A health technician analyses blood samples for tuberculosis testing in a high-tech tuberculosis lab in Carabayllo in Lima, Peru May 19, 2016..
(photo credit: MARIANA BAZO/REUTERS)
Of the 10.4 million people who contracted tuberculosis in 2016, 250 were diagnosed in Israel, the Health Ministry said on Sunday, one day after World Tuberculosis Day.
According to the World Health Organization (WHO), most of those who became infected with TB lived in Southeast Asia, sub-Saharan Africa and the Western Pacific. Of the new patients in Israel, about 80% were born outside of the country (both Israeli citizens and foreigners). The incidence rate in the total population in 2016 was 2.89 per 100,000 population, less than one-third the rate here in 1998.
Every day, more than 4,000 people worldwide die from TB, putting the disease at the top of the list of the most common causes of death that result from a single pathogen, usually Mycobacterium tuberculosis. The people who are most affected are those also suffering from an immune deficiency, such as an HIV infection.
The ministry’s TB and AIDS department is holding a national conference titled “Tuberculosis, HIV and the Third Age – New Challenges in the face of Changes in Age and Illness” on Monday
at the Neot Efal Conference Center.
The ministry’s national program for the elimination of TB is being carried out in cooperation with the four public health funds. There are nine centers around the country for diagnosis and treatment of the infectious disease. The main center is at Shmuel Harofeh Hospital in Be’er Ya’acov.
According to the ministry, the heart of the program is the provision of directly observed short-course tuberculosis therapy. For a complete cure, a “cocktail” of antibiotics must be taken for at least six months. This treatment results in full recovery in more than 90% of patients. Failure to complete treatment may cause the disease to be renewed and the spread of TB bacteria to continue. Irregular treatment leads to the development of drug-resistant strains and the risk of those being spread.
TUBERCULOSIS USUALLY affects the lungs, but can also affect other parts of the body. Most infections initially have no symptoms, known as latent tuberculosis.
In 1882, Dr. Robert Koch announced the discovery of the TB bacterium, which then caused the death of one in seven people in Europe and America. Despite the great hopes that accompanied the discovery of the bacterium, there has been an increase in TB morbidity in developed countries and the rest of the world in recent decades. In 1993, the WHO declared tuberculosis as a global emergency for the first time in its history.
Treatment of TB in an irregular manner may result in non-responsive, or resistant, bacterial strains of two main drugs for the treatment of tuberculosis – isoniazid and rifampicin – or other drugs. There are also reports of cases of tuberculosis that are extremely resistant to most of the drugs currently available. This greatly limits treatment options for patients infected with this bacterium. This phenomenon exists in most countries of the world, including Israel, where isolated cases of such resistant TB have been identified. In 2013, the WHO noted the Israeli program for treating TB patients as a “success story.”
Meanwhile, researchers at the University of Zurich and Makerere University in Kampala, Uganda, have declared that TB can be cured and eradicated. But for this to happen, they said, patients have to receive the correct treatment. The researchers maintained that the levels of medication used in various parts of the world are often too low, leaving patients contagious with the dangerous disease for longer than necessary.
The most important medications for treating tuberculosis date back to the 1960s. Treatment is lengthy, involves several pills, and comes with numerous side effects. People thus often discontinue their treatment, which means that patients continue to suffer from the disease and also pass it on to others. In addition, the optimal dose of tuberculosis drugs has not yet been determined.
The Swiss and Ugandan researchers spent more than two years measuring the concentration of TB medication in the blood of 268 patients suffering from pulmonary tuberculosis as well as an HIV infection. “We were able to show that the concentrations of the two principal tuberculosis drugs, isoniazid and rifampicin, in the blood were very clearly below the internationally targeted levels,” said Prof. Jan Fehr. These lower blood concentrations mean that TB patients cough up bacteria for a longer period of time, compared to patients with higher levels of medication in their blood.
The WHO wants to cut the TB rate by 90% by 2030, but the researchers add that global epidemic can be controlled only if the drug dosage is not too low.
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