TB-Related News and Journal Items - Week of June 26

>The CDC Center for HIV, STD, and TB Prevention provides the following
>information as a public service only. Providing synopses of key scientific
>articles and lay media reports on HIV/AIDS, other sexually transmitted
>diseases and tuberculosis does not constitute CDC endorsement. This update
>also includes information from CDC and other government agencies, such as
>background on Morbidity and Mortality Weekly Report (MMWR) articles, fact
>sheets, press releases, and announcements. Reproduction of this text is
>encouraged; however, copies may not be sold, and the CDC HIV/STD/TB
>Prevention News Update should be cited as the source of the information.
>*********************************
>"Sick Immigrants a Risk to Canadians: Report Says Monitoring Fragmented";
>Calgary Herald (www.canoe.ca/calgarysun) (06/26/00) P. A6; Moore, Dene
>
> Canada's system of monitoring immigrants for contagious diseases may be
>ineffective and pose health risks to Canadians, an internal immigration
>report claims. Tuberculosis (TB), the most common infection in immigrants,
>is "the one posing the greatest potential health risk since transmission is
>airborne," the report said. Although immigrants with active TB are not
>allowed entry into Canada, those with inactive TB can enter the country as
>long as they undergo medical surveillance. The report said that "portions
>of the migrant population are not complying with medical surveillance
>requirements, thereby increasing the risk of TB to the migrant and society."
>The report also questioned the quality of the medical exams in the
>individuals' home countries and noted that many migrants do not understand
>the system, as communication is in French or English only.
>************************************
>"TB-HIV Synergy Involves Immune Activation Mediated by INF-gamma,TNF-alpha";
>Reuters Health Information Services (www.reutershealth.com) (06/26/00)
>
> Two research teams from the Centers for Disease Control and Prevention
>have reported new findings about how active tuberculosis (TB) amplifies HIV
>replication. Led by Dr. Stephen Lawn, one team found increased viral
>replication in lymphocytes and macrophages of subjects with both active TB
>and HIV-1 infection, with higher levels of HLA-DR on viral envelopes. The
>second team, led by Dr. Julie Turner, examined the in vitro effect of HIV-1,
>Mycobacterium tuberculosis, or both pathogens on mononuclear cells from
>individuals who are PPD-negative and HIV-negative. The researchers
>presented their findings at Tuberculosis 2000 in New York City.
>****************************
>"D.C. Jail's Medical Costs Under GAO, Hill Scrutiny" ; Washington Post;
>(06/30/00); Fehr, Stephen C.
>
>The District of Columbia's jail has improved its conditions immensely in the
>past five years, according to Odie Washington, the city's corrections
>director. While the D.C. jail used to be plagued with high rates off
>suicide, AIDS, and tuberculosis, and at times inmates lacked eating utensils
>and toilet paper, Washington claims the jail's medical care can be matched
>"against any program in the country." However, the General Accounting Office
>is now looking into the program, which spends $11 million a year for 1,670
>inmates. Medical receiver Ronald Shansky spent $56.3 million in funds for
>five years to improve the prison's health conditions and other faults. The
>District has among the nation's highest incidences of HIV/AIDS,
>tuberculosis, drug abuse, suicide, heart disease, diabetes, and other
>diseases. Shansky started a clinic at the jail to screen and treat inmates
>for these diseases, noting that "this is a public health opportunity for the
>District to identify and treat its highest-risk patients in a manner that
>will ultimately benefit the entire community."
>************************************
>"Medicines on the Way" ; Washington Post (06/30/00); Spilker, Bert
>
>In a letter to the editor, Bert Spilker, senior vice president of Scientific
>and Regulatory Affairs at the Pharmaceutical Research and Manufacturers of
>America, takes issue with a recent article about the World Health
>Organization's (WHO's) call to fight drug resistance. WHO official David
>Heymann was quoted as saying, "There are no new drugs or vaccines ready to
>quickly emerge from the research and development pipeline." In fact, Spilker
>says, the Food and Drug Administration (FDA) approved three antibiotics last
>year, as well as drugs for hepatitis, AIDS, and influenza. And this year the
>FDA has approved a vaccine against pneumococcal disease. According to
>Spilker, there are a variety of drugs and vaccines in the pipeline,
>including those for the treatment of pneumonia, tuberculosis, chlamydia,
>gonorrhea, herpes, cholera, and other infectious diseases.
>*****************************************************
>OTHER NEWS ITEMS:
>**************************************************
>BOSTON: Boston Herald; DPH calls for end to TB tests in schools; M; Michael
>Lasalandra; Wednesday, June 28, 2000.
>
>In a major change of strategy in the fight against TB, state public health
>officials are urging an end to the routine testing of schoolchildren and
>workers. Instead, the Department of Public Health is urging the targeted
>screening of high-risk individuals, such as immigrants from Asia, the
>Caribbean and other places where tuberculosis is widespread. Letters will go
>out within the next few days to doctors and managed care plans advising them
>of the new recommendation, which is designed to cut down on the high number
>of false positives associated with the PPD skin test for latent TB
>infection. ``By directing resources and targeting our TB control efforts at
>those of highest risk of contracting tuberculosis, we have an achievable
>goal of ridding Massachusetts of TB cases in our lifetime,'' said Dr. Howard
>Koh, public health commissioner. A report released by DPH yesterday showed
>that cases of active TB were down 5 percent in Massachusetts last year,
>continuing a declining trend. However, of the 270 recorded cases, 69
>percent, or 187, were among people born outside the United States. The
>highest percentage, percent, represented those born in Asia. The 270 active
>cases, however, represent ``just the tip of the iceberg,'' said Dr. Edward
>Nardell of the DPH's TB program. He estimated there are between 300,000 and
>600,000 in Massachusetts who have latent TB, which is non-infectious and
>non-symptomatic but which will progress into active TB in from five to 10
>percent of cases. The PPD skin test seeks to detect those with latent TB,
>but the test is considered unreliable, with a high rate of false positives.
>All who test positive are urged to go on a two-to-six month regimen of drugs
>to eradicate the infection, but they can have side effects. Nardell said
>nearly every schoolchild in Massachusetts has been given the PPD test,
>either by their primary care doctors or at the insistence of their schools.
>``Most kids are tested more than once, I would guess,'' he said. While few
>school districts have been requiring across-the-board testing, some have
>been requiring testing of all students in schools that serve high numbers of
>immigrant children, he said. Even that type of policy is no longer
>recommended, he said. In addition, the DPH will seek to change a state law
>requiring all school teachers and school employees to be tested. Nardell
>said efforts will also be made to convince employers from requiring testing
>of all employees. ``Some factories test all their workers,'' he said. The
>new policy is being adopted in accordance with new recommendations issued
>by the U.S. Centers for Disease Control. Under the new policy, those who
>should get PPD tests include those born in high prevalence countries, as
>well as all those who have lived or traveled to such countries within five
>years. Also, those over age 70; those who have worked in prisons, long-term
>care facilities, homeless shelters, drug treatment centers and AIDS
>residences; those with a history of substance abuse within the past year;
>seasonal farm workers; and health care workers in the field of respiratory
>therapy or bronchoscopy.
>*****************************************************
>New York Times; June 23, 2000; Bankrolling Colombia's War on Drugs: House
>and Senate Will Now Reconcile Bills; CHRISTOPHER MARQUIS
>
>WASHINGTON, June 22 - Nearly a year after President Andrés Pastrana of
>Colombia asked the United States for emergency aid to battle narcotics
>traffickers and their rebel allies, the Senate cleared the way today for a
>package of 1.3 billion....... The Senate also increased spending by $30
>million to $255 million for international efforts to fight AIDS, and added
>$10 million for a total of $66 million to battle the global spread of
>tuberculosis. But it provided only $75 million in assistance to the world's
>poorest countries, a reduction from the administration's $262 million
>request.
>***************************
>CNN.COM: Los Angeles Times; Bush's Mexico connection signals key policy
>initiative; Esther Schrader; June 22, 2000.
>
>AUSTIN, Texas (Los Angeles Times) --To George W. Bush, Greeks may be
>Grecians, and the leaders of India, Pakistan and Chechnya may go unnamed.
>But when it comes to Mexico, even obscure officials are familiar
>territory.... Bush championed a program to help Mexico fight tuberculosis
>along the border ..... Bush is not the first Texas governor to make
>friends in Mexico. Many of his initiatives build on those of his
>predecessors, who have recognized that Mexico's consumer market and
>investment opportunities are important to the Texas economy and that
>problems in Mexico can easily spill over the border.... Bush says his record
>as governor shows he has reached out to Mexico when it matters. He cites the
>program to help Mexico fight tuberculosis: The Texas commissioner of health
>secured $3 million from Congress for the program; an additional $13 million
>is in the pipeline.
>****************************
>New York Times; June 29, 2000; Red Cross Says Three Diseases Kill Many More
>Than Disasters; ELIZABETH OLSON.
>
>GENEVA, June 28 -- Although earthquakes and floods usually receive the most
>prominent news coverage, infectious diseases are claiming far more lives
>than natural disasters, according to a report made public today by the Red
>Cross. The death toll last year from infectious diseases like AIDS,
>tuberculosis and malaria is 160 times greater than the number of people
>killed in last year's earthquakes in Turkey, cyclones in India and floods in
>Venezuela, said the International Federation of Red Cross and Red Crescent
>Societies, which assists countries suffering natural disasters. An
>estimated 150 million people have died from those three diseases alone since
>1945 compared with 23 million in wars during the same period, according to
>the federation's "World Disasters Report.".... Last year, 13 million people
>died from such diseases, which the report said could have been prevented by
>spending as little as $5 per person in health care. According to the
>report, public spending on health in poorer countries averages only 1
>percent of gross domestic product, compared with the 6 percent that
>wealthier countries spend. The report's authors said that money spent on
>changing people's behavior saves more lives than money for expensive
>facilities like hospitals and high-tech equipment.
>********************************
>New Class of Tuberculosis Drugs Developed; By Alka Agrawal, PhD
>
>WESTPORT, Jun 22 (Reuters Health) - A team of US researchers has developed a
>new class of antituberculosis drugs that are effective against static,
>replicating, and drug-resistant forms of the bacteria in animal models. The
>findings are reported in the June 22nd issue of Nature. When given orally
>in a mouse model of tuberculosis, the new class of compounds,
>nitroimidazopyrans, were highly specific for TB and were active and
>nontoxic. A particular compound, PA-824, reduced the amount of TB in the
>mice 10,000-fold, Dr. C. Kendall Stover of PathoGenesis Corporation, in
>Seattle, Washington, told Reuters Health. He noted that the activity was
>comparable or better than that of the current frontline TB drug, isoniazid.
>Further experiments showed that PA-824 was a prodrug that had to be
>activated, with activation dependent on the TB F420 cofactor. Once
>activated, the drug inhibited the synthesis of proteins and lipids. Dr.
>Stover said that it was likely that inhibiting lipid synthesis only weakened
>the bacteria, and that inhibiting protein synthesis was what actually caused
>death. He noted that inhibition of protein synthesis makes the drug unique.
>"None of the other TB drugs that are currently used as frontline therapies
>hit protein synthesis," he said. "Some of the second-line, more toxic,
>last-resort TB drugs do." Dr. Stover said that since his company is small
>and has limited resources, it would like to find partners to further develop
>the drug. "It's difficult to move a TB drug forward," he said. "It takes
>just as much money to develop a TB antibiotic as it does any other
>antibiotic, yet the market isn't as large." He said that more preclinical
>work needs to be done before the drug could go into a clinical trial,
>notably one that would test the drug in combination with other TB drugs.
>Nature 2000;405:962-966.
>*******************************
>June 26, 2000: READING THE BOOK OF LIFE; Data From Genome Project
>Transforming Biology Research; KENNETH CHANG.
>
>The effort to decode the biological instruction set of humans turned into a
>race between a private company, Celera Corporation of Rockville, Md., and a
>public consortium of universities. But participants on both sides are now
>minimizing the occasionally acrimonious competition and pointing to the ways
>that data from the project is already transforming biology research. "It
>gets a lot of attention, but it's a colossal distraction," said Dr. Eric S.
>Lander, director of the Whitehead Center for Genome Research in Cambridge,
>Mass., a major participant in the consortium. Emphasis on the race is
>diverting attention from the important contributions genome data are already
>making, he said. ..... Even incomplete, the databases of DNA sequences are
>a treasure trove for researchers, providing answers in a few minutes at a
>computer terminal rather than after months of laborious, expensive
>laboratory experiments........ For pharmaceutical companies, that speeds the
>development of new drugs with several promising compounds already undergoing
>human clinical trials. Genomes of other creatures can provide clues as
>well. At the Whitehead Institute, Dr. Richard A. Young, professor of
>biology, can track how the genes of the tuberculosis bacterium turn on and
>off as it infects human cells. .... the human genome (also) proved useful,
>offering clues about whether a potential antibiotic might also be toxic to
>people. "Do humans also have that gene?" said Dr. A. Bruce Montgomery,
>PathoGenesis's executive vice president of research and development. "If so,
>that's not a good drug target. We're looking for something the bacteria has
>and we don't." The wealth of genome information has also led drug
>researchers to a new, seemingly backwards, approach: instead of choosing a
>disease, finding a gene defect associated with the disease and then trying
>to devise a drug to counteract the defect, some researchers now look for
>genes that appear amenable to drug treatment and then try to figure out what
>diseases those drugs might cure.
>**********************************
>The Washington Times ; June 26, 2000; correspondence: Bill a comprehensive
>strategy to curb TB; JOANNE CARTER .
>
>The World Health Organization (WHO) warned on June 12 that super diseases
>are being created by overuse of antibiotics ("Bipartisan duo sees
>antibiotics overuse as a threat to security," World, June 13). Concerned
>leaders of the House International Relations Committee plan to hold a
>hearing on the risks this poses to U.S. security. The members of Congress
>already have introduced legislation to step up the U.S. response to
>drug-resistant diseases, particularly tuberculosis. Sen. Ted Stevens, Alaska
>Republican, and Sen. Daniel K. Inouye, Hawaii Democrat, introduced the Stop
>TB Now Act of 2000 (S.2643) on May 25. "The bill has two components," Mr.
>Stevens told colleagues, "a treatment strategy and the goal of arresting the
>rise of more resistant strains of tuberculosis." This bill calls for a
>larger portion of U.S. foreign aid to be devoted to international TB
>control, $100 million per year in 2001 and 2002. The Stevens-Inouye bill
>joins one introduced earlier in the House by Rep. Sherrod Brown, Ohio
>Democrat, and Rep. Constance A. Morella, Maryland Democrat. Upon
>introducing the Senate bill, Mr. Stevens said, "According to the World
>Health Organization, in another three to five years, without a comprehensive
>prevention and treatment strategy, drug-resistant strains of TB will be the
>dominant form of the disease." In this era of global trade and jet-speed
>movement of people, Americans in every state are at risk. In this country,
>multidrug-resistant tuberculosis (MDR-TB) is costly to treat - up to
>$250,000 per patient - and even with our advanced medical care, still kills
>half of its victims. There is a relatively cheap and successful treatment
>for ordinary TB that cures 95 percent of patients and stops development of
>MDR-TB. Unfortunately, this WHO-recommended regime is only reaching one out
>of five people sick with active TB. Because we can't seal our borders
>against TB, our best defense against MDR-TB is effective treatment for
>everyone in the hardest-hit countries. Congress should adopt the provisions
>of the Stop TB Now Act.
>***********************
>PRN NEWSWIRE; Infectech Obtains Two Patents in Bacterial Genomics; Tuesday,
>June 27, 2000.
>
>SHARON, Pa., Jun 27, 2000 /PRNewswire via COMTEX/ - Infectech, Inc.
>(National Quotation Board: IFEC), a biotechnology company, has received
>notification by the U.S. Patent and Trademark Office that it has been
>granted twelve patent claims for a broadly based method for DNA extraction
>from bacterial pathogens such as Tuberculosis, M. avium and Pseudomonas. In
>addition, Infectech has received notification of the publication of its
>patent 5,989,902 for the antimicrobial sensitivity testing of Tuberculosis,
>Leprosy, Pseudomonas and Nocardia. Dr. Robert Ollar, Infectech's Chairman
>and Director of Research said, "These patents will allow physicians to use a
>direct and simplified method to detect and more efficiently kill
>Tuberculosis. TB is a huge worldwide problem and kills over three million
>people per year. We have had recent communications with multinational
>companies in Europe, Australia, Korea and the U.S. which are interested in
>our novel method for Tuberculosis. This is another step in the evolution of
>Infectech into a major bacterial genomics company. Bacterial genomics has a
>market in excess of two billion dollars per annum. We certainly hope to
>capture a large part of that market." ....
>*******************************
>Market News Publishing; AQUILA BIOPHARMACEUTICALS INC - Receives Phase I
>SBIR Grant to Develop Chlamydia Vaccine Using - CD1 Technology; Thursday,
>June 22, 2000.
>
>New York, New York, Jun. 22, 2000 (Market News Publishing via COMTEX);
>Aquila Biopharmaceuticals, Inc. announced that it has been awarded a grant
>from the National Institutes of Health (NIH) to support the development of
>novel vaccines to prevent Chlamydia infections based on the CD1 immune
>enhancement technology. ..... Aquila has exclusive right to an issued US
>patent (# 5,679,347) that broadly covers products that act through the CD1
>pathway. In addition, Aquila has recently received a Phase II SBIR grant
>from the NIH to support similar CD1 antigen based vaccine development
>directed against tuberculosis.
>****************
>M2 Communications Ltd: INDIAN GOVERNMENT: India and Belarus to cooperate in
>biotechnology in a big way; June 22, 2000.
>
>JUN 22, 2000, M2 Communications - India and Belarus are to cooperate in
>Bio-technology in a big way. It includes exchange of Scientific Information
>and joint research in areas of Microbial Biotechnology, Plant Genomics,
>Plant Physiology, Natural Resource Management, Medical Biotechnology and
>Agricultural Biotechnology..... Cooperation in Medical Biotechnology will
>focus on diseases like Tuberculosis and Hepatitis. The two sides have also
>agreed on a work plan between the Department of Biotechnology and the
>National Academy of Sciences of Belarus. The first joint meeting of
>Indo-Belarus biotechnology Panel will be held in New Delhi in November this
>year to work out detailed collaborative projects.
>*********************************
>OTHER JOURNAL ITEMS:
>********************************
>(Chest. 2000;117:1771-1777.); American College of Chest Physicians; Role of
>Apoptosis in Host Defense and Pathogenesis of Disease; Mehrdad Behnia, MD;
>Kent A. Robertson, MD, PhD and William J. Martin, II, MD, FCCP
>
>Report notes that apoptosis is a form of cell death that has gained enormous
>attention during the past few years, and its mechanisms, important to
>biology and medicine, are being unraveled at an accelerating pace -
>apoptosis of lung cells occurs during lung infections and may be either a
>host defense mechanism or reflect the pathogenesis of the infection. In the
>first part of this report, the authors review the biochemistry and
>physiology of apoptotic pathways and its regulators and this is followed by
>an overview of apoptotic mechanisms in selected lung infections. Authors
>review the implications of apoptosis in host immunity, pathogenesis, and
>treatment of pulmonary infections is discussed in this context. In this
>report, authors note that when mycobacteria initially enter the lung, the
>first step in host defense is the ingestion and uptake of Mycobacterium
>tuberculosis organisms by host phagocytic cells such as alveolar macrophages
>(Ams); NO and natural resistance macrophage-associated protein (Nramp)-I are
>important factors in the macrophage response to M tuberculosis.36 37 In
>contrast, they say, M tuberculosis possesses specific virulence factors such
>as lipoarabinomannan (LAM) that promote survival of the organism inside
>macrophages. They explain that survival of M tuberculosis inside macrophages
>is required to successfully establish infection in the lung. They say
>apoptosis of host cells in response to M tuberculosis has been well
>documented and they note an important host defense mechanism to contain
>mycobacterial survival and growth is for the host macrophage to undergo
>apoptosis. In this way, they say, apoptosis of AM favors the host by
>depriving the pathogen of its intracellular sanctuary and in tuberculosis,
>chronicity and dissemination of the infection might relate to the paucity of
>apoptosis in the macrophages. They comment that controlling apoptotic
>signals that determine the fate of host phagocytic cells is an important
>skirmish line between the host and mycobacteria, and likely predicts whether
>spread of infection occurs or not. They report that following ingestion of
>mycobacteria by the AM, TNF- is released from the macrophages, provoking
>activation of NO synthase and production of NO; macrophages carrying the
>Nramp-I-resistant allele produce higher amounts of NO on exposure to M
>tuberculosis, and are more susceptible to apoptosis than macrophages that do
>not carry the gene. They point out nramp-I is recognized as being an
>important host determinant in resistance to M tuberculosis. They also note
>LAM is a structural analog of lipopolysaccharide and is an important
>component of the mycobacterial cell wall; the capping of LAM with mannose is
>a known virulence factor for mycobacteria. This capping of LAM inhibits
>macrophage apoptosis even in the presence of proapoptotic factors such as
>high NO levels. They observe Fas is expressed on the surface of AM; FasL
>promotes apoptosis of macrophages expressing Fas; Fas-FasL-mediated
>apoptosis of human macrophages infected with M tuberculosis has been well
>documented; FasL promotes apoptosis of macrophages expressing Fas and
>markedly curtails M. tuberculosis viability. Hence, they say, the expression
>of Fas on the surface of macrophages is another notable determinant in
>susceptibility of AMs to M tuberculosis-induced apoptosis. They say other
>nontuberculous mycobacteria also interfere with apoptosis of host phagocytic
>cells and thus, mycobacteria as intracellular pathogens tend to use
>comparable strategies to foster survival of the microorganism within the
>macrophage.
>***************************
>Proceedings of the National Academy of Science USA; Vol. 97, Issue 13,
>6981-6985, June 20, 2000; Colloquium Paper: Bacteria are different:
>Observations, interpretations, speculations, and opinions about the
>mechanisms of adaptive evolution in prokaryotes; Bruce R. Levin* and Carl T.
>Bergstrom.
>
>Report notes that, to some extent, the genetic theory of adaptive evolution
>in bacteria is a simple extension of that developed for sexually reproducing
>eukaryotes while, in other, fundamental ways, the process of adaptive
>evolution in bacteria is quantitatively and qualitatively different from
>that of organisms for which recombination is an integral part of the
>reproduction process. In this speculative and opinionated discussion,
>authors explore these differences. In particular, they consider (1) how, as
>a consequence of the low rates of recombination, "ordinary" chromosomal gene
>evolution in bacteria is different from that in organisms where
>recombination is frequent and (2) the fundamental role of the horizontal
>transmission of genes and accessory genetic elements as sources of variation
>in bacteria. They conclude with speculations about the evolution of
>accessory elements and their role in the adaptive evolution of
>bacteria.......... Authors say the regimes of recombination and horizontal
>gene transfer are associated with groups of organisms that have been
>successful and say there may well be bacteria in which horizontal gene
>transfer plays little role in adaptive evolution. They note Mycobacterium
>tuberculosis (perhaps) and higher eukaryotes that rarely, if ever, engage in
>homologous gene recombination and they say there may also be species of
>bacteria in which recombination occurs at high rates and species of
>contemporary eukaryotes in which infectiously transmitted viruses and other
>accessory elements play a prominent role as sources of variation for
>adaptive evolution. These authors propose, however, that these are the
>exceptions, and they postulate that evolutionary success of bacteria as a
>group is a consequence of their capacity to acquire and express genes from a
>vast and phylogenetically diverse array of species and that the success of
>eukaryotes as a group relies on the high rates at which genes are shuffled
>by recombination.
>*****************************
>British Medical Journal; 2000;321:59 ( 1 July ); Personal views; Looking
>after the health of refugees; Yohannes Fassi.
>
>The writer says he came to the United Kingdom 15 years ago as a political
>refugee from Eritrea after losing his home, family, friends, job, and social
>status. He says he knew nothing about the healthcare or social welfare
>systems, and, even though he had the advantage of a good education and spoke
>English, it took him a long time to understand them; he received no
>information about the health service and was not invited to register with a
>general practitioner; and despite coming from an area with a high prevalence
>of tuberculosis he was not offered a health check on arrival. He notes that
>eighty five per cent of refugees in the United Kingdom live in London and
>says his experience is certainly not unique with over 48 million refugees in
>the world today. He comments the majority seek protection in neighboring
>countries, largely in Africa and Asia, but an increasing number are coming
>to western Europe, including refugees from former eastern European
>countries; there are now over 300 000 refugees in the United Kingdom, and
>there has been an increase in the number of people applying for asylum each
>year from fewer than 2000 in the mid-1980s to more than 40 000 in 1997. He
>points out refugees face health problems similar to those of other deprived
>and ethnic minority communities, as well as specific health problems from
>the physical and mental after effects of displacement and social isolation,
>war, and sometimes torture, and communicable diseases, of which tuberculosis
>is the most important.... He says more than half of the cases of
>tuberculosis in London occur in people born outside the United Kingdom, but
>the current screening system reaches only a small minority of new entrants.
>He says about a half of asylum seekers declare themselves on entry and are
>given a medical examination and a chest x ray examination; only a quarter of
>these are notified to the consultant in communicable disease control in the
>health authority of intended residence, and only a small fraction are
>followed up to rule out tuberculosis. He claims this process is not only
>flawed, it is also stigmatizing. It has more to do with protecting the
>indigenous population from an infectious hazard than promoting the health of
>new arrivals. He calls for a better way of identifying them and a more
>comprehensive health assessment that includes an introduction to health
>services and an explanation of their rights and responsibilities. He says
>as long as there are conflicts in the world and as long as the divide
>between the rich and poor countries exists, people will continue to flee
>persecution and poverty and he hopes they will be treated with care and
>dignity.
>*****************************
>LANCET:Lancet 2000; 356: 22 - 25; Classification of drug-resistant
>tuberculosis in an epidemic area; Annelies Van Rie, Robin Warren, Madalene
>Richardson, Robert P Gie, Donald A Enarson, Nulda Beyers, Paul D Van Helden.
>
>
>Report notes that, traditionally, patients with drug-resistant tuberculosis
>are classified as having acquired drug-resistant or primary drug-resistant
>disease on the basis of a history of previous tuberculosis treatment and
>only cases of primary drug resistance are assumed to be due to transmission
>of drug-resistant strains. This is a study of 63 patients with
>drug-resistant tuberculosis designed to assess the relative contribution of
>transmission of drug-resistant strains in a high-incidence community of Cape
>Town, South Africa, by restriction-fragment length polymorphism (RFLP).
>Authors compared RFLP results with the results obtained by traditional
>classification methods. They report that according to RFLP definitions, 52%
>(33 cases) of drug-resistant tuberculosis was caused by transmission of a
>drug-resistant strain and the proportion of cases due to transmission was
>higher for multidrug-resistant (64%; 29 cases) than for
>single-drug-resistant (no cases) tuberculosis. By the clinical
>classification, they found only 18 (29%) patients were classified as having
>primary drug-resistant tuberculosis (implying transmission) and say the
>clinical classification was thus misleading in 25 patients. They note the
>term acquired drug resistance includes patients infected with strains that
>truly acquired drug resistance during treatment and patients who were
>initially infected with or reinfected with a drug-resistant strain. They
>point out this definition could lead to misinterpretation of surveillance
>studies, incorrect evaluation of tuberculosis programs, and delayed
>diagnosis and treatment of patients with multidrug-resistant disease. They
>believe the clinical term acquired drug resistance should be replaced with
>the term "drug resistance in previously treated cases", which includes cases
>with drug resistance due to true acquisition as well as that due to
>transmitted drug-resistant strains.
>*****************************
>OTHER:
>*********************
>June 22, 2000; A Draft Public Health Action Plan to Combat Antimicrobial
>Resistance - (Part I: Domestic Issues).
>
>This was posted on the internet at:
>(http://www.cdc.gov/drugresistance/actionplan/) A Notice of Availability
>and Request for Public Comment was published in the June 22, 2000 Federal
>Register. This plan was developed by an Interagency Task Force on
>Antimicrobial Resistance that was created in 1999. The Task Force is
>co-chaired by the Centers for Disease Control and Prevention (CDC), the Food
>and Drug Administration (FDA), and the National Institutes of Health (NIH),
>and also includes the Agency for Healthcare Research and Quality (AHRQ), the
>Department of Agriculture (USDA), the Department of Defense (DoD), the
>Department of Veterans Affairs (DVA), the Environmental Protection Agency
>(EPA), the Health Care Financing Administration (HCFA), and the Health
>Resources and Services Administration (HRSA).
>***********************************
>NEW Institute of Medicine Report: Public Health Systems and Emerging
>Infections: Assessing the Capabilities of the Public and Private Sectors.
>
>FYI - The IOM is issuing "Public Health Systems and Emerging Infections -
>Assessing the Capabilities of the Public and Private Sectors" (a workshop
>summary). Local public health departments are key players in handling
>outbreaks of infectious disease. Yet many are poorly prepared to cope,
>because of years of under funding, competing priorities, and lack of trained
>professionals.
>
>This summary reviews the readiness of the system - from the federal, state
>and local levels - to respond to disease outbreaks across four areas:
>epidemiological investigations, laboratory surveillance, communication and
>coordination, and strategic planning. It emphasizes three areas in which
>investments could make a positive contribution:
>
>1) development of a national infectious disease surveillance system,
>2) investment in human capital, and
>3) improved collaboration between the public and private sectors.
>
>For further >information contact Jonathan Davis at 334 2562; to read the
>report visit >http://books.nap.edu/catalog/9869.html and for a copy please
>reply to the listserve.
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>DEPARTMENT OF AGRICULTURE Animal and Plant Health Inspection Service 9 CFR
>Part 77; Tuberculosis in Cattle and Bison; State and Zone Designations.
>
>Story Filed: Wednesday, June 28, 2000 5:34 PM EST Washington, DC, Jun. 28,
>2000 (FedNet via COMTEX) - We are amending the bovine tuberculosis
>regulations regarding State and zone risk classifications to remove the
>split-State status of the State of Michigan and to classify the entire State
>as nonmodified accredited. This action is necessary to help prevent the
>spread of tuberculosis because Michigan no longer meets the requirements for
>split-State status. DATES: This interim rule is effective June 22, 2000.
>We invite you to comment on this docket. We will consider all comments that
>we receive August 28, 2000. AGENCY: Animal and Plant Health Inspection
>Service, USDA. ACTION: Interim rule and request for comments.
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>
>