8 December 2015

South Africa: Hope for Pregnant Women and Babies with TB

Pregnant women, with and without HIV infection, and babies at risk of contracting TB are finally starting to get the attention they deserve.

The 46th Union World Conference on Lung Health, held in Cape Town, has outlined evidence and research needs for the better treatment of pregnant women and their babies, while work on integrating health services for pregnant women is beginning to take off.

“Babies under 12 months are the most vulnerable to TB. TB infection can progress very quickly to TB disease in babies if they are not treated. It’s essential for us to focus more research on babies and pregnant women if we want to prevent deaths and bring down the TB rate in these vulnerable groups,” said neonatologist, Adrie Bekker, of the Desmond Tutu TB Centre (DTTC) at Stellenbosch University near Cape Town.

Bekker has called for a TB registry for pregnant women, so that crucial information on different studies and research can be collated. Evidence from such a global effort could be used to inform the safe and effective treatment of pregnant women. Bekker made her call to childhood TB specialists around the world.

TB among mothers is associated with a six-fold increase in perinatal deaths, and a two-fold increase of premature birth and low birth-weight. TB in pregnant HIV-infected women can also lead to a higher risk of HIV infection to the baby.

Globally, research on TB and pregnant women and babies has been neglected until recently. The Union meetings have heard that TB in pregnancy data is not routinely collected, while the safety of drugs to treat Multidrug-Resistant TB in pregnant women is largely unknown. Trials of new TB medications exclude pregnant women.

Dr Lindiwe Mvusi, director in the TB Control and Management cluster within South Africa's National Department of Health, said the department was having some success in integrating TB services into maternal and child health programmes. However, she said there was still fragmentation, with pregnant women often going to three different clinic appointments if they were HIV positive and needed to be screened for TB.

“It is possible to integrate TB services into maternal and child health programmes. We are getting there, but it requires advocacy and commitment from all stakeholders,” Mvusi told the conference.

Meanwhile, the recent announcement by TB Alliance of more child-friendly TB medicines has been widely welcomed.

They are the first treatments to meet guidelines set by the World Health Organisation (WHO) to allow for higher doses of the “first-line” TB drugs to treat drug-susceptible TB in children, which is more than 90% of the TB burden in children. The affordable medication can be dissolved in water within seconds and is palatable, which is especially important for children. .

The Desmond Tutu TB Centre at Stellenbosch University is one of several institutions that will be involved in a trial looking at the possibility of shortening the treatment of TB for children from six months to four months. Together with research institutions in India, Zambia and Uganda - the DTTC will participate in the Shorter Treatment for Minimal TB in Children (Shine), a programme initiated by the British Medical Research Council Clinical Trials Unit, and led by Professor Di Gibb. The trial will include 1 200 children, 250 of them from Cape Town.

According to the WHO, at least one million babies and children become ill with TB each year, with 140 000 children dying of this curable disease. Until now, children around the world have not had access to child friendly medicines. It is hoped that if the new formulations are taken up into TB control programmes globally, the care of TB in children would be substantially improved in future.

South African TB specialists wins major award

In other news from Stellenbosch University, the university's Distinguished Professor in Paediatrics and Child Health, Robert Gie, has been honoured with the 2015 Princess Chichibu Global TB Memorial Award in recognition of his international work in childhood tuberculosis.

The annual award, presented by the Japan Anti-Tuberculosis Association (JATA), in collaboration with The International Union against Tuberculosis and Lung Disease, is given to someone who has shown remarkable achievement in the global fight against TB.

“Professor Gie has been an active driver in the process to get childhood TB acknowledged worldwide,” Chairman of JATA, Dr Shoji Kudoh, said at the awards ceremony in Cape Town on Sunday.

He said Gie, a paediatric pulmonologist, with special interest in research and international policy in childhood tuberculosis, had also assisted many young doctors and students by teaching internationally on childhood TB and childhood pneumonia, especially in poorly resourced countries.

Professor Gie has been recognized for raising awareness of childhood TB internationally at a time when it was barely acknowledged and considered an orphan disease.

As chairman of the technical advisory committee of the World Health Organisation’s Global Drug Facility, he was instrumental in getting TB medication to children in countries that couldn’t afford to import the drugs.

Through the initiative of the committee, subsidized TB drugs were distributed to 200,000 children in countries in Africa and Southeast Asia who didn’t have access to TB medication.

Professor Gie has played a key role in establishing WHO international health guidelines for the treatment of childhood TB and has both chaired and served on top-level international committees.

Professor Gie welcomed the award, but credited international colleagues and experts, who he said had collectively raised awareness of TB in children.

“I feel privileged to have worked with so many people internationally that have been involved in this effort to ensure that children with TB are recognized and correctly treated. It is very rewarding to see the rapid increase in efforts to get children with TB treated.

“At least a million children become ill with TB ever year globally. These children need child-friendly drugs and improved diagnostic tests. There are still many obstacles ahead in overcoming childhood TB, but at least it is now receiving the attention, research and management it deserves.”

According to the WHO, 140 000 children a year die of TB, a curable disease. In South Africa, 40 000 cases of childhood TB were reported in 2013.

The award, presented at the 46th Union World Conference on Lung Health in Cape Town, was established by JATA to commemorate the work of the late Princess Chichibu, a member of the Japanese imperial family.

Princess Chichibu devoted her life to the prevention of TB, after her husband, Prince Yasuhito died after a 10-year struggle with the disease. Princess Chichibu served as patroness of JATA for 55 years.

Dr Kudoh said the award was initiated based on Princess Chichibu’s will to make the world free from TB.

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