Stop Tuberculosis- IVSA Poster

Stop Tuberculosis "PREVENTION AND SCREENING OF TB"

STOP TB DAY 2016 "Prevention & Screening of TB" Stop TB Day is coming up on March 24th This year, the international medical, pharmaceutical, and veterinary student associations are working together against Tuberculosis!

How can you get involved?

Join us in our campaign with your own local project to raise awareness and to fight together to stop tuberculosis!

Create a campaign with local members from IFMSA, IPSF & IVSA on the topic of Prevention and Screening of Tuberculosis

Want more information? cIFMSA: Jozo Schmuch, scophd@ifmsa.org IPSF: Mac Ardy J. Gloria, healthadvocacy@ipsf.org IVSA: Elizabeth Malcolm, publichealth@ivsa.org

CONTENTS

Communal Message from IVSA, IFMSA & IPSF

Information on Tuberculosis

Prevention and Screening of TB

Get Started with Your Project

DEAR MEMBERS, Once again IVSA (International Veterinary Students Association), IFMSA (International Federation of Medical Students Association) and IPSF (International Pharmaceutical Students' Federation) act in joint forces to fight Tuberculosis.

For the third time the three organizations appear as collaborators to have a bigger impact in the fight against tuberculosis. Not only is it our aim to raise awareness amongst students of all three sectors but we also believe that together within a joint appearance we can achieve more.

"A good prevention is the first step to contain tuberculosis in a long term!"

As students and future academics we think it is our duty to share our knowledge.

Information and knowledge is important to see an approaching threat.

Veterinarians, Doctors and Pharmacists – we all have the opportunity to educate people on three different levels on the threats presented by tuberculosis. Furthermore it is possible for us to sensitize them on a scientific basis for symptoms of tuberculosis.

A good prevention is the first step to contain tuberculosis on a long term.

Even within the WHO you can find “prevention” and “screening” on top of their „The End TB Strategy“. They put their focus on an early detection and simultaneously call for a good screening of high-risk groups.

Therefore specialists have to integrate not only politicians working in health departments, but also civil organizations, which are decisive to get tuberculosis under control.

One should not ignore the fact that dependent on the region additional fields must be considered and taken into cooperation.

DEAR MEMBERS, In Vorarlberg, Austria cases of tuberculosis caused by Mycobaterium caprae were detected just recently in red deer. In total 8 farms had to be blocked to get the cows checked for tuberculosis. Two of them have already got negative test results. In this region there is a close collaboration between the veterinary bureau, the local rangers and the department of health.

(APA, 15.2.2016)

A solid screening and monitoring systems, same as measures of prevention are needed and must be implemented.

“Recognition of tuberculosis symptoms need to be integrated into immediate health assessments of refugees, including children and adolescents.” (N. Ritz et al., 2015)

All of the examples above show that local circumstances always must be A late study in South taken into consideration and must Africa, Zimbabwe and be analyzed. Collaborations "They must be Mozambique has shown between different departments informed about that young female African must be supported on a local potential risks of basis. buffalos (Syncerus caffer caffer) are a threat to infection and Therefore it is even more local cattle. They move important that young people transmission" crossing the borders of within their education and the national parks up to a training already start working on distance of 90km. They are communal resolution strategies likely to transmit diseases, like bovine and act as one unit in the fight against tuberculosis, through contact to other health threatening diseases. ruminants. (Caron et al., 2016) Let’s take „Prevention and Screening of Tuberculosis“ as a cause for tightening our The governmental health departments collaborations! should be alert concerning the current Within all three sectors important steps immigration situation in Europe. are to be taken to develop preventive Movement and flows of immigration can actions against tuberculosis. Veterinarians, always carry potential health risks.

Doctors and Pharmaceutics can take essential measures, to achieve progress in the fight against this disease.

For more information on tuberculosis and the Stop TB day, visit the Stop TB website: www.stoptb.org

DEAR MEMBERS, It is at least as important to educate the general public on important facts concerning tuberculosis. They must be informed about potential risks of infection and transmission.

Prevention is not only important on a clinical level but starts with each and every one of us, especially in high-risk regions.

It is our duty as clinicians and scientists to support patients and pet owners and to raise awareness towards TB amongst future generations in our fields and the society.

"Prevention is not only important on a clinical level but starts with each and every one of us, especially in high risk regions"

We hope that many of you are enthusiastic to join us in our campaign.

We wanted to demonstrate to you how important it is to set collaborative actions and to fight actively against tuberculosis.

Feel free to contact us with your questions.

Elizabeth Malcolm, Ivsa.publichealth@gmail.com Sarah Romeili, healthawareness@ipsf.org Jozo Schmuch, scophd@ifmsa.org We are looking forward to working with you!

Information on Tuberculosis General Information Tuberculosis is an infectious disease caused mainly by the Mycobacterium tuberculosis.

Mycobaterium bovis or Mycobacterium africanum can also be the cause for the disease. (National Institute for Health and Excellence, 2016.)

Mycobacterium bovis which is the main cause for bovine tuberculosis can lead to symptoms within humans. Even though the number of infected people with explicit symptoms of tuberculosis caused by mycobacterium bovis is lower than with mycobacterium tuberculosis, their number should not be underestimated.

Infections with mycobacterium bovis in human are more likely in lower income countries where infection rate in cattle is

Tuberculosis can be transmitted and is spread through the air by infected people, for example by coughing. Since the lungs are the organs which are infected in most of the cases. But other organs can be affected as well. (WHO, 2015.) Not all infected people show symptoms. In combination with an HIV infection symptoms are more likely to develop.

It is regarded as one of the leading causes of death among people worldwide. (WHO, 2015.)

But according to WHO number of deaths caused by tuberculosis almosted halved since 1990. (WHO, 2015.)

Most important though, tuberculosis is curable and preventable!

higher. (Lewerin, 2015) In 2014 9.6 million people fell ill with tuberculosis and 1.6 million deaths occurred. (WHO, 2015.)

Figure 1: WHO, 2015: WHO map of estimated TB mortality rates excluding TB deaths among HIV positive people, 2014.

For further information visit the WHO website. WHO published the World TB Report also online. http://www.who.int/topics/tuberculosis/en/

Information on Tuberculosis

Figure 2: WHO, 2015: Progress

Tuberculosis is regarded as one of the leading causes of death among people worldwide.

Figure 3: WHo, 2015: Challenges

Information on Tuberculosis Once a person really gets infected by tuberculosis symptoms might not be severe in the beginning.

Coughing, fever, night sweats and weight loss are some of the very unspecific symptoms that can be shown.

If symptoms get worse the cough can be contaminated with sputum or blood.

(WHO, 2015.)

There are different methods of diagnosing infections with tuberculosis. Below only the most common techniques will be briefly explained.

The oldest and still common technique is the tuberculin skin test (TST). It is cheap and can easily be applied. But there is the possibility of false positive results. After a vaccination with BCG or other reasons there is of course a sensitising effect on the immunsystem which can cause the false positive results. (NICE, 2016.) There are further negative aspects on this testing method, which will not be discussed right now.

Immunological tests can be applied as well. It is an interferon gamma release assay, hence called IGRA. It uses early targets for antigens to diagnose infections.

Figure 4: TB Skin Test

In low income countries with limited resources the sputum smear microscopy test is commonly used.

Sputum samples are analysed by trained laboratory technicians to detect Mycobaterium tuberculosis.

(WHO, 2015.)

STOP TB DAY March 24th to fight this...

Figure 5: Mycobacterium tuberculosis looked upon in a scanning electron microscope

Prevention and Screening of TB Preventing TB needs a multi-based approach.

Pillar 1 of “The End TB Strategy” by WHO “focuses on early detection, treatment and prevention for all TB patients including children.” (WHO, 2015.)

Figure 6: WHO, 2015: How Pillar 1 works: key components.

Early detection of new infections is a “key component” stated by the WHO to improve TB care and of “preventing the disease”. (WHO, 2015.)

WHO claims that 3 million people out of the 9 million infected are not being treated with sufficient medicine.

This can lead to a further spread of the disease. (WHO, 2015.)

Expanded access to treatment is a major goal in the fight against TB. It is also an important aspect in preventing further TB cases.

WHO recommends that children of high risk regions should be vaccinated with BCG (Bacille Calmette Guérin).

The protection for children has been verified, but it does not prevent adults from lung TB, which is transmitted very easily. (National Institute of Allergy and Infectous Diseases, 2012.)

Travellers should also be careful and try to avoid spending long times with TB patients in enclosed environment.

(CDC, 2012)

EARLY DETECTION STOP TRANSMISSION TREATMENT VACCINATION WITH BCG FOOD HYGIENE TRAVELLING

The accurate pasteurization of milk is also an aspect in the prevention of tuberculosis. In low income countries transmission from cattle to human is often caused by unpasteurized milk products. In late stadium of tuberculosis or organ infiltrated stadiums the udder can be affected as well. The bacteria can be found in the milk. Only pasteurization can minimize the risk of transmitting tuberculosis via contaminated milk. Even though the risk is not high, it cannot be excluded. (AGES, 2008.)

Prevention and Screening of TB New guidelines and strategies for screening TB are provided by the WHO. The importance of a systematic screening in high risk groups is mentioned in the WHO’s “The End TB Strategy”. High risk groups are “any group of people which the prevalence or incidence of TB is significantly higher than in general population” (WHO, 2015.) One should not mistake a screening test for a diagnostic testing since the screening does not intend be of diagnostic purpose.

2015 the WHO published a document on “Systematic screening for active tuberculosis: an operational guide”.

The screening system must be adapted to the local health system and the epidemiological and social situation in each region. Before a screening can be set out these aspects must be analysed to put the right objectives into focus.

(WHO, 2015.)

Figure 7: WHO, 2015: The six essential steps in the cycle of designing and implementing a tuberculosis screening

Screening tests Common clinical examinations Coughing & Other TB symptoms Chest radiography Figure 7: Chest X Ray

Prevention and Screening of TB WHO presents in their publication "Systematic screening for active tuberculosis: an operational guide" six key principles which have to be taken into account when a new screening system shall be

Figure 8: WHO, 2015: Principles of and recommendationnfor systematic screening for Tuberculosis

Further facts and informations on TB There are more threats to Mycobacterium tuberculosis than the infectious disease described above.

TB and HIV Out of the 9.6 million people been diagnosed with HIV as well to the infection with tuberculosis.

An instable and weak of an infection with tuberculosis.

30 times more likely to develop without HIV.“ (WHO, 2015.)

"Among people with latent TB strongest known risk factor for 2012)

Dr. Kenneth Castro talks about TB and HIV Coinfection Video, CDC TB & HIV

mentioned above 1.2 people have and 0.4 million of them died due (WHO, 2015.) immunsystem raises the chances „People living with HIV are 20 to active TB disease than people infection, HIV infection is the progressing to TB disease." (CDC,

Personal Stories of People who survived TB Multidrug Resistance Tuberculosis Another big threat is the rising number of cases of MDR TB (multidrug resistance tuberculosis). Those cases are also caused by the bacterium Mycobacterium tuberculosis which are resistant to the two most important antibiotics: rifampicin and isoniazid.

Between 2009 and 2013 the number almost doubled – 250000 cases raised to a number of 480000 infected people. (Sloan and Lewis, 2016) The treatment for MDR- TB is much more expensive – approximately 3 times more expensive and takes longer – Solutions proposed by about 25 times. (Manjelievskaia et al, 2016.)

WHO: In some regions of the world the threat of MDR-TB is higher than in others, shown by the rising number of new infections with cure TB the first time MDR-TB. (Manjelievskaia et al., 2016) access to diagnosis Out of the 480000 of MDR- TB cases mentioned above, infection control approximately 9,7% were cases of XDR-TB (Extensively drug appropriate use of second 2015.) resistance tuberculosis). (WHO, line drugs Last years theme of the Stop TB Day was “Multi Drug Resistance TB”. Progress is made but there is still a lot that needs to be done.

Interprofessional collaboration

For this year's World Stop TB day WHO calls to "Unite to End TB"

Since all mycobacteria from the mycobacterium complex can cause tuberculosis within humans, tuberculosis control within animals got more important throughout the last decades.

Detected cases in cattle/cows usually get reported to public health authorities. But veterinary offices on the other hand get no notifications on cases within humans. (Lewerin, 2015) Since tuberculosis is a zoonosis and transmission can be made on both sides interprofessional collaborations are of high importance.

Not only should we take into consideration that tuberculosis is a zoonosis and therefore doctors and veterinarians are obliged to work together but also the fact that the increasing number of MDR-TB and XDR-TB (extensively drug resistance TB) is a threat to our health and thus doctors and pharmaceutics need to fight mycobacterium tuberculosis together.

The risk of transmission of the bacterium via unpasteurized milk is a cause to get specialists from food industry, veterinarians and microbiologist to work together.

These are just some examples to show the significance of interprofessional collaborations in the fight against tuberculosis.

"These efforts cut across disciplines and sectors, and can help accelerate progress towards the Sustainable Development Goals..."

(WHO, 2016.)

Get started with your project

This year we want to put “Prevention and Screening of Tuberculosis” into focus.

Get in contact with local members from IVSA/IFMSA/IPSF and start your interprofessional collaboration!

After you have gathered a team make sure you decide on a topic you are really enthusiastic about and will have fun working together on it.

With your project you can choose which aspect you want to emphasize on.

Once you have outlined your project and worked out the details you can register your project online.

Follow the link to the google form and fill out all open fields.

GOOGLE FORM FOR REGISTRATION Example 1: Lecture on Tuberculosis: The importance of Screening and potential methods Step 1: What do you need? Make a list and timeline for your project.

Step 2: Distribute tasks Step 3: Fundraising - Do you need money/ How much money do you need?

Step 4: Speaker: find a suitable speaker for your event. (Health Department) Step 5: Lecture hall: make sure you have a valid reservation for your lecture hall Step 6: Fyler: Design a flyer and promote the event on different media plattforms.

Step 7: Make sure you have anything ready for the event (gift for speaker, drinks, technical settings, etc.)

Example 2: Fundraising Event: Choose an international project related to TB Prevention, get in contact, advertise their aim and set out an event to raise money for their cause.

Step 1: Step 1: What do you need? Make a list and timeline for your project.

Step 2: Distribute tasks Step 3: How are you going to raise money?

Selling cakes, organizing a run, … decide on a method you are going for (there are many different approaches) Step 4: Room/ Area: make sure the room/ area you need for your event will be available to you Step 5: Flyer: Design a flyer for your event and promote it on different media platforms.

Step 6: Preparations for the event

Further Information

Check out IPSF information file on TB

WHO Stop TB Day 2016

AGES (Österreichische Agentur für GmBH), 2008: Wissenschaftliche von Milcherzeugnissen bei Verdacht

Gesundheit und Ernährungssicherheit Stellungnahme zur Risikobewertung auf TBC, http://www.ages.at/fileadmin/

StopTB.org 2016 Campaign

AGES2015/Themen/Krankheitserreger_Dateien/ B r u c e l l o s e /

Personal Stories

Risikobewertung_Milcherzeugnisse_Brucellose_02.pdf. , 23.2.2016.

Sources APA, 2016: Tuberkuloseverdacht bei Vorarlberger Rindern. Der Standard, 15.2.2016, http://derstandard.at/.

2000031100049/Rinder-Tuberkuloseverdacht-in-Vorarlberg, 23.2.2016.

A.Caron, D.Cornelis, C.Foggin, M. Hofmeyr, M.de Garine Wichatitsky., 2016: African Buffalo Movement and Zoonotic Disease Risk across Transfrontier Conservation Area”. Emerging Infectious DIseases, 22/2, 277ff.

Center for Disease Control, 2012: Tuberculosis: Infection Control and Prevention, http://www.cdc.gov/tb/topic/ infectioncontrol/, 24.2.2016.

Center for Disease Control, 2012: Tuberculosis: TB and HIV Coinfection, http://www.cdc.gov/tb/topic/ tbhivcoinfection/default.htm, 24.2.2016.

S. Lewerin, 2015: Tuberculosis and One Health, Frontiers in Veterinary Science, 2/54.

J. Manjelievskaia, D. Erck, S.Piracha, L. Schrager, 2016: Drug resistant TB: deadly, costly and in need of a vaccine, Transactions of the Royal Society of Tropical Medicine and Hygiene, 110(3): 186-191.

National Institue of Allergy and Infectous Diseases, 2012: Tuberculosis (TB) Prevention, https:// www.niaid.nih.gov/topics/tuberculosis/understanding/pages/prevention.aspx, 24.2.2016.

NICE (National Institute for Health and Care Excellence), 2016: Tuberculosis: Prevention, diagnosis, management and service organisation, NICE, 2016.

N. Ritz, F. Brinkmann, B.S. Garcia, M. Tebruegge, B. Kampmann, 2015: Tuberculosis in young refugees, The lancet, 386 19/26, 2475f.

D. Sloan, M. Lewis, 2016: Managment of multidrug resistent TB: novel treatments and their expansion to low resource settings, Transactions of the Royal Society of Tropical Medice Hygiene, 110(3), 163-172.

WHO, 2015: Tuberculosis: Factsheet No.°104, http://www.who.int/mediacentre/factsheets/fs104/en/., 23.2.2016.

WHO, 2015: Global Tuberculosis Report 2015, World Health Organization, 2015.

WHO, 2015 : Systematic screening for active tuberculosis: an operational guide, WHO, 2015, http:// www.who.int/tb/publications/systematic_screening/en/, 23.2.2016.

WHO, 2016: World TB Day 2016: Unite to end TB, www.who.int/campaign/tb-day/2016/en/ , 23.2.2016 Figures: Figure 1: WHO, 2015: map of estimated TB mortality rates excluding TB deaths among HIV positive people, 2014, http://gamapserver.who.int/mapLibrary/Files/Maps/Global_TB_MortalityRates_HIVnegative_2014.png, 23.2.2016.

Figure 2: WHO, 2015: Progress, The End TB Strategy, http://www.who.int/tb/End_TB_brochure.pdf?ua=1, 23.2.2016 Figure 3: WHO, 2015: Challenges, The End TB Strategy, http://www.who.int/tb/End_TB_brochure.pdf?ua=1, 23.2.2016

Figure 4: Theurgentcare, 2016: TB Skin Test, http://theurgentcare.com/services/vaccination/tb-skin-tests, 24.2.2016 Figure 5: DocCheckCommunity, 2013: Mycobacterium tuberculosis: der Grund für TB,

http://pictures.doccheck.com/ de/photo/22306-mycobacterium-tuberculosis-der-grund-fuer-tbc, 24.2.2016 Figure 6: WHO, 2015: The six essential steps in the cycle of designing and implementing a tuberculosis screening,in: Systematic screening for active tuberculosis: a guidline,, http://apps.who.int/iris/bitstream/ 10665/181164/1/9789241549172_eng.pdf, 23.2.2016 Figure 7: Thenounproject, Chest XRay, https://thenounproject.com/term/x-ray/641/, 24.2.2016 Figure 8: WHO, 2015: Principles of and recommendation for systematic screening for Tuberculosis (TB), in:Systematic screening for active tuberculosis: a guidline,, http://apps.who.int/iris/bitstream/ 10665/181164/1/9789241549172_eng.pdf, 23.2.2016

Video: Center for Disease Control, 2012: TB and HIV Coinfection, https://youtu.be/mzi_3_Mf5aE, 23.2.2016.