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new england journal of medicine

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    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
    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.

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