Transcript TB: Now A Worse World Crisis

TB: Now A Worse World Crisis
Sir John Crofton
TB: Pre-Antibiotic Mortality
• LUNG 50%
• MENINGITIS 100%
• MILIARY 100%
SPUTUM POSITIVE PULMONARY
TUBERCULOSIS:
EDINBURGH 1955-60
• Follow-up plus / minus 10 years
Total:
651
Negative/Cured
Exceptions
Later relapses
98.9 %
1.1%: 7 early deaths (all causes)
4%: 33: all except 1 explicable
Dramatic effect on Incidence and Resistance
Source: Pearce and Home 1974
Prevention
• PRE-1922: IMPROVED SOCIAL
CONDITIONS
• 1922: BCG: variable
• GOOD MASS CHEMOTHERAPY ++
(Edinburgh 1950s: 60% Decrease In 3 Years)
Third World
1. BMRC studies 1950s – 1970s
2. IUATLD support for national tuberculosis
control programmes: 1980s – to date
World Bank: highly cost effective
3. WHO global programme 1991 – to date
DOTS IN NATIONAL TB PROGRAMS:
FIVE POINT PACKAGE
1. GOVERNMENT commitment
2. “Passive case” - finding by MICROSCOPY
3. SHORT COURSE chemotherapy for sputum
positive DIRECTLY OBSERVED (esp. in
intensive phase)
4. Regular DRUG SUPPLY (reliable drugs)
5. MONITORING:
Cohort reports
Supervision
Evaluation
TB: WORLD PERSPECTIVE AND
CHALLENGES AHEAD
1. The World Crisis: The Global Outlook
2. Responses to the Crisis
3. CHALLENGES Ahead
• Funding
• Persuading Governments
• Organisation of Control
Programmes
• TB HIV
• Multiple Drug Resistance
• New Drugs
• Molecular Methods
Diagnosis
Epidemiology
• Vaccines
HELP IN EUROPE
INEQUALITY
ALCOHOL
SMOKING
HELP IN THIRD WORLD/GLOBALLY
FINANCE
POLITICAL OPINION