Tuberculosis update 2018 from A/Prof Anna Ralph

Guest posting: Associate Professor Anna Ralph, Director of Global and Tropical Health at Menzies School of Health Research, Darwin, Northern Territory, Australia. 

News :  UN General Assembly first ever High-Level Meeting on the fight against tuberculosis, September 28th 2018.

New(ish) WHO strategy and targets: 

  SDGs End TB Strategy
Reduction in number of deaths vs 2015 90% 95%
Reduction in TB incidence vs 2015 80% 90%
TB-affected families facing catastrophic costs 0% 0%

New terminology

  • Active TB = TB disease
  • Latent TB = TB infection

New treatment approaches

  • TB disease:
    • Rifampicin dosing ≥20mg/kg
    • MDR-TB: WHO Landmark announcement 17 August 2018 
    • Revised grouping of drugs – see page 2
    • all oral bedaquiline-based regimen – based on : in which death rate was halved in those receiving bedaquiline compared with other MDR/XDR regimens (retrospective register study, South Africa)
    • Subgroups who might be able to avoid prolonged injectables: children with lesser-burden disease. 
  • TB infection:
    • New WHO 2018 guideline 
    • Progressive shortening of regimens for TB infection for DS-TB contacts: can we get away with 1 month? 1HP vs 9H
    • For MDR-TB contacts:
    • V-QUINN study – levofloxacin vs placebo, contacts aged >15: still enrolling
    • PHOENIx study – delaminid vs INH, all ages: still enrolling
    • Example of high-burden national policy (Indonesia): levofloxacin plus ethambutol

What’s old but still interesting:

What’s new through a human rights lens

MDR-TB drugs – Old WHO grouping (WHO 2010)

MDR-TB drugs – New WHO grouping (WHO 2018 )

From WHO Latent Tuberculosis Infection: Updated and consolidated guidelines for programmatic management

About mdjkf

Microbiologist and Infectious Diseases Physician
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