http://www.nytimes.com/2012/03/23/world/europe/mohammed-merah-toulouse-shooting-suspect-french-police-standoff.html

NY Times

By SCOTT SAYARE and STEVEN ERLANGER

http://www.who.int/mediacentre/news/releases/2012/tb_20120321/en/index.html

Childhood TB is a hidden epidemic

21 March 2012 | Geneva -Tuberculosis (TB) often goes undiagnosed in children from birth to 15 years old because they lack access to health services – or because the health workers who care for them are unprepared to recognize the signs and symptoms of TB in this age group. With better training and harmonization of the different programmes that provide health services for children, serious illness and death from TB could be prevented in thousands of children every year, WHO and Stop TB Partnership said today.

Childhood TB a hidden epidemic

“We have made progress on TB: death rates are down 40% overall compared to 1990 and millions of lives have been saved,” said Dr Mario Raviglione, Director of the WHO Stop TB Department. “But unfortunately, to a large extent, children have been left behind, and childhood TB remains a hidden epidemic in most countries. It is time to act and address it everywhere”.

Most families who are vulnerable to TB live in poverty and know little about the disease and how to obtain care for it. All too often, when an adult is diagnosed with TB, no attempt is made to find out whether children in the household also have the disease. This is a crucial step, since most children catch TB from a parent or relative. Any child living with a TB patient and that has an unexplained fever and failure to thrive may have the disease and should be evaluated by a health worker for TB. Those who are not ill with TB should be protected against the disease through preventive therapy with the drug isoniazid. Those who are ill should receive treatment.

Low cost solutions to treat and cure

“Two hundred children die from TB every day. Yet it costs less than 3 cents a day to provide therapy that will prevent children from becoming ill with TB and 50 cents a day to provide treatment that will cure the disease,” said Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership. “But before we can give prevention or treatment we have to find the children at risk of TB, and this will only happen if governments, civil society and the private sector work together. From now on let us agree: It is unconscionable to let a single child die of TB.”

TB can be hard to diagnose

Another problem is that TB can be hard to diagnose. While high-income countries now use sophisticated childhood molecular tests to detect TB, most developing countries still use a method developed 130 years ago. The patient must cough up a sample of sputum, which is then checked under the microscope for the bacteria that cause TB. Young children generally are unable to produce a sample. Even if a child with active TB succeeds in providing a sample, it often contains no detectable bacteria.

Recent studies have shown, however, that when health programmes do start looking for children with TB, they find far more cases than expected. In Karachi, Pakistan, in 2011, researchers trained community members in the Korangi and Bin Qasim Towns to use an electronic score card on a mobile phone to find people who needed a TB test and then accompany them to the hospital or clinic. One result was a 600% increase in detection of pulmonary TB among children. Another recent study in Bangladesh found that the number of children found to have TB more than trebled when workers at 18 community health centres received special training on childhood TB.

Actions to improve TB care

WHO and the Stop TB Partnership point to three key actions needed to improve TB care and prevent TB deaths in children:

• Examine all children who have been exposed to TB through someone living in their household. If they are very ill or living with HIV, treat them for TB immediately if they have typical signs and symptoms – even if a definitive diagnosis unavailable.
• Provide preventive treatment with the drug isoniazid to all children who are at risk for TB but are not ill with the disease.
• Train all health workers who care for pregnant women, babies and children to check patients for TB risk, signs and symptoms and refer them for TB preventive therapy or TB treatment as needed.

Children at special risk of TB

TB most commonly affects the lungs, but it also can affect other parts of the body. Infants and young children are at special risk of having severe, often fatal forms of TB, such as TB meningitis, which can leave them blind, deaf, paralysed or mentally disabled. Children are just as vulnerable as adults to developing – or becoming infected with – drug-resistant forms of TB that require a lengthy, costly treatment with often severe side effects.

At least half a million babies and children become ill with TB each year and as many as 70 000 are estimated to die of the disease. Children under 3 years of age and those with severe malnutrition or compromised immune systems are at greatest risk for developing TB.

The only vaccine currently available for TB is the Bacillus Calmette-Guérin (BCG), which offers limited protection against severe forms of TB, such as TB meningitis, in young children. BCG does not create lifelong protection against pulmonary TB, and is unsafe for use in children living with HIV. Scientists are actively searching for a fully effective vaccine to protect children and adults against all forms of TB.

http://www.health.state.mn.us/oep/postal.html

May 6, 2012: Operation Medicine Delivery

Testing the use of postal teams to deliver emergency medicine.

On May 6, U.S. Postal Service volunteers will make an unusual Sunday morning run through selected Twin Cities neighborhoods. Their mission: Leave a simulated supply of medicine – in the form of an empty pill bottle – at each mailing address.

This event will be part of a test called Operation Medicine Delivery. The purpose is to see how fast postal teams can deliver medicine to homes in an emergency.

The May 6 event is only a test! We have no reason to believe a real emergency will happen that day – or that one is imminent.

A plan for using the postal service to deliver emergency medicine in the Twin Cities has been in place since early 2010. The Postal Plan is a joint project of MDH, the U.S. Department of Health and Human Services, CDC, the U.S. Postal Service, and local public health, law enforcement and emergency management agencies.

This will be the first “real world” test of the Postal Plan in Minnesota. Here are a few facts about the Postal Plan – and the May exercise:

• The simulated emergency medicine will be delivered by teams of postal service volunteers and law enforcement officers in regular postal service vehicles.
• The medicine bottles will be delivered to approximately 35,000 mailing addresses in four Twin Cities ZIP codes:
  • 55101 (St. Paul – Downtown)
  • 55102 (St. Paul – West 7th/Fort Road)
  • 55411 (Minneapolis – North Side)
  • 55422 (Portions of Robbinsdale, Golden Valley and Crystal)
• The bottles will be delivered to residential mailing addresses only – not to post office boxes or business locations.
• People who receive the bottles won’t need to do anything – just recycle the empty bottle.
• The idea of using postal delivery teams to deliver emergency preventive medicine has already been tested, on a limited basis, in Boston, Philadelphia, and Seattle.
• This is the first metro area in the country to recruit a full complement of postal volunteers for this program, and set up a fully developed postal delivery system.
• Over 300 postal workers have been recruited and trained for the Postal Plan in the Twin Cities metro area.
• The postal delivery plan is part of a larger public health preparedness program known as the Cities Readiness Initiative.
• The Cities Readiness Initiative helps communities prepare for public health emergencies where it may be necessary to get medications and vaccines to people quickly.
• For example, if there were a bioterrorist attack using anthrax, it would be necessary to get people started on antibiotics within 48 hours. The Cities Readiness Initiative is designed to help us do that.

What if we had a real emergency?

• In a real emergency, it might be necessary to get medicine to as many as 3.2 million people in the metro area.
• Most people would get their medicine by going to a special “medication center,” not through postal delivery.
• Several of these centers would be set up around the metro area. Information on finding one would be available on the MDH website.
  Postal delivery might be used in some densely populated parts of town, to take pressure off of the medication centers.
• Regardless of how people got their medicine – medication center or postal delivery – they would only get enough at first to get them started taking it.
• Sooner or later they would need to visit a medication center to get more.
• No one would need to worry about having enough medicine to go around. Ample supplies of antibiotics and other medicines have been set aside or stockpiled for use during an emergency.
• The medications would be provided to the public free of charge.

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(12)70112-2/fulltext