Newsdesk

www.thelancet.com/infection Vol 13 December 2013 1017

For more on polio in Syria see http://www.who.int/csr/don/2013_10_29/en/

For more on wound botulism in Norway see http://www.emcdda.europa.eu/news/2013/ecdc-botulism

For more on cholera in Nigeria http://allafrica.com/stories/201311010649.html

For more on multidrug-resistant Salmonella Heidelberg http://www.cdc.gov/salmonella/heidelberg-10-13/

Infectious disease survelliance update

looking a lot earlier at how to combine these drugs, if we don’t we could lose this opportunity to get on top of the tuberculosis epidemic”, Brigden concluded.

The epidemic took about 1·3 million lives in 2012, according to WHO’s report. They estimated that 8·6 million people developed the disease, 3 million of whom were missed by national notification systems, either because they were undiagnosed or because they were hidden in the private sector (mostly in the Indian subcontinent).

Needless to say, a key challenge is multidrug-resistant tuberculosis. According to WHO, around 450 000 people developed the disease in 2012, with roughly 170 000 deaths. “It is becoming an epidemic in its own right—people are getting multidrug-resistant [disease] as their fi rst form of tuberculosis”, said Brigden. But roughly three of four cases go undiagnosed. And even among the 94 000 diagnosed in 2012, some 17 000 were not treated, because of a scarcity of resources and trained staff .

Those who are lucky enough to receive treatment face 2 years of gruelling therapy, including 8 months of daily injections, at the end of which the chances of failure outweigh those of success. “The current WHO recommended regimen is expensive and diffi cult to implement, and there is a lack of political will to match the scale of diagnosis and the required scale of treatment”, explained Brigden. Treatment of multidrug-resistant tuberculosis can run into hundreds of thousands of dollars. But investment in research could obviate the need for such vast expenditure—Spigelman believes that the cost of treatment of multidrug-resistant forms could be reduced by 90% with the right regimen.

The future is dependent on the availability of resources. Roughly half of the world’s tuberculosis burden is in Brazil, China, India, Russia and South Africa, countries that could be expected to increase their contributions to control eff orts. Elsewhere, nations are dependent in varying degrees on international donors, and WHO

emphasises the importance of replenishing the Global Fund.

Raviglione talks about cutting incidence by 10% every year (at the moment, it is falling by 2%). Europe was able to do this after World War 2, but there they had universal coverage and the Marshall Plan. “In some places today, they are still charging patients, this is preventing access and good treatment outcomes”, said Raviglione. China, for example, aims to achieve universal coverage by 2020. A sharp decline in cases is contingent on bolstering of health-care infrastructure, and there is no guarantee that the money for this will be forthcoming. “At the heart of all this we have a neglected disease and it is neglected on multiple fronts” points out Spigelman. Brigden agrees. “In a lot of countries, there is not the civil society to make the demands on the Governments to prioritise tuberculosis, to start investing in it and stop it from being a donor driven programme”, she told TLID.

Talha Burki

Polio in Syria Wild polio virus type 1 has been isolated in ten of 22 patients with acute flaccid paralysis in Syria, as reported by WHO on Oct 17. Polio has not been recorded in the country since 1999. Most patients are children younger than 2 years old who were not immunised or did not receive the full schedule of polio vaccine. Genetic sequencing is being used to establish the origins of the virus. An immunisation plan was launched on Oct 24, with the aim of rapidly vaccinating 1·6 million children in Syria. Conflict in Syria has led to reduced in immunisation coverage and increased movement of people. Additional immunisation drives targeting 22 million in other Middle Eastern countries will begin in November.

Wound botulism in NorwayAs of Oct 28, six cases of wound botulism (four suspected and two confirmed) have been reported in people who injected heroin in Norway. The source is thought to be a batch of heroin contaminated with Clostridium botulinum. The European Commission have requested a rapid risk assessment of the outbreak. People working with those at risk have been issued guidance on the symptoms and treatment of wound botulism.

Cholera in Nigeria86 people have died and 1623 cholera cases have been confi rmed across six Nigerian states by Federal Ministry of Health on Oct 31. Onyebuchi Chukwu, Nigerian Minister of Health, stated that the cases are caused by Vibrio cholerae serotypes 01 and 0139. Coordinated

response activities against the epidemic include the distribution of emergency drugs, diagnostic kits, mobilisation of health workers, and free treatment for patients with cholera at all federal health facilities.

Salmonella Heidelberg in USAAs of Oct 29, 362 people in 21 US states and Puerto Rico have been infected with the seven strains of Salmonella enterica serotype Heidelberg. Three strains are multidrug resistant. No deaths have been reported. 38% of cases have been hospitalised and 14% have had blood infections. The Foster Farms brand of chicken is the likely source of the outbreak. More than 23 000 units of rotisserie chicken have been recalled.

Francesca Towey