The World Health Assembly, convened annually by WHO at the UN Palais des Nations in Geneva, passed a resolution in May 2014 approving with full support the new post-2015 Global TB Strategy with its ambitious targets.
The strategy aims to end the global TB epidemic, with targets to reduce TB deaths by 95% and to cut new cases by 90% between 2015 and 2035, and to ensure that no family is burdened with catastrophic expenses due to TB. It sets interim milestones for 2020.
Tuberculosis and Hepatitis C
Tuberculosis (TB) is a bacterial infection which can affect most parts of the body, but most commonly the lungs where it causes severe coughing. It is transmitted through respiratory fluids carried in the air when a person with TB coughs or sneezes. There is a vaccine against TB and the disease is treated by a six-month course of antibiotics.
Hepatitis C is a blood-borne virus which attacks the liver, causing cirrhosis (scarring) and damage. While there is little data on the rates of TB and hepatitis C coinfection, the incidence of both diseases is high in similar patient populations. The toxic effects of TB drugs on the liver can make it more challenging to treat people with both TB and hepatitis C.
•There were 7,892 notified cases of TB in the UK in 2013 and London accounted for 37.8% of these cases.
•73% of TB cases occurred among people born outside the UK, but only 15% of cases in people born outside the UK were in recent migrants (diagnosed within two years of entering the UK)
•Within the UK, those born outside the country demonstrate a TB infection rate 18 times that of the UK-born population.
•In a post-mortem analysis of people who died of TB in London, comorbidities were present in 35 of 46 cases, mainly hepatitis C virus and HIV infections, cancer, cardiovascular disease, and chronic obstructive pulmonary disease.
Tuberculosis - Health impact
•Most healthy people’s immune systems kill or contain TB infection without developing symptoms.
•Latent TB infection is an asymptomatic and non-transmissible form of TB.
•In people with weakened immune systems, latent TB may develop into active TB disease.
•Active TB disease presents symptoms including: persistent cough lasting more than three weeks; bringing up phlegm containing blood; loss of appetite; weight loss; night sweats; fever; fatigue; swellings that haven’t gone away after a few weeks.
“The link between these two diseases is becoming more
widely recognised, particularly given the increased focus
on prevention and public health.”
Mike Mandelbaum, Chief Executive TB Alert
“TB and hepatitis C are two public health issues of
personal priority to me as public health minister.
I am eager to see us tackle both infections thereby reducing health inequalities and premature mortality.
Both infections are challenging to control and share a range of common problems. They affect similar groups of people and sufferers share common problems around access to care.”
Jane Ellison, Minister for Public Health
Interaction with hepatitis C
•Standard treatments for TB have been shown to have hepatotoxicity, meaning that they are toxic to the liver and can exacerbate liver disease.
•Treating TB in patients with hepatitis C can require a longer duration of therapy and increased monitoring.
•Both infections are normally treated concurrently, presenting patients with difficult side effects. In future, new hepatitis C medicines may alleviate this.
Recent policy developments
•The Collaborative Tuberculosis Strategy for England 2015-2020 was profiled by Jane Ellison, Minister for Public Health, at a joint TB and hepatitis C summit held in March 2015. The strategy was developed by Public Health England and NHS England. A similar Hepatitis C Improvement Framework is planned.
•‘Find and Treat’ is a local initiative in London, where vans with mobile x-ray units are used to screen high risk populations for TB infection. Many of these populations are also those at greatest risk of hepatitis C infection.
Sources for further information:
Source of information the Hepatitis C Coalition
The Hepatitis C Coalition is a group of leading clinicians, patient organisations and other interested parties committed to the reduction of morbidity and mortality associated with Hepatitis C and its eventual elimination.