new england journal of medicine

G'day,

The New England Journal of Medicine has, today, published the results of a study which utilised CDC and WHO data to examine the benefits of testing all immigrants for latent TB. (this is what Quantiferon from Cellestis does).

Amongst other matters the report concludes that the US alone would save $US60m-$US90m for every year of latent TB testing conducted.

This is another bit of good news for Cellestis.

I do not have access to the full article from NEJM but the following is the press release that was released to the wire services a few hours ago and has since been picked up and treated in a number of newspapers.

Note that whilst the study was done by Canadian researchers, it was based on US data.


Attention Health/Assignment Editors:

Researchers study screening and treatment of new immigrants for latent stage of tuberculosis

TORONTO, Dec. 4 /CNW/ - Study findings from the Inner City Health
Research Unit at St. Michael's Hospital/University of Toronto and the NewYork-
Presbyterian Hospital Weill Cornell Medical Center demonstrate that screening
and treating new immigrants from developing nations for the latent stage of
tuberculosis infection would result in substantial public health and economic
benefits. Results are published in tomorrow's issue of The New England Journal
of Medicine.
Tuberculosis is one of the world's most prevalent diseases which infects
nearly two billion people worldwide or roughly one-third of the world's total
population, most of which live in developing nations. Tuberculosis is also one
of the world's leading causes of death by an infectious disease resulting in
approximately two million fatalities every year. In 1993, the World Health
Organization (WHO) declared tuberculosis a "global emergency," the first
disease to be given this classification in the organization's history.
When healthy individuals are exposed to tuberculosis, the body's immune
system usually contains the infection, but is unable to completely eliminate
it. This state is known as latent infection and even though it causes no
physical illness and cannot be transmitted to others, it persists over a
person's lifetime. However, latent infection has the potential to become
active at any time, which usually occurs if the immune system becomes
weakened. Active disease, in contrast to latent infection, is a very serious
medical condition which if left untreated, can result in death as well as the
spread of infection to others. Individuals identified during the latent stage
of infection can be treated with antibiotics which substantially reduces their
risk of developing active disease.
In industrialized nations, efforts to control tuberculosis in immigrant
populations have been met with limited success. Currently, all immigrants to
the United States and Canada are screened for the active stage of
tuberculosis, however testing for latent infection is not part of the health
screening system in either country.
In 2001, the U.S. reported that half of the nation's 16,000 cases of
active tuberculosis were in foreign-born persons, with foreign-born persons
making up one-tenth of the total U.S. population. In Canada, foreign-born
persons account for about two-thirds of all active tuberculosis cases
nationwide, and about 90 per cent of all active cases in Toronto.
"Although the bulk of the world's tuberculosis burden exists in the
developing world, the phenomenon of globalization has brought it right to our
doorstep, and has reminded us that we live in an increasingly interconnected
world," says Dr. Kamran Khan, a specialist in infectious diseases and public
health, and a clinician-scientist at St. Michael's Hospital, Inner City Health
Research Unit. "International travel and immigration are increasingly
important factors that are contributing to the global spread of this disease."
Data for this study, which was conducted in the U.S., was obtained from
the Centers for Disease Control and Prevention, WHO, and the U.S. Immigration
and Naturalization Service. This data was used to construct a mathematical
model or simulation which estimated the number of active tuberculosis cases
that would be expected to develop over the lifetime of the more than 650,000
immigrants who came to the U.S. from developing nations during the year 2000.
The study then assessed the health and economic implications of screening and
treating those immigrants for the latent stage of tuberculosis infection.
Study results predict that in the U.S., between nine and ten thousand
future cases of active tuberculosis could be averted and $60 to $90 million
could be saved for each year of screening. "By preventing the development of
active tuberculosis, screening could improve the health status of immigrant
populations, reduce the transmission of infection to others in the community,
and concurrently decrease the utilization of future health-care resources,"
says Khan. "Based on these findings, we strongly support a practice of
screening and treating new immigrants from developing nations for latent
tuberculosis infection. And while this research was done in the U.S., these
results are also important for Canada and other industrialized nations around
the world."
In addition to examining the health and economic implications of
screening, the study also explored different treatment strategies taking into
account global differences in antibiotic resistance patterns. "In some regions
of the world, the bacteria that cause tuberculosis have become highly
resistant to the antibiotics we use for treatment," says Khan. "This research
provides health-care professionals with an important new tool that allows them
to tailor the treatment of latent infection to specific antibiotic resistance
patterns from around the world."
"Ultimately, controlling tuberculosis in our own backyard will depend on
how successful we are at controlling it in the developing world," says Khan.
"Industrialized nations must recognize that in the 21st century, tuberculosis
is very much a global problem that can only be remedied with a global
solution."
The Inner City Health Research Unit at St. Michael's Hospital addresses
issues which are relevant across the globe and organized the first-ever
international conference on Inner City Health - Improving the Health of the
Disadvantaged - in October 2002.
St. Michael's Hospital is a Catholic teaching and research hospital,
fully affiliated with the University of Toronto, specializing in heart and
vascular disease, inner city health, trauma/neurosurgery, diabetes
comprehensive care, minimal access therapeutics, and neurological and
musculoskeletal disorders.
The Department of Public Health of NewYork-Presbyterian Weill Cornell and
Weill Cornell Medical College in New York generously supported the research of
Dr. Khan, while he was a resident/fellow in preventive medicine in the
Department of Public Health at Weill Cornell.
Interviews are available with Dr. Kamran Khan, clinician-scientist, Inner
City Health Research Unit, St. Michael's Hospital, Dr. Jae Yang, medical
director, Respirology, St. Michael's Hospital, and Jean Wilson, RN,
tuberculosis case manager, Respirology, St. Michael's Hospital.