The Edgar Laurent Foundation

1. The Edgar Laurent Foundation Established on the 31th December 1951

2. Sir Edgar Laurent

3. 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

4. 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.

5. 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 16th of July 1968 at the age of 83 in his still existing house at Brown Sequard St, Port-Louis (another famous Mauritian Medical pratitioner.

6. 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.

7. 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

8. NEW ASPECTS OF TUBERCULOSIS Dr.R.Donat

9. Are you breathing ? Then you can get tuberculosis – a disease that kills 5000 people everyday – nearly 2 million last year.

10. 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.

11. 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.

12. Global status of TBTB 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

13. 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

14. 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

17. Prevalence Rate

18. 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.

19. 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.

20. 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

21. 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

22. 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

26. Bactèriologie • Phénomène de résistance • Les examens – Direct – ZN- Détection des bacilles Acido- Alcoolo Résistants • Culture- Antibiogramme • Lowenstein – Jensen- Milieu solide lecture aprés 4 – 6 semaines • Middlebrook- Milieu gélosé- lecture aprés 3 semaines • Bactec- Milieu liquide- Méthode radioactive- lecture ā partir de 8 jours • PCR- Méthode Génétique- amplification géonomique- lecture 24-48 heures

27. Drug Resistance

28. Résistance Secondaire ou Acquise • Traitement Inadéquat • Résistance Primaire • Contamination par un porteur de bacilles résistants • Résistance Naturelle

29. Phenomene Fall & Rise Bacilles sensibles Bacilles résistants 108 106 104 100 12 24 8 16 18 4 Traitement par INH seul Semaines de traitement

30. 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.

35. Treatment

36. (1)Les médicaments antituberculeux Majeurs On associe toujours au moins 3 anti TB

37. (2)Les médicaments anti-tuberculeux mineures • Ethionamide • Prothionamide • Kanamycine • Cycloxerine • Capreomycine • Viomycine • PAS • Thiacetazone • Fluoroquinolones

38. MDR TB • XDR TB

39. 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 thetwo most important anti-TB drugs, isoniazid and rifampicin + resistance to an injectable aminoglycoside + esistance to a Fluoroquinolone

40. 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.

41. 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

42. 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 non-resistant TB develops drug-resistant TB. If the patient who has MDRTB spreads TB to others, they will have MDRTB as well.

43. 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.

44. 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.

46. Products in the pipeline

47. 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)

48. What is in the TB pipeline? PRECLINICAL Dipiperidine (SQ-609) Synthase inhibitor FAS200313 Translocase I inhibitors Discovery Stage Quinolones AstraZeneca Portfolio

49. 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

50. 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