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18 Oct 2016

Highlights from the Asian TB Expert’s Community Meeting in Taiwan: Addressing latent TB infection

By Peter Trevan, Manager of the Victorian Tuberculosis (TB) Program

Associate Professor Justin Denholm, Medical Director of the Victorian Tuberculosis Program and I attended the 5th annual Asian TB Expert’s Community Meeting in Taiwan with delegates from 18 Asian and Pacific countries.

We were there to identify best practices, challenges and opportunities in the implementation and management of latent tuberculosis infection (LTBI) in Asia and to review the landscape of research including ongoing clinical trials of LTBI treatment and new diagnostic tools.

Andrew Codin from TB REACH spoke of the need for a ‘paradigm shift’ if Asia was to have any hope of achieving TB elimination by 2020.

Mr Codin went on to talk about ‘TB: Reach’ – Zero TB initiative, a project aimed at developing ‘islands of low incidence in high incident settings’ and talked briefly about some of the project areas, including in Chennai in India where there has been an 80.9 per cent increase in screening for people with suspected TB resulting in a 64.7 per cent increase in people detected with TB. This has led to a significant increase in the number of children aged under five provided with isoniazid preventive therapy (IPT).

Further projects are planned with coalitions formed in Kenya, Indonesia, Vietnam and Russia.

Japan has made significant progress in TB reduction with a rate of 42 per 100,000 in 1990 down to 14.4 per 100,000 in 2014 with the highest rate within the elderly population. Japan now has a program of directly observed treatment (DOTS) /LTB treatment targeted at the elderly and has mandated notification of LTBI.

Malaysia had 20,000 cases of active TB in 2015 (80 per 100,000) while identifying 275 cases of TB in health care workers (0.125 per 100,000). There was some movement towards using Rifapentine for LTBI in the private sector for the next 12 months before being evaluated on a national basis.

Within Korea, screening for LTBI has been linked to a national screening program where all those registered receive a call to have a heath check at age 40 that also includes screening for diabetes, hepatitis B and hypertension.

Active screening for LTBI in Taiwan has increased progressively since 2005 when the rate for active TB was 72.5 per 100,000. In 2015, as a result of a number of initiatives the rate has fallen to 45.7 per 100,000 with the highest rates for disease in people over 65.

In 2014, over one million cases of TB were diagnosed in Indonesia with a rate in some areas in excess of 399 per 100,000. 26,000 children were diagnosed in the same year with active TB with recommendations now in place for screening and treatment for LTBI for all HIV positive children and contacts of smear positive cases.

Within India estimates of LTBI within the population suggest as many as 40 per cent of people (500 million) may be infected.  Dr DJ Christopher from CMC Hospital in Bangalore looked at a group of nurses over a period of four years from 2007 to 2011. At baseline, 46.5 per cent of nurses doing the Diploma course and 42.6 per cent of those doing the degree course tested positive for LTBI (IGRA).  Over the following four years LTBI incidence for the whole group rose to 91.3 per cent with four cases of active TB diagnosed.

Professor Wang Yee Tang from Singapore spoke about the progress in screening for LTBI, having established by 2013 a comprehensive program with 98,000 people screened  in 2015.

My overall impression of the meeting was of the huge amount of great work being done within Asia but also the enormity of the work still to be done.