TB: Now A Worse World Crisis

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TB Now A Worse World Crisis

• Sir John Crofton

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TB Pre-Antibiotic Mortality

• LUNG 50
• MENINGITIS 100
• MILIARY 100

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SPUTUM POSITIVE PULMONARY TUBERCULOSISEDINBURGH
1955-60

• Follow-up plus / minus 10 years
• Total 651
• Negative/Cured 98.9
• Exceptions 1.1 7 early deaths (all causes)
• Later relapses 4 33 all except 1 explicable
• Dramatic effect on Incidence and Resistance
• Source Pearce and Home 1974

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Prevention

• PRE-1922 IMPROVED SOCIAL CONDITIONS
• 1922 BCG variable
• GOOD MASS CHEMOTHERAPY
• (Edinburgh 1950s 60 Decrease In 3
  Years)

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Third World

• BMRC studies 1950s 1970s
• IUATLD support for national tuberculosis control
  programmes 1980s to date World Bank highly
  cost effective
• WHO global programme 1991 to date

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DOTS IN NATIONAL TB PROGRAMS FIVE POINT PACKAGE

• GOVERNMENT commitment
• Passive case - finding by MICROSCOPY
• SHORT COURSE chemotherapy for sputum positive
  DIRECTLY OBSERVED (esp. in intensive phase)
• Regular DRUG SUPPLY (reliable drugs)
• MONITORING Cohort reports
• Supervision
• Evaluation

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TB WORLD PERSPECTIVE AND CHALLENGES AHEAD

• The World Crisis The Global Outlook
• Responses to the Crisis
• CHALLENGES Ahead

• Funding
• Persuading Governments
• Organisation of Control Programmes
• TB HIV
• Multiple Drug Resistance

• New Drugs
• Molecular Methods
• Diagnosis
• Epidemiology
• Vaccines

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• HELP IN EUROPE
• INEQUALITY
• ALCOHOL
• SMOKING
• HELP IN THIRD WORLD/GLOBALLY
• FINANCE
• POLITICAL OPINION