Monday, September 24, 2018

TB partners launch first roadmap to stop zoonotic tuberculosis, calls it ‘hidden problem’ in Bangladesh

  • Nurul Islam Hasib from Guadalajara in Mexico,
    Published: 2017-10-13 00:50:38 BdST

Paula Fujiwara

The UN agencies and the Union have launched the first-ever roadmap to combat animal tuberculosis and its transmission to humans.

They have called upon the countries for close collaboration between those working for human and animal health.

The global experts call it a “hidden problem” in Bangladesh like many other countries where this type of TB is being noticed.

The roadmap launched on Thursday at the 48th Union World Conference on Lung Health in Guadalajara, Mexico set ten priorities for the countries as the zoonotic TB remained a neglected issue in many parts of the world.

Experts say this can hinder the progress of the human TB outcomes.

The roadmap was built on a ‘One Health Approach’, addressing health risks across sectors for the animal tuberculosis known as bovine TB and its transmission to humans, called zoonotic TB.

The World Health Organization (WHO), the World Organisation for Animal Health (OIE), the Food and Agriculture Organization (FAO) of the United Nations (UN) and the International Union Against Tuberculosis and Lung Disease (The Union) joined forces to develop this roadmap and address the major health and economic impact of this disease.

New data released by the WHO estimates that over 140,000 people fall ill and more than 12,000 people lose their lives each year to zoonotic TB – mostly in the African and the South-East Asian regions.

“It’s a hidden problem,” The Union’s Scientific Director Paula Fujiwara told as Bangladesh does not report any zoonotic TB.

She said to know the problem, “first of all you have to look for it”.

Bovine TB is most often communicated to humans through food consumption, usually non-heat-treated dairy products or raw or improperly cooked meat from diseased animals.

Direct transmission from infected animals or animal products to people can also occur.

Globally it is recommended not to treat TB-infected cattle as it can spread the bacterium further.

In Mexico, the authorities maintain a strong surveillance and identify the cattle with TB in the farm and kill that. The government-subsidised slaughterhouses also check the presence of TB before the meat go to market.

“This multidisciplinary roadmap represents a milestone in the fight against TB in both people and animals,” said Dr Fujiwara said.

“Better technologies, better science and better governance for affected communities bearing the bovine TB burden in poorer rural areas must become the new mantra if we are to get on the path to eliminating TB absolutely everywhere.”

Ten priorities in the roadmap

It calls for improving the evidence base by:

1. Systematically survey, collect, analyse and report better quality data on the incidence of zoonotic TB in people, and improve surveillance and reporting of bovine TB in livestock and wildlife.

2. Expand availability of appropriate diagnostic tools and capacity for testing to identify and characterize zoonotic TB in people.

3. Identify and address research gaps in zoonotic and bovine TB including epidemiology, diagnostic tools, vaccines, effective patient treatment regimens, health systems, and interventions coordinated with veterinary Services.

Then it calls for reduction of transmission between animals and humans by:

4. Develop strategies to improve food safety.

5. Develop capacity of the animal health sector to reduce the prevalence of TB in livestock.

6. Identify key populations and risks pathways for transmission of zoonotic TB.

And then strengthening inter-sectoral collaboration:

7. Increase awareness of zoonotic TB, engage key public and private stakeholders and establish effective intersectoral collaboration.

8. Develop and implement policies and guidelines for the prevention, surveillance, diagnosis, and treatment of zoonotic TB, in line with intergovernmental standards where relevant.

9. Identify opportunities for community-tailored interventions that jointly address human and animal health.

10. Develop an investment case to advocate for political commitment and funding to address zoonotic TB across sectors, at the global, regional and national levels.

Simona Forcella, focal point at the OIE, said this is the beginning. This roadmap also calls for action for mid and long term.

There is no bovine TB vaccine in the pipeline, she said at a press briefing.

Hannah Monica Yesudian Dias

Hannah Monica Yesudian Dias

Hannah Monica Yesudian Dias, information and technical officer policy, strategy and innovations of the WHO’s Stop TB Department, also called it a “hidden problem” in Bangladesh, when asked.

“We now really have something to push countries for stronger actions,” she said about the roadmap.

Dias said countries have made progress towards ending TB, yet to a large extent, people with zoonotic TB are left behind.

The priorities outlined in this roadmap highlight the need for multisectoral action to tackle this neglected form of TB and achieve the targets of the UN SDGs and the WHO’s end TB strategy.

The advanced laboratory tools required to diagnose zoonotic TB are frequently unavailable.

The disease is resistant to pyrazinamide - one of the standard first-line medications used to treat TB. Patients are, therefore, often misdiagnosed and may receive ineffective treatment.

Using pyrazinamide to treat patients with bovine TB increases the risks of treatment failure and developing resistance to other TB medicines used in course of treatment.

In zoonotic TB, patients must take drugs for nine months, compared with the standard six-month TB treatment, doctors say.