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Tuberculosis – The situation today

 

• What is tuberculosis?
• Treatment
• Epidemiology
• Sanofi-aventis and tuberculosis

What is tuberculosis?

Koch's bacillus (Mycobacterium tuberculosis), which causes tuberculosis, is an infectious agent transmitted by breathing in airborne droplets expectorated by infected patients. The inhalation of a few contaminated droplets is sufficient to infect a person. The bacteria usually leads to infection of the lungs, but sometimes other organs are affected too (bones, the meninges, lymph glands).

A person with untreated tuberculosis can infect an average of 10 to 15 people every year. Population movements (travelers, war refugees, the homeless in industrialized countries) have greatly contributed to the global spread of the disease in the last 40 years.

Not all people infected with Koch's bacillus will develop the disease. The bacillus can remain dormant in the body for years without symptoms. Only 5% to 10% of those infected will develop tuberculosis. Immuno-suppressed people, particularly patients with H.I.V/AIDS, have a greater risk of developing tuberculosis after being infected.

Together the H.I.V virus and Koch's bacillus are a fatal mix, with each infectious agent promoting the progression of the other. Tuberculosis is the main cause of death in patients with H.I.V/AIDS; this disease is responsible for the death of a third of these patients worldwide and 40% of the deaths among H.I.V/AIDS patients in Africa.  

Treatment

The aim of curative treatment is to destroy the bacteria present in the infected organs. It is based on a combination of four antibiotics: rifampicin, isoniazid, pyrazinamide and ethambutol. This is the standard treatment currently recommended by the WHO. It must be started as early as possible and must be followed for at least six months.

The WHO considers that, from the public health standpoint, incomplete treatment or poor compliance is worse than no treatment at all.

Indeed, if the infection is not eliminated, it can lead to the appearance of antibiotic-resistant bacilli in the patient. Treating resistant bacilli, when it is possible at all, takes a lot longer, is more complicated and more expensive.

These people spread drug-resistant strains of bacteria and are contributing to the emergence, already particularly worrying, of multi-resistant bacilli.

So as to ensure correct adherence to first-line treatment, fixed-dose combinations (or F.D.Cs) have been developed. The four main drugs of the initial two-month phase of treatment are rolled into one single tablet, or the two main drugs for the following phase of at least four months' duration, and considerably reduce the number of tablets to be taken each day.

Patient supervision and monitoring throughout the treatment also ensures better treatment compliance.

At international level, the recommended weapon to effectively combat tuberculosis is "DOTS" or Directly Observed Treatment Short-course strategy. DOTS refers to the close monitoring of daily administration of medication by a person other than the patient, known as a "DOTS supporter".

After diagnosing cases of tuberculosis, healthcare personnel, community care workers or volunteers with the required training supervise the patients directly to make sure they take the prescribed dose of antituberculosis drugs for the entire duration of the treatment.

After two months of treatment, and again at the end of the treatment, a new sputum examination is performed to ensure that tuberculosis has been cured. The patient registration and disease notification system permits surveillance of disease's development throughout the entire treatment. It also means that assessments can be made of the proportion of patients cured, thus providing a program quality indicator.

If correctly applied, this strategy could avoid millions of cases and deaths in the coming decade.  

Epidemiology

Tuberculosis is, along with H.I.V/AIDS and malaria, one of the most serious infectious diseases at large in the world. Today, one third of the world's population is infected. It has been estimated that every second someone in the world is infected with Koch's bacillus, and that every year around 8 million people will develop the disease and 2 million people will die from it.

Twenty-two countries alone account for 80% of tuberculosis cases worldwide. Over 2 million of the annual cases occur in Sub-Saharan Africa, a figure which is rapidly increasing due to the H.I.V/AIDS epidemic which also particularly affects the region. Nearly 3 million of the annual cases of tuberculosis are registered in South-East Asia, and over 250,000 are in Eastern Europe.

The H.I.V/AIDS epidemic and the emergence of bacilli that are multi-resistant to antibiotics help exacerbate the impact of the disease, considered by the WHO to be a global health emergency. The WHO estimates that between 2000 and 2020, nearly a billion new people will be infected, of which 200 million will develop the disease, and 35 million will die if there is no improvement in handling the infection  

Tuberculosis risk

Sanofi-aventis and tuberculosis

Historically, sanofi-aventis was the very first company to manufacture rifampicin and remains one of the main producers of this fundamental ingredient in all antituberculosis treatments. Several of the Group's manufacturing facilities have developed and currently produce a complete range of antituberculosis agents, distributed in many countries. Building on the strength of this experience, sanofi-aventis recently redefined its contribution to the fight against tuberculosis.

A program of optimization and industrial development has begun, so that the product range can be extended and so offer better-adapted products at the lowest prices, improving access to treatment for a greater number of patients.

This program essentially relies on existing capacities in South Africa, including the Waltloo industrial site, which will ultimately produce all of the Group's antituberculosis drugs.
Sanofi-aventis is already providing patients with a fixed association of the four drugs for the first stage of treatment and two drugs for the subsequent phase.

The goal of the tuberculosis program is to offer health authorities in the affected countries a range of high-quality antituberculosis products, as well as tailored support initiatives, as part of the fight against the disease.  

• Download the sanofi-aventis Access to Medicines brochure (new window, PDF, 8.1 Mb)