The WHO 2014 Global tuberculosis report-further to go

The global tuberculosis epidemic and progress in care, prevention, and research: an overview in year 3 of the End TB era

Minimally invasive surgical approach versus open procedure for pancreaticoduodenectomy: A systematic review and meta-analysis

Tuberculosis (TB) is a leading cause of morbidity and mortality worldwide, accounting for about 9.6 million new cases and 1.5 million deaths annually. The poorest and socially excluded groups carry the largest burden of disease, which makes it essential to properly address the social determinants of health through poverty reduction measures and targeted interventions on high-risk populations. The spread of multidrug-resistance TB requires special attention and highlights the need to foster research on TB diagnostics, new drugs and vaccines. Although many advances have been made in the fight against TB over the last twenty years, a lot is still needed to achieve global elimination. The new end-TB strategy that was first launched in 2014 by the World Health Organization, is fully in line with the seventeen Sustainable Development Goals that came into effect since January 2016 and sets ambitious goals for the post-2015 agenda. A 90% reduction in TB-related mortality and an 80% decline in TB incidence within 2030 as well as the abolition of catastrophic expenditures for TB-affected people are the main targets of this strategy. Strong government commitment and adequate financing from all countries together with community engagement and appropriate investments in research are necessary in order to reach these objectives.

/pdf/tuberculosis-2015-burden-challenges-and-strategy-for-control-srh77zd5l3.pdf

Tuberculosis 2015: Burden, Challenges and Strategy for Control and Elimination.

Metagenomic next-generation sequencing (mNGS) is a comprehensive approach for sequence-based identification of pathogenic microbes. However, reports on the use of mNGS in pulmonary infection applied to lung biopsy tissues remain scarce. In this study, we applied mNGS to detect the presence of pathogenic microbes in lung biopsy tissues from 20 patients with pulmonary disorders indicating possible infection. We applied a new data management for identifying pathogen species based on mNGS data. We determined the thresholds for the unique reads and relative abundance required to identify the infectious pathogens. Potential pathogens of pulmonary infections in 15 patients were identified by mNGS. The comparison between mNGS and culture method resulted that the sensitivity and specificity were 100.0% (95% CI: 31.0-100.0%) and 76.5% (95% CI: 49.8-92.2%) for bacteria, 57.1% (95% CI: 20.2-88.2%) and 61.5% (95% CI: 32.2-84.9%) for fungi. The positive predictive value (PPV) (42.9% for bacteria, 44.4% for fungi) was much lower than negative predictive value (NPV) (100% for bacteria, 72.7% for fungi) in mNGS vs. culture method. The mNGS showed the highest specificity (100.0 and 94.1%) and PPV (100.0 and 75.0%) in the evaluation of fungi and MTBC respectively, when compared with histopathology method. The study indicated that mNGS of lung biopsy tissues can be used to detect the presence (or absence) of pulmonary pathogens in patients, with potential benefits in speed and sensitivity. However, accurate data management and interpretation of mNGS are required, and should be combined with observations of clinical manifestations and conventional laboratory-based diagnostic methods.

/pdf/detection-of-pulmonary-infectious-pathogens-from-lung-biopsy-1rpr47v2ue.pdf

Detection of Pulmonary Infectious Pathogens From Lung Biopsy Tissues by Metagenomic Next-Generation Sequencing.

WHO's 2013 global report on tuberculosis: successes, threats, and opportunities

World TB Day 2014: finding the missing 3 million

Since the WHO declared tuberculosis a global health emergency in 1993, important strides have been made in global tuberculosis control efforts. Tuberculosis associated mortality has halved and 45 million lives have been saved. Despite these advances, an estimated 9·6 million people developed tuberculosis worldwide in 2014, of whom 1·5 million died. Of the estimated 480 000 cases of multidrug-resistant tuberculosis, three quarters remained undetected and untreated. Tuberculosis is now the leading cause of death worldwide surpassing malaria and HIV. To reduce this continuing unacceptable burden of tuberculosis, the WHO End TB Strategy was adopted by the World Health Assembly in May 2014. It has targets linked to the new Sustainable Development Goals (SDGs), which aim to reduce by 2030 the global number of new tuberculosis cases by 80% and tuberculosis deaths by 90%. The Stop TB Partnership’s revised Global Plan to Stop TB, 2016–20, delineates what the global community must do to achieve these aims. However, funding shortfalls will need to be filled before more effective diagnostic, treatment, and prevention interventions are developed. In 2015, funding gaps amounted to US$1·4 billion for implementation of existing interventions and US$1·3 billion for new research and development. Novel efforts into harnessing and sustaining resources are thus required. In the early 1990s, the resurgence of tuberculosis epidemic occurred in parallel with the HIV epidemic. While the HIV epidemic has been brought under control by major political and financial investments, similar investments for tuberculosis control have lagged behind. The tuberculosis community has repeatedly called for a step-change in political will and donor investments. The challenge now for the tuberculosis community is to find ways to further strengthen existing political will, and to secure the resources and the policy change needed to end the global tuberculosis epidemic. For the first time in two decades, there is major political support for efforts to tackle the global tuberculosis epidemic. The Global TB Caucus, a novel international network of parliamentarians, was formed in Barcelona, Spain, in 2014 with the express intention of raising tuberculosis up the political agenda. The Caucus launched the Barcelona Declaration, a political call-to-arms, which is open to any political representative in the world to sign as a demonstration of support for the objective of ending the tuberculosis epidemic. As of the end of January, 2016, more than 1000 parliamentarians from over 100 countries had signed the Declaration. In Cape Town, South Africa, at the end of November, the Caucus met for the 2nd Global TB Summit. 50 parliamentarians from 30 countries attended the meeting, which was the biggest political meeting on the disease in 100 years. At the meeting, delegates agreed to focus on supporting the replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the roll-out of the Global Plan, as well as committing to launch national and regional networks. Such national tuberculosis caucus, or All-Party Parliamentary Groups, will be crucial if progress is to be made against tuberculosis. In the UK, partly as a result of the efforts of the UK All-Party Parliamentary Group on Global TB, the Conservative Party made a manifesto pledge “to lead a major new programme to accelerate research and development of drugs and vaccines to eliminate the world’s deadliest infectious diseases”. This commitment was realised in November, 2015, through the announcement of the Ross Fund, which will spend £1 billion over 5 years on infectious disease research and development, including tuberculosis and antimicrobial resistance. The challenge for those who work in tuberculosis is to find ways to further strengthen that political will and use the support of the Global TB Caucus as effectively as possible to secure the resources and the policy change needed to end the tuberculosis epidemic. We have a window of new opportunity to advance new investments to accelerating progress in global tuberculosis control efforts and to make a major impact, but the tuberculosis community as a whole must engage with the Caucus and work with political leaders to get the job done. There are clearly a great number of parliamentarians worldwide and an increasing number For more on Global TB Caucus see http://www.globaltbcaucus. org/

World TB Day 2016--advancing global tuberculosis control efforts.

Advancing political will to end the tuberculosis epidemic.

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