A report on Xinhua News says that Singapore’s Agency for Science, Technology and Research (A*STAR) is providing US$2.2 million to establish a joint laboratory with bioindustrial group Institut Merieux where the research will be conducted.

Dr Enrique Sancho added that while TB drugs were provided free by the government, it did not provide medicines for MDR-TB: “Four percent of regular TB cases become MDRTB and complete treatment duration for these patients requires 18-24 months with multitude of drugs given that are more expensive and not part of the government’s free anti-TB medicines”.

At present MDR-TB treatment is available in only two centres in the Philippines, one in the capital Manilla and one in Cebu Province.

Further information in the Manilla Bulletin.

Call for expression of interest: Consultant/expert roster for the cutaneous leishmaniasis control programme

Background
The World Health Organization (WHO) Regional Office for the Eastern Mediterranean provides technical support in the planning and implementation of national programmes for the control of cutaneous leishmaniasis and facilitates regional/international cooperation on control of the disease.

Call for expression of interest
In view of strengthening and scaling up its technical support to countries on the control of cutaneous leishmaniasis, the Regional Office would like to expand its expert database to compile a list of potential consultants for current and future assignments in the Eastern Mediterranean Region.

Fields of expertise should include one or more of the following categories related to cutaneous leishmaniasis.

1. Epidemiology, prevention and control
2. Clinical and laboratory diagnosis
3. Case management and treatment follow‐up
4. Entomology and mammology
5. Public health policy development and assessment for harmonization of prevention
and control measures.

Applicants are requested to send their CV either in English or French (preferably using the WHO CV template available through the WHO e‐Recruitment system at http://www.who.int/employment/vacancies/en) along with a cover letter indicating field(s) of expertise; which period of the year you are most likely available; the minimum time frame to be contacted; and the maximum length of assignment that you could accept.

The documents should be sent to ctd@emro.who.int by 30 September 2010.

Recent articles include an examination of the neglect of women in many TB control programmes. Dr Ann Ginsberg, Chief Medical Officer at TB Alliance and a member of the Board of Directors of the Aeras Global TB Vaccine Foundation, told Citizens News that TB has a profound effect on women and their families. The burden of the disease is greater on the woman of the house; she has to bear the physical, mental and economic trauma of the disease. The woman may be sick herself or have sick children or a sick husband to take care of them. Women suffering from TB are often unable to care for their children and have trouble performing household chores. They may have to walk miles to get the treatment which has severe side effects. The health of children with an infected mother is also greatly affected. In addition there is no one to bring money in the family, as the disease leads to a loss of work and loss of wages. The article includes a podcast of the interview with Dr Ginsberg.

Involving communities in TB control is the subject of another article, which focuses on discussions on this theme at a recently concluded meeting held in Addis Ababa, Ethiopia - “Open Forum 4: Critical Path to TB Regimen: New Hope of Life for TB Patients”. Citizens News has also published other reports from this meeting.

Dr Shobhona Sharma, one of the researchers, told the Hindustan Times that: “In children, both sexes are affected by the parasite in the same manner, but the moment one goes to the pubertal age group, men tend to show and experience the symptoms more than women. We think the hormones testosterone and oestrogen may be influencing the way immune cells react when exposed to the parasite”.

The research team’s work has yet to be formally published but the same group, using mice, have reported a gender difference in response to malaria infection [1].

Reference
1. Basant A, Rege M, Sharma S, Sonawat HM (2010). Alterations in urine, serum and brain metabolomic profiles exhibit sexual dimorphism during malaria disease progression. Malar J;9:110.

NDM-1 makes bacteria resistant to one of the most powerful groups of antibiotics - carbapenems - which are generally reserved for use in emergencies and to combat hard-to-treat infections caused by other multi-resistant bacteria. Many of the UK patients found to have NDM1-producing bacteria had been admitted to hospitals in India; some of them had travelled there for cosmetic surgery and other procedures.

Speaking to the Guardian newspaper, Professor Tim Walsh of Cardiff University, who discovered the gene, said: “Because of international travel, globalisation and medical tourism, [the gene] now has the opportunity to go anywhere in the world very quickly … This is potentially the end. There are no antibiotics in the pipeline that have activity against NDM 1-producing Enterobacteriaceae”.

The BBC website has also published a helpful account of the new findings.

References
1. Yong D, Toleman MA, Giske CG, et al. (2009). Characterization of a new metallo-β-lactamase gene, blaNDM-1, and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother; 53:5046-5054.
2. Kumarasamy KK, Toleman MA, Walsh TR et al. (2010). Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infectious Diseases: Early Online Publication, 11 August 2010. Available online: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(10)70143-2/fulltext#bib22

According to a report from IRIN News, TB prevalence has fallen from 800 per 100,000 people in the 1990s to 79 per 100,000 last year. Rates are nevertheless still much higher in low-income groups, particularly those in the rural areas and with least education.

The improvement in the country’s TB position is attributed to efforts commenced in 1993 to implement a DOTS programme (directly-observed treatment, short-course) throughout the country. This has enabled many patients to be diagnosed earlier and started on effective treatment. Bangladesh has has achieved the Millennium Development Goal for 70% detection and an 85% cure rate.

Should the claim be supported by evidence - which presumably will be published later - the news will be welcome indeed. Artemisinin is now the mainstay of malaria treatment, older drugs now being ineffective. The appearance of resistance to the drug in the Thailand-Cambodia region, which was confirmed early last year, has been the cause of much concern, with fears that resistant strains could spread to other malaria-endemic countries. A project, largely funded by the Gates Foundation, has been attempting to screen the entire population in a pilot area and to provide prompt and effective treatment to all individuals testing positive for the malaria parasite.

An article from the Citizen News service, quotes experts in Indonesia and India who want to see more attention paid to paediatric TB, which often goes undiagnosed (due to technical issues as well as a lack of resources). They say that more information is needed as to how common the condition is in both HIV-infected and HIV-uninfected children. Greater efforts are needed to bring TB treatment to the children who need it.

Sanchita Sharma blames stress, late nights, smoking and dieting for turning a latent infection into active disease, when it appears in young professionals. That’s not something everyone would agree with but the columnist does well to remind us that TB should never be considered to be a disease that doesn’t happen to “people like us”.