TB spreading in Thailand

[Gert van der Hoek]

TB epidemic in Thailand

Thailand has the 17th highest incidence of tuberculosis in the world.

Bangkok Metropolitan Administration Health Department deputy director Dr Chanchai Kumphong said 90,000 people were infected with tuberculosis every year. About 15,000, or 16.5 per cent, are in Bangkok.

At least 60 per cent of Bangkok infections involve people younger than 45. Most live in crowded areas, he said.


"There is a high risk of passing the disease to others because tuberculosis symptoms do not appear immediately," Chanchai said.


National Health Security Office senior official Dr Chuchai Sornchamni said random checks of crowded places like shopping centres, department stores and fresh markets found one tuberculosis sufferer in every 500 people.


Chanchai said there was a 98 per cent chance of full recovery if treated.


"If you cough for two weeks, start losing weight and have a slight fever in the evenings, see a doctor," Chanchai added.

http://nationmultimedia.com/2007/05/22/national/national_30034839.php

 

[Gert van der Hoek]

Re: TB epidemic in Thailand

Re: TB epidemic in Thailand

EDITORIAL (from The Nation, Thailand)

Scourge of TB rears its ugly head

Public health campaign needed to educate the public on tuberculosis and to combat rise of drug-resistant strains

A resurgence of tuberculosis (TB), which was declared a global public health emergency more than a decade ago, has focussed the world's attention on the need to redouble efforts to try to contain the spread of this deadly disease. Thailand, which had been so successful in combating TB in the past, has contributed to the widespread misconception that the disease has already been beaten.

The disease, however, has come back with a vengeance in recent years mostly in developing countries, including Thailand. Public health experts have expressed concern about the emergence of drug-resistant strains of the disease and the Aids pandemic, which, they say, could combine to bring death and suffering to millions of people worldwide.


Thailand was caught by surprise when the World Health Organisation ranked the country 17th out of 22 countries in the world with the highest rates of TB infection. According to a Public Health Ministry estimate, the TB rate in densely populated areas like Bangkok could be as high as one in every 500 people.


Most infected people are not aware of the disease, which is caused by the Mycobacterium tuberculosis bacillus and can be spread through the air like the common cold. According to the WHO, if left untreated, one person with infectious TB will pass it on to an average of 12 to 20 people, and that two to four of these will develop infectious TB.


According to the WHO, even though the global TB rate may have stabilised over the past few years due to greater awareness among public health officials and control efforts, the actual number of people with TB has increased markedly as a result of an increase in the world's population. The world health body said there were about 8.8 million new TB cases and 1.6 million deaths due to the disease in 2005.


Thailand is a classic example of how a high rate of HIV/Aids infection can fuel a TB resurgence. It has taken Thai health authorities years to shed complacency and wake up to the threat posed by the HIV/Aids-TB combination to the country's public health system.


A recently released study by Dr Amara Soonthordhada entitled "TB Policy in Thailand: A Civil Society Perspective" exposes a striking lack of social and political commitment to control tuberculosis, one of the leading causes of death in Thailand.


Due to the absence of TB awareness among members of the Thai public, there is little understanding of how TB is spread and the fact that it can be cured. According to the study, many patients do not seek treatment because of the social stigma attached to the disease, a lack of information, and the high costs of the cure.


The emergence of drug-resistant strains of TB is a great possibility in Thailand where too many people have developed the habit of self-medicating by buying medicines, like antibiotics, from local pharmacies - many of which are not staffed by qualified pharmacists - and then not bothering to complete the whole course.


Health authorities are just now beginning to encourage people with TB to come forward to seek free treatment. TB can be cured with a treatment regimen that typically takes six months to complete. The most important thing is to ensure that patients take the right dose of medicine and complete the whole course to prevent strains of TB becoming drug resistant.


The Public Health Ministry's statistics shows that while TB rates fell by 50 per cent from 1985 to 1991, the HIV/Aids epidemic may have contributed to a resurgence of TB, which kills about 12,000 people a year in this country.


Public Health officials will find it difficult to identify people with TB. The standard, error-prone procedure for diagnosing tuberculosis was developed some 100 years ago and it involves putting sputum samples under a microscope and lab technicians identifying the bacteria that cause TB. That's why a public awareness campaign is very important to alert people of the looming public health threat.


For a country like Thailand where HIV/Aids and TB tend to combine with devastating effects, public health authorities must rationalise their work by merging HIV/Aids and TB treatment programmes in order to lower the death rate from TB, which is curable.


http://nationmultimedia.com/2007/05/25/opinion/opinion_30035143.php

 

[Gert van der Hoek]

Re: TB epidemic in Thailand

Re: TB epidemic in Thailand

13 cases of 'super TB' strain found

Thailand has 13 confirmed cases of the dangerous and highly drug-resistant form of tuberculosis, according to the chairman of the Drug Resistant TB Research Fund.


Dr Manoon Leechawengwong said yesterday the fund, under the patronage of the Siriraj Foundation, started research into drug-resistant forms of TB in 2001 and had found 13 cases identified as XDR-TB.

This definition means the TB strain is extremely drug-resistant, especially to first- and second-line drugs. Treatment options for patients with XDR-TB are severely limited.

However, Dr Mongkol na Songkhla, the public health minister, said he had not yet been informed of the XDR cases here. He claimed the ministry monitored drug-resistant forms of TB, but only multi-drug-resistant MDR had been found.

The difference between patients with MDR-TB and XDR-TB is that the first group has more treatment options than the latter. MDR-TB is resistant only to first-line drugs.

XDR-TB recently became world news after a law, unused for 44 years, was invoked to isolate a man in the United States last month. Currently there is no treatment for XDR-TB.

Manoon's disclosure about the confirmed XDR-TB cases contradicted information from the ministry. Last week, Dr Tawat Suntra-jarn, head of the Disease Control Department, insisted there were no cases of Thais infected with XDR-TB.

But Manoon claimed the Health Ministry did not pay enough attention to monitoring and preventing the spread of drug-resistant TB.

"We have to speak the truth and look for a way to prevent the spread of the disease," he said.

In order to identify drug-resistant forms of TB, Manoon said hospitals nationwide had cooperated by sending TB germ samples from patients.

While there are about 80,000 new TB cases each year, he had only been sent 15,000 samples over five years of his research project. Besides the 13 cases of XDR-TB, his lab tests also found about 500 cases of MDR-TB.

Manoon wants the ministry to be more proactive in controlling the spread of TB, especially the strains resistant to drugs. He suggested it seriously examine TB cases to identify XDR and MDR cases.

"If possible, the government should have the power to restrict the movement of those infected with drug-resistant forms of TB - to reduce the chance of them spreading the disease."

He said the main concern was how the country prevented the spread of the disease.

http://nationmultimedia.com/2007/06/13/headlines/headlines_30036723.php

 

[Gert van der Hoek]

Re: TB spreading in Thailand

Drug-Resistant TB Surfaces in Thailand

June 15, 2007


Thai officials have stepped up surveillance and protective measures after 13 Thai citizens and two ethnic Karen migrants from Burma were found to be carrying a dangerous and highly drug-resistant form of tuberculosis.

Dr Thawat Sunthrajarn, director-general of Thailand’s Disease Control Department, said that while infected TB patients needed to be on medication continuously for six months only 79 percent diagnosed with the disease in Thailand completed their treatment. The World Health Organization’s required standard was 85 percent, he said.

If treatment were neglected or not completed, the disease built a resistance to the medicine and most patients died, Dr Thawat warned.

Thailand’s Ministry of Public Health adopts various strategies to combat outbreaks of TB and says it insists o*n following up o*n patients and their medication closely. It is common practice to treat TB and HIV together, because 30 percent of HIV patients also have TB.

The ministry has also identified special risk groups such as migrants and people living along border areas and collaborates with international aid organizations working in those areas to tackle the problem.

Recently, the ministry also announced a campaign to promote the use of hygienic masks to prevent the spread of respiratory-transmitted diseases like the common cold, influenza, pneumonia and TB. The current annual budget for treatment of these diseases is about 5 billion baht (US $138,500,000).

The medical aid organization Médecins Sans Frontières has reported that two cases of “Extremely Drug Resistance-TB (XDR-TB)” cases had been diagnosed in Karen migrants from Burma. Dr. Thawat confirmed that o*ne case was found in a refugee camp near Mae Sot o*n the Thai-Burmese border, but said it was believed that the other infected person had returned to Burma and could not be located. He said details of all cases of XDR-TB would be forwarded to the WHO.

A member of staff at the Mae Tao clinic in Mae Sot confirmed that the number of patients with TB entering the clinic has been increasing, although about a half of the people suspected of having TB have to be referred to MSF because the small clinic does not have the facilities to cater for so many patients.

Dr. Manoon Leechawengwong, chairman of the Drug Resistant TB Research Fund, said that the foundation, under the patronage of the Siriraj Foundation, began research into drug-resistant forms of TB in 2001 and had since found 13 cases identified as XDR-TB, according to a report in The Nation. Dr. Manoon warned that respiratory- transmitted diseases could spread easily, particularly in air-conditioned public places in big cities.

The worldwide spread of TB continues to cause concern. In March, the WHO reported that there were 269 XDR-TB cases in 35 countries worldwide. In Thailand, an estimated 91,000 people have TB, 40,000 of whom are contagious. So far in 2007, 10,000 new cases have been diagnosed.

http://www.irrawaddy.org/article.php?art_id=7486