1. Bi-State TB Elimination April 10, 2014 Anna Frye Michelle Goodyear Tuberculosis: Recent Trends and Relevant Research

2. Rates of TB by racial population (CDC) www.lung.org/finding-cures/our-research/trend-reports/TB-Trend-Report.pdf

3. Rates of TB By Sex

4. According to the CDC, in 2012 a total of 9,945 cases (a rate of 3.2 cases per 100,000 people) was reported in the United States. 569 deaths in 2010 vs. 776 deaths in 2000 27% decrease in TB over a decade http://www.cdc.gov/tb/publications/factsheets/statistics/TBTrends.htm

5. According to the CDC, in 2012 63% of TB cases in the United States occurred among foreign-born people.

6. Rates of TB By State

7. TB Funding http://www.treatmentactiongroup.org/sites/g/files/g450272/f/201310/TAG_ TB_2013_8.5.pdf

8. http://www.treatmentactiongroup.org/sites/g/files/g450272/f/201310/TAG_ TB_2013_8.5.pdf

9. WHO Global TB Report of 2013 Research on Tuberculosis More than 50 companies are involved in the development of a new diagnostic tools. 10 new or repurposed TB drugs are in the late phases of clinical development. The “Stop TB Strategy” developed by the World Health Organization envisions a Tuberculosis-free world in which TB will not be a Public Health problem by 2050. http://www.who.int/tb/publications/global_report/en/

10. The Stop TB Strategy Objectives of the Strategy Achieve universal access to high-quality care for all people with TB. Reduce the human suffering and socio-economic burden associated with TB. Protect vulnerable populations from TB and TB/HIV and Drug- Resistant TB. Support development of new tools and enable their timely and effective use. http://www.who.int/tb/strategy/en/

11. Components of The Stop TB Strategy 1. Address TB/HIV, MDR/TB, in the needs of poor and vulnerable populations. Scale up collaborative TB/HIV activities Scale up prevention and management of MDR/TB 2. Contribute to health system strengthening based on primary health care. Help improve health policies, financing, supplies Strengthen infection and control in health services 3. Engage all care providers. Involve all public, voluntary, corporate and private providers Promote use of the international standard for TB care http://www.who.int/tb/strategy/en/

12. Components of The Stop TB Strategy 4. Empower people with TB and communities through partnership. Pursue advocacy, communication and social mobilization Foster community participation in TB care, prevention and health promotion 5. Enable and promote research. Conduct program-based operational research Advocate for and participate in research to develop new diagnostic drugs and vaccines 6. Pursue high quality DOTS expansion and enhancement. Secure political commitment Monitor and evaluate performance and impact http://www.who.int/tb/strategy/en /

13. Tuberculosis Database TB education and training resources are readily available through the Center for Disease Control and Prevention. Searchable database for materials from National and International Organizations. Share information about TB with Health Professionals How to order materials Locate funding opportunities Discover information about preventative organizations Learn of up coming events and sign up for a News Letter www.findtbresources.org

14. The Union Mission: The Union brings innovation, expertise, solutions and support to address health challenges in low and middle-income populations. Vision: Health solutions for the poor. http://www.theunion.org/where-we-work/north-america

15. U.S. Agency for International Development “Through funding support from USAID, The Union has launched an ambitious initiative called TREAT TB: "Technology, Research, Education and Technical Assistance for TB." Through this initiative, supported by a five year USAID Cooperative Agreement that commenced in October 2008, The Union aims to build a successful research partnership model that has every potential to stimulate changes in international standards and practice in ways that serve country needs. TREAT TB seeks to contribute to new knowledge through field evaluations of diagnostic tools, clinical trials of priority research questions, and targeted operational research benefitting global, regional and country TB control efforts.” http://www.treattb.org/

16. Bill and Melinda Gates Foundation Their strategy: Advocate for adequate financing to combat the disease (research and development). Develop faster/more accurate diagnostic tools (leads to earlier treatment and decreases transmission risk). Shorter, simpler treatment regimes. Goal: To accelerate the decline in TB incidence worldwide by investing in better vaccines, treatment regimes, and diagnostic tools. http://www.gatesfoundation.org/

17. Discovering a more effective Vaccine The TB vaccine used today provides limited protection for newborns and children and no protection against pulmonary TB in adults. Pulmonary TB accounts for most TB cases worldwide A more effective new vaccine would be the most powerful tool to reduce the incidence of TB cases worldwide. Could decrease TB incidence by 39-52% by 2050 http://www.gatesfoundation.org/What-We-Do/Global-Health/Tuberculosis

18. Discovering a more effective Vaccine Finding a new vaccine could take years! It is critical to develop short and medium term strategies. A short, simple course drug regime would improve treatment success rates because patients would be more likely to complete it. A number of vaccines are in clinical development, but they can only reach those who need them most if affordable and deployed efficiently. http://www.gatesfoundation.org/What-We-Do/Global-Health/Tuberculosis

19. World TB Day Press Release FIRS to assist in finding the 3 million “missed” TB cases “Forum of International Respiratory Societies members represent 70,000 health professionals working in almost every country of the world, so the capacity to increase case finding and provide TB care that meets the International Standards of TB Care is there.” “The goal of FIRS is to unify and enhance efforts to improve lung health through the combined work of its more than 70,000 members globally.” “Dr Montes de Oca summarized the challenges that need to be tackled in order to find the missing 3 million TB cases” http://www.theunion.org/news-centre/press-releases

20. New Research in TB Vitamin A could boost immune system to fight TB A recent study from UCLA suggest that there may be a link between Vitamin A intake and TB incidence. If it is possible to reduce the cholesterol level in a cell infected with TB, Vitamin A may be able to aid the immune system in better responding to the infection. To investigate this, Vitamin D and Vitamin A exposed cells were compared for similar responses, but only Vitamin A decreased the cell’s cholesterol level. The next stage of research will focus on better understanding of how the immune system takes the inactive form of Vitamin A. The research team notes that this is a new research topic and that more research will need to be conducted before further conclusions can be stated. http://newsroom.ucla.edu/portal/ucla/vitamin-a-may-help-boost-immune-249933.aspx

21. New Research in TB Vinegar could kill drug resistant Mycobacterium Tuberculosis A team of international researchers with the American Society for MicroBiology have concluded that the active ingredient in vinegar, Acetic Acid, can effectively kill Mycobacteria. Whether vinegar can be used for sterilizing medical equipment remains to be determined. The Mycobacteria may be used as an inexpensive and non toxic disinfectant against drug-resistant TB. Working with drug-resistant TB bacteria carries serious biohazard risks. Chlorine Bleach is often used to disinfect TB cultures but bleach is toxic and corrosive. There is a need for less toxic and less expensive disinfectants that can eliminate TB especially in resource poor countries. $100 could buy enough acid to disinfect up to 20 liters of TB cultures. https://www.asm.org/index.php/journal-press-releases/92867-vinegar-kills-tuberculosis-and- other-mycobacteria

22. Thank You!