The Edgar Laurent Foundation Established on the 31th December 1951
Jan 20, 2016
The Edgar Laurent Foundation
Established on the 31th December 1951
Sir Edgar LaurentSir Edgar Laurent
Sir Edgar Laurent - BiographySir Edgar Laurent - Biography
Born in 1885 at Cluny Grand Port
Brilliant Studies at Royal College Curepipe
Started Theological studies at Ahmedabad, India
Changed his mind quickly and went to Paris, France for Medical Studies
Sir Edgar Laurent - BiographySir Edgar Laurent - Biography
Came back in 1914 and started his medical practice at 58, Desforges Street and stayed there far more than 50 years.
Went into Politics in 1915, has been several times mayor of Port-louis and member of the legislative Council. He retired from Politics in 1946
In 1950, he received ‘La Legion d’Honneur from the French government and in 1951 was Knighted by the British government.
Sir Edgar Laurent - BiographySir Edgar Laurent - Biography
In his last years, he retired completely from public life and devoted himself to the practice of Medicine. He also became a Devout Anglican.
Apart from the creation of the Tuberculosis foundation, Sir Edgar helped in the setting up of the St.Andrews College, the Clinique Mauricienne and the Esplanade at of Marie Reine de la paix.
He Died on the 16th of July 1968 at the age of 83 in his still existing house at Brown Sequard St, Port-Louis (another famous Mauritian Medical pratitioner.
The Objectives of the FoundationThe Objectives of the Foundation
To further prevention and control of tuberculosis and the treatment, after-care and rehabilitation of the Tuberculous patient
To improve the environmental conditions which favour the development and spread of tuberculosis
To help to set up and maintain an organisation of voluntary welfare workers to assist the government Medical and welfare services to fight against tuberculosis.
Who are the members?Who are the members?
For the purpose of managing the foundation and exercising any of the powers vested in the foundation by the provisions of this Ordinance, there was established a board which consisted of 6 members.
Nowadays, the board of trustees consists of the following members: Chairman Consultant in charge – chest disease P.M.O curative 2 other members
NEW ASPECTS OF TUBERCULOSIS
Dr.R.Donat
Are you breathing ?Are you breathing ?
Then you can get tuberculosis – a
disease that kills 5000 people
everyday – nearly 2 million last year.
Global Status of TBGlobal Status of TB
Tuberculosis (TB) kills 1.6 million people a year 0.2 million people infected with HIV 98% of these deaths occur in the developing world.
Close to 9 million new cases develop every year and about one third of the world’s population is infected with Mycobacterium tuberculosis.
TB is a major cause of death among people with HIV/AIDS and infection is the most potent risk factor for the conversion of latent TB infection to active TB.
Global status of TBGlobal status of TB
Multidrug-resistant TB (MDR-TB) has emerged in nearly every country of the world. Extensively drug-resistant TB (XDR-TB) has been identified in 17 countries and in all geographical regions.
While the TB incidence rate is stable or in decline in all six WHO regions, and has reached a peak worldwide, the total number of new TB cases is still rising slowly as the case load continues to grow in the African, Eastern Mediterranean and South-East Asia regions.
Global status of TBTB is the second leading infectious cause of death in
the world, after the HIV
Global status of TBTB is the second leading infectious cause of death in
the world, after the HIV
In 1997, 8 million new cases of TB & RATE OF 136 / 100,000
3 million deaths per year < 40% of cases are reported to WHO 24 % of all preventable life-years lost annually
due to TB
Cont’d…80 % of all cases worldwide occur in S S Africa and
SE Asia
Cont’d…80 % of all cases worldwide occur in S S Africa and
SE Asia
Biggest burden in SE Asia 3 million TB cases / YR in SE Asia 3 million/YR occur in S S Africa > ¼ million cases / YR in East Europe Case and deaths increasing in former Soviet
Union
The burden of illnessThe burden of illness
Usually 1 in 10 people infected by TB bacteria
will ever fall ill with the disease. But you are
at greater risk if you are poor, malnourished
or burdened with other illnesses. If you fall ill,
early diagnosis and treatment is critical.
Without treatment, there is more than a 50%
chance TB will kill you
Prevalence RatePrevalence Rate
Development lagging behind…WHY?Development lagging behind…WHY?
Today’s first-line anti-TB medicines are more than 40 years old and must be taken for 6-9 months. Erratic or inconsistent treatment generates drug resistance.
Today’s most commonly used diagnostic tool, the light microscope, is more than 100 years old and is relatively insensitive (particularly in the presence of HIV co infection), giving no indication of drug susceptibility.
Today’s vaccine, bacilli Calmette-Guerin (BCG), is more than 85 years old and provides acceptable protection only against disseminated forms of disease in infants and little, if any, protection beyond childhood.
Tuberculosis- The BasicsTuberculosis- The Basics
TB is caused by an organism called Mycobacterium Tuberculosis
TB is spread from person to person through the air
Transmission is the spread of an organism, such as M.tuberculosis, from one person to another
Not everyone who is exposed to an infectious TB patient becomes infected.
Tuberculosis - The Basics (continued)Tuberculosis - The Basics (continued)
Infection begins when TB organisms in the droplet nuclei reach the small air sacs of the lung called alveoli
TB infection means that tubercle bacilli are in the body but the immune system is keeping them under control
People who have TB infection but not TB disease are NOT infectious
What factors affect the infectiousness of a TB patient?
What factors affect the infectiousness of a TB patient?
The infectiousness of a TB patient is directly related to the number of tubercle bacilli that he or she expels into the air
Usually, only people with pulmonary or laryngeal TB are infectious
Patients who have a cavity in the lung may be expelling tubercle bacilli if they are coughing
Patients expel more tubercle bacilli if they have a cough that produces a lot of sputum
What factors affect the infectiousness of a TB patient?
What factors affect the infectiousness of a TB patient?
Patients who do not cover their mouths when they cough are more likely to expel tubercle bacilli
The presence of tubercle bacilli on a sputum smear indicates that the patient may be expelling tubercle bacilli
Patients who have not been receiving adequate treatment are much more likely to be infectious than patients who have been receiving adequate treatment
Infectiousness appears to decline very rapidly after adequate treatment is started, but how quickly it declines varies from patient to patient
BactèriologieBactèriologie
Phénomène de résistance
Les examens – Direct – ZN- Détection des bacilles Acido-
Alcoolo Résistants
Culture- Antibiogramme
I. Lowenstein – Jensen- Milieu solide lecture aprés 4 – 6
semaines
II. Middlebrook- Milieu gélosé- lecture aprés 3 semaines
III. Bactec- Milieu liquide- Méthode radioactive- lecture ā partir
de 8 jours
IV. PCR- Méthode Génétique- amplification géonomique- lecture
24-48 heures
Drug Resistance
Résistance Secondaire ou Acquise Traitement Inadéquat
Résistance Primaire Contamination par un porteur de bacilles
résistants
Résistance Naturelle
Phenomene Fall & RisePhenomene Fall & Rise
100
104
106
108
Bacilles
sensibles
Bacilles
résistants
4 8 12 16 2418
Traitement par INH seul
Semaines de traitement
Is TB curable ?Is TB curable ?
Yes, through the cost effective Tb control
strategy known as DOTS. Drugs for a six
month course of treatment under DOTS costs
as little as USD 10. DOTS saves lives and
also prevent the disease from spreading.
Treatment
(1)Les médicaments antituberculeux Majeurs(1)Les médicaments antituberculeux Majeurs
On associe toujours au moins 3 anti TB
(2)Les médicaments anti-tuberculeux mineures
Ethionamide Prothionamide Kanamycine Cycloxerine Capreomycine Viomycine PAS Thiacetazone Fluoroquinolones
MDR TB XDR TB
What is MDRTB?What is MDRTB?
Multi-drug resistant TB, usually called MDRTB, is TB that is resistant to at least the two most important anti-TB drugs, isoniazid and rifampicin. This means those two drugs do not effectively treat the TB disease.
What is XDRTB?
Extensively drug resistance TB is TB that is resistant to the two most important anti-TB drugs, isoniazid and rifampicin + resistance to an injectable aminoglycoside + esistance to a Fluoroquinolone
Why is MDRTB a problem?Why is MDRTB a problem?
Because the two most important anti-TB drugs are not effective in treating MDR-TB, treatment requires drugs which are more toxic, more expensive, take longer to work and that do not work as well (called “second line” drugs). Also, these second line drugs are not widely available in resource-limited settings.
MDR TB – some figuresMDR TB – some figures
Taux de mortalité de 40%
Résistance aquise ā l’INH et RMP- 2 anti TB Majeurs
Résultat de Traitement mal conçus, mal surveillés, mal suivis
Pays ā forte prévalence- Chine, Estonie, Iran- 35%
France 6 %
Hollande 1 %
Médiane mondiale 9 %
Risque d’épidémie en millieu hospitalier carcéral
TT utilisés- 5 Anti TB pendant au moins 18 mois
What causes MDRTB?What causes MDRTB?
MDRTB is the result from poor anti-TB treatment adherence or by incorrect treatment.
If the wrong drugs or the wrong combinations of drugs are prescribed, or providers fail to ensure that they are taken correctly on schedule, the bacteria causing TB may develop resistance to the drugs.
When this happens, the patient who initially had non-resistant TB develops drug-resistant TB. If the patient who has MDRTB spreads TB to others, they will have MDRTB as well.
How is MDRTB prevented?How is MDRTB prevented?
MDRTB is a condition that can be prevented by following the international TB control strategy called DOTS, which stands for Directly Observed Treatment, Short-course.
Health care providers should always adhere to the National
Tuberculosis Program Guidelines and use only the recommended anti-TB treatment regiments, drug combinations and drug dosages.Anti-TB drugs, preferably Fixed Dose Combinations of high quality should be available in regular and sufficient quantities.
Adherence to anti-TB treatment must be ensured with support,
encouragement and monitoring of adherence by a relative, community volunteer, or a clinic nurse.
How do we know if a patient has MDRTB?How do we know if a patient has MDRTB?
The diagnosis of MDRTB can only be made in a laboratory that can test sputum specimens for the presence of M.tuberculosis (the TB germ isolated by culture) and then test those TB isolates for drug resistance.
Patients who report interrupted treatment for TB, or failure to have symptoms improve after one to two months of TB treatment, may have drug-resistant TB, and should be separated from persons with HIV infection until their condition is evaluated.
Products in the pipelineProducts in the pipeline
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
ReferenceLab
PeripheralLab
Clinic HealthPost
Medecines
Vaccines
Diagnostics
Urinar
y ant
i-gen
dete
ction
Mox
ifloxa
cin
Gatiflo
xacin
Optimising sputum microscopy
Vaccin
e
Diarylq
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ne
TMC20
7
Otsuka
Com
poun
d
Pyrro
le LL
3858
Nitroim
idazo
le PA-8
24
Diamine
SQ-1
09
Low co
st
fluor
esce
nce
Same
day
Smea
r micr
osco
py
Bleach
Dige
stion
LED F
luore
scen
ce
Micr
osco
pyFirs
t
Gener
ation
NAA
Antibo
dy a
ssay
Specia
tion
Test
Liquid
bas
ed
syste
m fo
r cas
e
dete
ction
, DST
Phage
d-ba
sed
DST Man
ual
Nuclei
c-ac
id
Ampli
ficat
ion D
ST
Autom
ated
NAAT
What is in TB pipeline?What is in TB pipeline?
New anti-TB medicine CLINICAL TESTING
Gatifloxacin Moxifloxacin Diamine(SQ-109) Nitrodihydro-imidazooxazole derivative OPC-
67683 Pyrrole LL3858 (Sudoterb) Diarylquinoline (TMC-207) Nitroimidazole (PA-824)
What is in the TB pipeline?What is in the TB pipeline?
PRECLINICAL Dipiperidine (SQ-609) Synthase inhibitor FAS200313 Translocase I inhibitors
Discovery Stage Quinolones AstraZeneca Portfolio
What is in the TB pipeline (continued)What is in the TB pipeline (continued)
New TB diagnostics REFERENCE LABORATORY
Liquid culture system for case detection and drug susceptibility testing (DST)
Speciation Test Phage-based DST Manual nucleic acid amplification DST Automated nucleic acid amplification test DST Urinary nucleic acid amplification
What is in the TB pipeline?What is in the TB pipeline?
PERIPHERAL LABORATORY Same-day sputum smear microscopy Low-cost fluorescence microscopy Bleach digestion of sputum LED fluorescence microscopy First-generation isothermal nucleic acid
amplification
HEALTH POST Urinary antigen detection Antibody detection tests
What is in the TB pipeline?What is in the TB pipeline?
New Anti-TB vaccines VIRAL VECTORED VACCINES
MV A85A Aeras-402
MODIFIED-RECOMBINANT BCG M72 HyVac 4 Hybrid-1
BACTERIA-VECTORED VACCINES Aeras-X05
The call to stop TBThe call to stop TB
Because each year nearly 2 million people die and 9 million people become sick with TB, and because TB infects one-third of the world’s population.
Because TB is a global pandemic and an emergency in Africa and the European region.
Because TB is the biggest killer of people with HIV/AIDS and multi-drug resistant forms of TB are a threat around the globe
Because TB is curable.
The Call to stop TBThe Call to stop TB
Because the Stop TB strategy is getting results
Because 14 million more lives can be saved over the next 10 years
Because treating and curing people with tuberculosis prevents the spread of the disease, reduces poverty, strengthens health systems, engages all care providers and empowers those affected.
Because new vaccines, drugs and diagnostics to stop TB are urgently needed.
The Call to stop TBThe Call to stop TB
Because access to TB treatment is a human right.
Because TB can be eliminated by 2050 if we take action now
For these 10 reasons, we commit ourselves, through our actions, to a world free of TB.
Thank you