Established on the 31th December 1951

Sir Edgar Laurent

Sir 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 - 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 - 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 16 th 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 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?

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

Dr.R.Donat

5000
2

Global 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 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 TB
TB 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

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 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 Rate

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 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)

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?

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?

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

Bact èriologie

Phénomène de résistance

Les examens – Direct – ZNDétection des bacilles Acido-
Alcoolo Résistants

CultureAntibiogramme
I.
Lowenstein – JensenMilieu solide lecture aprés 4 – 6 semaines
II.
Middlebrook Milieu gélosé- lecture aprés 3 semaines
III.
Bactec - Milieu liquideMéthode radioactive- lecture ā partir de 8 jours
IV.
PCR Méthode Génétique- amplification géonomique- lecture
24-48 heures



Traitement Inadéquat


Contamination par un porteur de bacilles résistants


Phenomene Fall & Rise
Bacilles sensibles
10 8
10 6
10 4
10 0
4
Traitement par
INH seul
8
Bacilles résistants
12
16 18
24
Semaines de traitement

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.

(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?

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?

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 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?

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 nonresistant 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?

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?

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 pipeline
Diagnostics
Reference
Lab
Peripheral
Lab
S pe ci at io n
Te st
Li qu id
b as ed sy st em
fo r c as e de te ct io n,
D
S
T
P ha ge d-
D ba se d
S
T
M an ua l uc le ic
N
A m pl ifi
-a ci d ca tio n
D
S
T
A ut om
N at
A ed
A
T
S am ea r m
S m e da ic y ro sc op y
Lo w
c os t or es ce nc flu e
B le ac h
D ig es tio n
LE
D
F lu or es
M ic ro sc ce nc op y e
Fi rs t
G en er at io n
N
A
A
Optimising sputum microscopy
U rin ar y de an tige n te ct io n
A nt ib od y as sa y
Clinic Health
Post
G at ifl ox ac in
M ox ifl ox ac in
D ia ry lq ui no lin e
20
7
TM
C
O ts uk a
C om po un d
P yr ro le
L
L3
85
8
N itr oi m id az ol e
P
A
-8
24
D ia m in e
S
Q
-1
09
Medecines
V ac ci ne
Vaccines
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

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?

PRECLINICAL

Dipiperidine (SQ-609)

Synthase inhibitor FAS200313

Translocase I inhibitors

Discovery Stage

Quinolones

AstraZeneca Portfolio

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?

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?

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 TB

Because each year nearly 2 million people die and 9 million people become sick with TB, and because TB infects onethird 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 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 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.