

  

The butler did it.

Consider this, a New Jersey Hospital checked it's records and found 34 HCWs to be positive by the TB skin test. They also checked their records and found that they had no active TB in the hospital. So how did the HCWs become infected?

Someone came through our doors and exposed our staff to TB...It could have been anybody.

What this official is asking us to believe is just silly, people just don't become infected that easily. In fact, the evidence suggests that in a hospital setting brief and/or casual contact is not sufficient to develop infection

TB transmission seems unlikely and contact tracing not generally warranted after cumulative exposure less than 40 hours

Unfortunately this hospital is a victim of it's own poor choice, by electing to use the outdated and imprecise TB skin test they should expect more not less mysterious TB outbreaks.

Obama and TB

IDSA have looked at the 2011 budget and are not happy, saying that they

have seen how cuts in critical funding for federal health agencies have devastated the lives of Americans and people around the globe. Although the cuts now being proposed by House leaders may appear "penny wise," we believe they are "pound foolish."

When it comes to TB they are more than just "unhappy"

We are disappointed, however, that the budget proposes a decrease in domestic tuberculosis (TB) funding at a time when multi-drug resistant TB (MDR-TB) remains a serious threat.

Copper will give you cancer and make you impotent.

I read this on one of those god awful share trader chat sites

The share price tells us a lot about this company and directors it rises when they relate news to the market but weakness in its price quickly returns after a very short time there seems to be little sustainable interest in this company somehow it needs to emerge from its small minded mentality!

So this poster called "Klem" (rhymes with flem?) has become an expert on identifying

small minded mentality

I guess I will have to take Klems word on it, when it comes to small minds he is an expert.

False negative diagnosis by the Mantoux skin test.

Whilst TB false positives by the Mantoux skin test has been well documented and accepted false negatives also need to be examined. According to sources in Taiwan

around 9·3% of patients with rheumatoid arthritis treated with adalimumab develop tuberculosis despite prescreening with the tuberculin skin test.

Show me the money.

There was a lot of interest today in what the administrator of the NIH had to say about how they were going to spend their budget. One item stood out

cure 2.4 million people infected with TB.

If they don't cure all people of TB there is a good chance that the 2.4M will become reinfected by those who fell outside of the 2.4M pool - which is currently

In 2007, an estimated 13.7 million people had active TB disease, with 9.3 million new cases and 1.8 million deaths

The Big Chill

Canadian TB control gets a belting from the Canadian Medical Association Journal; in a recent press release TB Control was described as A Century Of Failure.

"The ensuing mistrust of physicians and public health, combined with the stigma of tuberculosis, may still be hampering control efforts,"

The press release has attracted all sorts of media attention - invariably the wrong sort of media if you are part of TB Control - public trust in officials has been lost

the editorial says that shouldn't stop governments from doing what they can to alleviate the problem. It calls for more emphasis on early diagnosis, testing and screening as well as for education programs to rebuild public trust.

Neat comparison

Quest Diagnostics are holding a one hour presentation "The Most Widely Misunderstood Diagnostic Test", which is to be hosted by Lee B. Reichman.

As this is to be about the role and limitations of the Mantoux tuberculosis test there should be plenty to talk about.

On the Quest Nicols Institute site the same presentation is advertised alongside the QuantiFERON link

It doesnt hurt to repeat the Quest message

Nice example of P2P marketing

Link here

.................

EVENT DETAIL

UChicago Rheumatology
"Diagnosis of Tuberculosis and Interferon Gamma Release Assays"

DATE: February 15, 2011
TIME: 8:30 AM - 9:30 AM
SPEAKER: Karen M. Frank, M.D., Ph.D., Department of Pathology, Clinical Microbiology & Immunology Labs, University of Chicago
LOCATION: Medical Center (= Billings) Room N002, University of Chicago

More on HCWs - from Japan

This study confirms that QuantiFERON is being used regularly on high risk groups in Japan

We conducted a cross-sectional study for screening TB infection (active and latent TB infections) using questionnaire, chest X-ray (CXR), newly available assay for latent TB infection (QuantiFERON-TB Gold In-Tube; QFT) and clinical evaluation by physicians at the Osaka Socio-Medical Center Hospital between July 2007 and March 2008..

..Complete responses were available from 436 individuals (263 homeless persons and 173 caregivers).

Importantly this study shows how QuantiFERON was critical in evaluating risk

The QFT has excellent specificity and gives us valuable information of latent TB infection, even for a Japanese Bacillus Calmette-Guérin (BCG)-vaccinated population, whereas the accuracy of the tuberculin skin test (TST) is hampered by poor specificity due to the widespread use of BCG vaccination and re-vaccination in Japan.

The results convey confidence and are clear.

We found that the prevalence of latent TB infection was approximately 50% for homeless people and 25% for caregivers, and a long duration spent by both groups in the Airin district in Osaka, Japan, was associated with latent TB infection. Although no active TB was found for caregivers, one-quarter of them had latent TB infection. In addition to homeless persons, caregivers need examinations for latent TB infection as well as active TB and careful follow-up, especially when they have spent a long time in a high TB prevalence area and/or have been exposed to TB patients.

Not for the boofheads..

Forrest has a link to the latest Shaw broker analysis, it can be seen here.

Shaw has also included Cellestis in their morning bulletin;

As stupid as a...?

Some shareholders are critical of the performance of Cellestis; regarding the pending half yearly report one in particular said

bring it on boofheads..........

All we are saying..

..is give peace a chance.

PeaceHealth Laboratories have had this recent update

New Tuberculosis Blood Test Now Available Using QuantiFERON-TB Gold In-Tube Methodology

A quick look at PeaceHealth Laboratories reveals

Locations
10 laboratories across Alaska, Oregon, and Washington
22 patient service centers 

Employment
Employs over 750 in four states
More than one-third of employees have been with PeaceHealth Laboratories for 10 or more years, and 85 percent have been with PeaceHealth Laboratories for five years or more 

Recognition
For five consecutive years, named one of Oregon Business magazine's top 100 Best Companies to Work For in Oregon
Designated a Molecular Center of Excellence by Roche Diagnostics
Recipient of the Emerald Award for Job Growth

Vote 1 for Mr Potato Head

World TB Day 2011

From 1/17 March 2011 the European Respiratory Society (ERS) will be offering a series of online lectures on tuberculosis. The course was designed by Prof. Giovanni Battista Migliori who selected the most interest topics and proposing the best speakers available.

"Europe made a commitment to eliminate TB by 1990, a target which, despite some successes, it has yet to achieve," says Prof. Migliori. "TB can be controlled by the early identification of infectious cases and rendering them non infectious through rapid implementation of effective treatment," he stresses.

Importantly they have shifted their focus from vaccination (prevention) to targeting latent TB (elimination)

Prof. G-B Migliori: "elimination needs a more aggressive and ambitious strategy based on identifying the truly infected individuals and rendering them non-infectious through the treatment of the latent TB infection to prevent further cases from occurring."

The course includes a lecture and a podcast on IGRA.

Significantly, the ERS link to the CDC website on IGRA. As Prof Miglori noted

TB experts are a family, and communications within the community are easy,

The threat of drug resistant strains keeps TB in the spotlight

the lecture series is taking place at a time when Europe is facing an important MDR/XDR-TB epidemic in the epidemiologic context of a significant—and in some settings, increasing—epidemic of HIV, in the majority of the Former Soviet Union (FSU) countries.

Activist lobbying pays off

According to RESULTS their ongoing media campaign to

leverage millions of dollars for programs and improved policies

has borne fruit, for example

When it seemed the administration would shrink funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria rather than expand funding to meet the need, we took a bold stand.

RESULTS staff worked with Rep. Barbara Lee (D-CA) to support a letter to the president urging a three-year pledge for 2012-2014 of $6 billion. Thanks in large part to RESULTS grassroots activists, the letter was signed by 101 members of Congress and was sent to the administration on July 27.

We amplified our message with a media drive that included a multi-city tour by four African health activists and dogged efforts by RESULTS grassroots. These combined efforts resulted in over 80 media clips.

The result: The administration made its first-ever three-year pledge — $4 billion for 2011-2013, a 38 percent increase over the preceding three-year period. Many thought a multi-year pledge impossible just a few months earlier.

Australian Tuberculosis Review

Dr John Thompson, Canberra looks at the study Revisiting rates of reactivation  tuberculosis: a population–based approach and, despite the study's lack of objectivity

The greatest part of this decline may be attributed to the disappearance of old, healed TB in the population

succumbs to the temptation to add a bit of his own

This could reflect increasing affluence in the population during this time, despite the advent of HIV.

Dr John identifies the inherent weakness of this study

Unfortunately the tuberculin used to diagnose LTBI 50 years ago is not the same as today.

Not sure what he means by the following sentence

It is important that this study be repeated not just once but in many regions of the affluent world to confirm or deny that we may be overusing chemoprophylaxis.

given the observation that the quality of tuberculin is inconsistent.

The hunt for a TB vaccine, just a dash for cash?

Intelligent Investor thinks that a TB vaccine could make testing for latent TB redundant

TB vaccines superior to the existing one are under development which, if approved, could eventually eliminate the need for a test altogether.

Bill Gates thinks that a vaccine, any vaccine is better than sliced bread

In the same way that during my Microsoft career I talked about the magic of software, I now spend my time talking about the magic of vaccines. Vaccines have taken us to the threshold of eradicating polio. They are the most effective and cost-effective health tool ever invented. I like to say vaccines are a miracle.

So what of the hunt for a TB vaccine? TBVI recently had a look at the current crop

The process of bringing a candidate vaccine from initial discovery to licensed vaccine involves different phases of testing and trying. Many candidate vaccines will not survive this process and therefore dozens of candidates are needed. The TuBerculosis Vaccine Initiative (TBVI) is an independent non-profit foundation. TBVI facilitates the development of new vaccines by giving financial support and bringing expertise to a network of over 40 universities, institutes and industries that have promising candidate vaccines. Currently, TBVI supports a portfolio of 39 candidates that are in different phases of development and testing. The organization is hopeful that two of those candidates could make it to the market by 2020 and another two by 2025. Worldwide, there are about ten candidates in various stages of clinical trials and about 50 more in development.

Lets look at how one researcher, Statens Serum Institut (SSI) are faring. In July 2007 SSI announced a new deal on a promising new candidate, named H1.

The successful outcome of the phase I trial has paved the way to move our novel TB vaccine forward.

SSI are now up to vaccine H56 and their latest candidate claims to give protection before and after infection

The H56 vaccine promotes a T cell response..

This is the bit that I dont understand, in normal healthy people TB does promote a T cell response and that T cell response is sufficient to either eradicate the infection or render it harmless.