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Introduction by Dr Ibrahim Abubakar
Head of TB Section, Centre for Infections, Health Protection Agency
This Annual Evidence Update provides a collection of evidence that has emerged over the last twelve months on tuberculosis accompanied by commentaries from experts. This year’s topic is in keeping with the World Health Organization’s focus; “I am stopping TB”. The evidence provided here include guidelines, systematic reviews, articles, reports and useful websites.
Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis. It remains the leading cause of death due to a single infectious agent globally with about 1.5 million deaths annually. Over 8000 new cases of tuberculosis are currently reported each year in the United Kingdom highlighting the importance and relevance of this week.
Tuberculosis is usually curable provided the full course of treatment is taken. Appropriate use of TB medication also substantially reduces the risk of transmission, but failure to complete the course of treatment could result in the development of multi drug resistant (MDR) tuberculosis. When the bacteria develop the ability to withstand antibiotics, the outcome of care is poor and the strain can be spread from one person to another. Treatment completion, which is key to controlling TB, and particularly drug resistant TB, is discussed by Dr. Marc Lipman, a consultant physician at the Royal Free Hospital NHS Trust. Early diagnosis drug resistance can help clinicians to prescribe the correct medication and stop the spread of the drug resistant TB. New molecular tests such as line probe assays for the early diagnosis of drug resistance have recently been developed and approved by the World Health Organization for use globally. Professor Francis Drobniewski, the Director of the National Mycobacterium Reference Unit and WHO Supranational Reference Laboratory has provided a commentary on these assays.
Many initiatives are underway to develop vaccines with improved protection against tuberculosis. These new TB vaccines are either based on improving the Bacille Calmette-Guérin (BCG) vaccine using defined molecules to boost the protection already provided by a previous dose of BCG vaccine, or developing an attenuated strain of M. tuberculosis. Professor Phil Marsh, the Health Protection Agency’s lead on tuberculosis vaccines, has provided a commentary on this.
Human immunodeficiency virus (HIV) infection poses one of the greatest challenges to tuberculosis control with recent UK data suggesting an increase in the proportion of tuberculosis cases co-infected with HIV. New United Kingdom guidelines for HIV testing were recently published by the British HIV Association, the British Association for Sexual Health and HIV and the British Infection Society, in September 2008. These guidelines recommend more widespread HIV testing in clinical services such as TB clinics. This subject is discussed by Dr. Ann Chapman, a consultant infectious disease physician at the Royal Hallamshire Hospital, Sheffield. | 