McGill TB Research Group

1. McGill TB Research Group Madhukar Pai, MD, PhD Associate Professor madhukar.pai@mcgill.ca

2. What is TB? • Tuberculosis is an infectious disease • Patient is sick, contagious • We call this ‘TB’ • Mycobacterium tuberculosis is name for the bacteria that causes TB • Most infected people do not develop the disease • These people are not contagious • We call this ‘latent infection’

3. Clinical manifestations of TB • General • Fever, weight loss, weakness • “Consumption”, “Phthisis” • Organ specific • Lungs: cough, spitting up blood • Others: • Scrofula: swollen lymph nodes • Spine: ‘hump-back’ • Etc.

4. Chest x-ray in pulmonary TB Cavity represents collection of millions of bacteria that are transmitted by cough TB is reason why X-rays are done with immigration

5. TB disease and infection: Natural History Infection without disease – 90% Infection Person with active TB

6. TB disease and infection: Natural History Infection without disease – 90% Infection Person with active TB Preventive treatment: Isoniazid Progression to active TB disease - 10%

7. Global epidemiology • Tuberculosis disease • ~9 million new cases per year • 1.5 million deaths per year • Every 15 seconds • Latent infection • 2 billion persons infected • One person infected each second • If 10% progress, 200 million future cases

8. 0 - 24 25 - 49 50 - 99 100 - 299 300 or more No estimate TB incidence per 100,000 people Estimated new TB cases (all forms) per 100 000 population Source: WHO

9. 0 - 999 1000 - 9999 10 000 – 99 999 100 000 - 999 999 1 000 000 or more No estimate TB cases Estimated number of new cases (all forms) Source: WHO

10. TB in Canada has declined to low levels, but it remains an important concern in immigrants and Aboriginals April 2011

12. Globally, incidence rates falling after peak in 2004, but only at <1%/year Incidence (all forms, incl. PLHIV) Notification gap Peak in 2004 shaded area = uncertainty band TB Notifications Incidence TB in PLHIV Courtesy: WHO Stop TB Department

13. TB elimination is impossible with current tools http://www.worldcarecouncil.org

14. Diagnostic tools that Robert Koch used… Culture Tuberculin test Microscopy

15. are still in use today! • Active TB • Sputum microscopy [1882] • Mycobacterial culture [1882] • Chest X-rays [1896] • Latent TB (LTBI) • Tuberculin skin test [1890]

16. We desperately need new TB vaccines and drugs BCG: 1920s Rifampin: 1950s

18. Host genetics and strain variations

19. New TB diagnostics

20. New TB drug regimens

21. Global health and TB

22. Modeling and cost-effectiveness

23. Social determinants

24. Statistical methods and approaches

25. Knowledge translation and policy

28. Sources of funding

29. Thank you!