National News  | Alaska's Largest TB Outbreak in 8 Years Contained on Y-K Delta ALASKA :: TB
Alaska Dispatch (07.29.2013) :: By Eli Martin | | | The Alaska Department of Health and Human Services reported that the recent TB outbreak in a Yukon-Kuskokwim Delta village was under control and that the outbreak presented no elevated risk to community members. Alaska Tuberculosis Control Officer Dr. Michael Cooper stated that eight patients with active TB were receiving treatment in the village and all were “doing well.” Cooper declined to name the small village, citing Alaska’s Infectious Disease Program patient privacy policy.
Cooper stated the Yukon-Kuskokwim Delta outbreak had its origin in high TB incidence among Alaskan Natives in the 1940s and 1950s. From 1948 to1951, approximately 89 percent of Alaskan Natives in the region tested positive for TB. Cooper attributed the high TB incidence to remote geography, poor healthcare infrastructure, crowded living conditions, and the immigration of nonnatives who brought in “weakening” diseases like measles and influenza from which Alaskan Natives had no immunity. Extending healthcare to the region has helped TB rates plummet throughout the years.
However, many Alaskan Natives who were alive during the region’s period of high incidence still have latent TB, which could become active as aging weakened their immune systems. In addition, poor living conditions and lack of access to quality medical care still exist in remote areas.
In 2012, Alaska had more TB cases than any other state, with a rate of nine cases per 100,000 people. Sixty-nine percent of Alaska TB cases occurred among Alaskan Natives, and 66.6 percent of the infections occurred in the Yukon-Kuskokwim Delta. Alaskan Natives accounted for only 15 percent of the state’s population. The decline in Alaska’s TB rates is likely to continue as the state health department identifies and treats latent cases, but the eradication of TB in Alaska is unlikely, according to Cooper.
In other states, foreign-born populations accounted for most US TB cases. |  Read Full Article | Share this Article     | | Back to Top  |  | | International News  | 12,000 Kumasi HIV/AIDS Patients Dying GHANA :: HIV/AIDS
ghanaweb.com (07.29.2013) | | | Early in 2012, a section of the Komfo Anokye Teaching Hospital (KATH) that served 12,000 HIV/AIDS patients in Ghana’s Ashanti region closed for renovation. Hospital authorities stated the renovations were necessary to correct structural defects that allowed TB to spread among the hospital’s patients. Before closing the HIV section, KATH officials gave HIV-infected patients a four-month supply of antiretroviral therapy (ART), but made no other provisions to continue HIV care during the construction. Although officials expected renovations to be complete in four months, construction has stopped and the HIV section remains closed. The contractors reported that KATH claimed it had no funds to pay for the work.
The international nongovernmental organization The Global Fund to Fight AIDS, Tuberculosis, & Malaria originally supplied funding for the renovation, but KATH officials claimed that Ghana’s National Tuberculosis Programme has not released the funds to the hospital. It was not clear how many HIV-infected patients have died as a result of interruptions in HIV care and treatment. Displaced KATH patients who attempted to obtain HIV medications from other clinics or hospitals faced discrimination and stigmatization. Because Ghana’s government supplied ART to HIV-infected people, obtaining ART from pharmacies was very difficult. In an attempt to assist HIV patients, KATH pharmacists have resorted to distributing ART without prescriptions on the hospital grounds.
Hospital sources stated that KATH was taking steps to release funds to the contractor so construction could recommence.
| | Read Full Article | Share this Article | | Back to Top | | | Medical News  | RA: Can Some Low-Risk Older Patients Skip TB Prophylaxis? GLOBAL :: TB
Medscape Medical News (07.28.2013) :: By Janis C. Kelly | | | Glen S. Hazlewood, MD, and colleagues contend that latent TB infection (LTBI) treatment, such as nine months of isonaizid to prevent TB, before beginning treatment with tumor necrosis factor (TNF) inhibitors might not be necessary for some low-risk elderly patients with rheumatoid arthritis, if these patients’ TB skin tests were 5 millimeters (mm) or smaller, they had no other risk factors, and lived in countries with low TB prevalence.
The researchers created a Markov decision analytic model to estimate outcomes as patients moved between various health states throughout time. They based the model on a hypothetical 65-year-old with a 5- to 9-mm tuberculin skin test (TST), who had not received the Bacille Calmette-Guérin vaccine and had rheumatoid arthritis (RA) and anti-TNF treatment as their only TB risk factors. The researchers reviewed data on the risk of developing active TB for patients from Canada, the United States, France, the United Kingdom, Sweden, and Spain. The researchers sought to determine whether or not to administer isoniazid based on a primary outcome of quality-adjusted life expectancy and a secondary outcome of life expectancy.
The model showed that prophylaxis provided an average gain of 1.1 quality-adjusted life expectancy days and 2.6 days of overall life expectancy. Based on this model, researchers expected 1.4 TB-related deaths per 1,000 patients with prophylaxis and 3.3 deaths per 1,000 patients without it. They also expected 0.2 hepatitis-related deaths per 1,000 with prophylaxis and 0 per 1,000 without it. The decision analysis favored no prophylaxis, based on quality-adjusted life expectancy for elderly patients with low risk of TB reactivation, and prophylaxis for patients with a TST larger than 10 mm or those from a higher-risk country with a TST larger than 5 mm. For overall life expectancy, regardless of preferences, researchers favored prophylaxis.
Joel D. Ernst, MD, from New York University School of Medicine’s Division of Infectious Diseases, noted that researchers limited results to specific types of patients—those with TST results of 5- to 9-mm induration—and that the researchers were not recommending against treatment of LTBI for elderly RA patients in general.
The full report, “Prophylaxis for Latent Tuberculosis Infection Prior to Anti-TNF Therapy in Low-Risk Elderly Patients with Rheumatoid Arthritis: A Decision Analysis,” was published online in the journal Arthritis Care & Research (2013; doi: 10.1002/acr.22063).
| | Read Full Article | Share this Article | | Back to Top | | | Local and Community News  | Groups Sound Alarm About Hepatitis C MASSACHUSETTS :: Viral Hepatitis
Cape Cod Times (Hyannis) (07.29.2013) :: By Cynthia McCormick | | | As part of its World Hepatitis Day involvement, access nantucket, a Massachusetts-based HIV and hepatitis advocacy group, is offering $10 grocery store gift cards to individuals who get tested for hepatitis C through Thursday, August 1. Public health officials often refer to hepatitis C as a “silent disease,” because someone could have it for decades before showing symptoms, which could include liver cancer or failure.
"There are many people who are living with it who don't know they're living with it," according to Libby Maynes, program manager for access nantucket. The group noted that hepatitis C affected both baby boomers and young injection drug users on Cape Cod in epidemic proportions. CDC currently urges all adults born between 1945 and 1965 to be tested for hepatitis C, as baby boomers accounted for 75 percent of chronic hepatitis C cases.
Access nantucket’s free and confidential pinprick rapid test provides results in 20 minutes. Maynes noted that the rapid test was "a huge improvement" from the previous test, which involved drawing blood and took approximately two weeks to provide results. She also explained that staff would assist any individual who received a positive test result with making an appointment for further testing to see if they had an active strain of the virus.
Max Sandusky, director of prevention and screening services for AIDS Support Group of Cape Cod, explained that additional testing was useful in determining a positive individual’s viral load, as approximately 20 percent of people infected with hepatitis C have proven able to clear the disease without medical intervention. In 2007, hepatitis C surpassed HIV in US deaths, with more than 15,000 hepatitis-related deaths compared to 12,734 HIV-related deaths, according to CDC. Hepatitis C is a major cause of liver transplantation, cirrhosis, and liver cancer.
| | Read Full Article | Share this Article | | Back to Top | | | | News Briefs | | | | | Healthcare Workers Trained in Prevention, Care and Control of Tuberculosis WEST INDIES :: TB
St. Kitts-Nevis Observer (07.26.2013) :: By Monique Washington | | | Last week, 27 Caribbean health professionals received specialized training in the prevention and treatment of TB and TB/HIV. The one-day workshop, sponsored jointly by the Pan American Health Organization and Caribbean HIV/AIDS Regional Training Network, focused on the Caribbean’s TB guidelines. In 1993, the World Health Organization called TB a public health “global emergency” and estimated that one in three persons carried the infection. Minister of Health Mark Brantley pointed out to attendees the importance of having such a workshop, stating, “It is imperative that all our doctors, nurses, and other health professionals, including pharmacists, lab technologists, and environment and health promotion officers, strengthen their knowledge in this area.” Fellow speaker Dr. Judy Nisbett, medical health officer on Nevis, remarked that, “TB is a contagious airborne disease that can be transmitted from one person to another, but it is also treatable and preventable. It is a debilitating disease that requires a long course of treatment to ensure cure.” She said the workshop’s topics would concentrate on prevention, treatment, and care guidelines.
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7/30/2013
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