The New York Times has an Op-Ed today by Peter Hotez, professor at George Washington University and president of the Sabin Vaccine Institute.

Perhaps the world’s most vocal advocate for the control of neglected diseases, Hotez is constantly coming up with creative arguments to engage and connect with a US audience far removed from the diseases in question. Writing in Scientific American last December, for example, he appealed to Americans’ consumption savvy by making the case for a global economic incentive for defeating NTDs and by marketing an investment in their control as a public health “best buy”.

“Now Hotez is trying a different tack to make Americans care. Writing in the Times (”Parasites in Paradise”), he points out that, in fact, Americans are not as far removed from neglected diseases of poverty as many of them might have thought. Leptospirosis lurks in their own big cities, and close to three million African-Americans suffer from toxocariasis, a parasitic worm infection transmitted by dogs. And then there’s the Caribbean, where a host of other parasites all but unknown in “paradise” - Chagas’ disease, schistosomiasis, and hookworm to name just a few - have thrived ever since the slave trade.

And here, Hotez introduces yet another angle, this one sure to resonate with American readers on both sides of the political aisle: disease as vestige of slavery and racism. Indeed, if there’s one thing with the potential to raise awareness through the roof - even for something as obscure and forgettable as “trichomoniasis” - it’s the notion that racism is in some way responsible.

Hotez says most of the neglected diseases in the Caribbean could be controlled or eliminated for an estimated $20 million a year, “a total that is roughly equivalent to one dollar for every tourist who visits there ever year”. He adds that the Sabin Vaccine Institute, in collaboration with the World Health Organization and the Interamerican Development Bank, is working to find that funding.

[Prof Hotez was also the subject of a recent TropIKA.net Profile article.]

Ethiopia’s capital, Addis Ababa, will host the latest in a series of meetings organized by the Global Alliance for TB Drug Development to examine regulatory issues surrounding the development of new TB drugs.

After many years in which there was little support for efforts to find new drugs for TB, progress is now being made but there are concerns that national and international processes for drug regulation could lead to unnecessary delays in getting new treatments to all those who need them. The Alliance is therefore seeking to develop new guidelines for TB drug registration and approval.

The next meeting in the Alliance’s “Open Forum” series to discuss this issue will feature presentations by leaders in TB drug development, regulators, and public health policy-makers. It will focus on regulatory challenges specifically relevant to the African region. The meeting will take place 18-19th August 2010 at Addis Ababa’s Hilton Hotel.

Registration for the event is free and currently open. The draft agenda is also available.

Many patients with active tuberculosis are not diagnosed until a late stage. Further confirmation of this situation comes in a recently published study [1] from Guinea Bissau, West Africa.

Routine TB surveillance in the area studied is based on passive case finding. Researchers made household visits and employed a standard questionnaire to screen for symptoms of pulmonary TB; suspected cases were then investigated with sputum smear microscopy and X-ray. Four cases cases were found among a cohort of 2,989 adults of all ages, and in a second cohort of 571 adults over 50 years of age a further four cases were identified. Of the eight cases found, two were unknown to the local TB programme. (Five cases were HIV uninfected while three were of unknown HIV status.)

Previous studies [e.g. 2, 3, 4] have often found that active case finding leads to a higher proportional increase in the number of known TB cases. However, this study is also useful because information on TB prevalence in Africa is sparse. The researchers have shown prevalence to be moderately high in the area studied, with a higher rate of prevalence in older individuals.

Late diagnosis can worsen the prognosis for patients and left untreated they can go on to infect many other people. Delays can also increase the costs to patients, which can pose serious demands on people with low incomes. A new study [5] from Ethiopia interviewed recently diagnosed patients about their healthcare seeking behaviour at the time of diagnosis, the delays which occurred, and the costs they had to meet. The researchers concluded that costs arising from time lost in seeking care comprises a major portion of the total cost of diagnosis, and may worsen the economic position of patients and their families. Factors responsible for delays in diagnosis include patients seeking care outside the health system and a low index of suspicion public health providers.

These studies provide further evidence of the need for improved screening for TB, greater TB awareness amongst the public and health care providers, and better referral systems.

References
1. Bjerregaard-Andersen M, da Silva ZJ, Ravn P, Ruhwald M, Andersen PL, Sodemann M, Gustafson P, Aaby P, Wejse C (2010). Tuberculosis burden in an urban population: a cross sectional tuberculosis survey from Guinea Bissau. BMC Infect Dis;10:96.
2. Zachariah R, Spielmann MP, Harries AD, Gomani P, Graham SM, Bakali E, Humblet P (2003). Passive Versus Active Tuberculosis Case Finding and Isoniazid Preventive Therapy Among Household Contacts in a Rural District of Malawi. Int. J. Tuberc. Lung Dis; 7(11):1033-1039.
3. Shargie EB, Yassin MA, Lindtjorn B (2006). Prevalence of smear-positive pulmonary tuberculosis in a rural district of Ethiopia. Int J Tuberc Lung Dis; 10(1):87-92.
4. 14.Wood R, Middelkoop K, Myer L, Grant AD, Whitelaw A, Lawn SD, et al. (2007). Undiagnosed tuberculosis in a community with high HIV prevalence: implications for tuberculosis control. Am J Respir Crit Care Med; 175(1):87-93.
5. Mesfin MM, Newell JN, Madeley RJ, Mirzoev TN, Tareke IG, Kifle YT, Gessessew A, Walley JD (2010).
Cost implications of delays to tuberculosis diagnosis among pulmonary tuberculosis patients in Ethiopia.BMC Public Health; 10:173.