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

The Edgar Laurent Foundation

Established on the 31th December 1951

Sir Edgar LaurentSir Edgar Laurent

Sir Edgar Laurent - BiographySir 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


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.


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.

The Objectives of the FoundationThe 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.

Who are the members?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

NEW ASPECTS OF TUBERCULOSIS

Dr.R.Donat

Are you breathing ?Are you breathing ?

Then you can get tuberculosis – a

disease that kills 5000 people

everyday – nearly 2 million last year.

Global Status of TBGlobal 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.

Global status of TBGlobal 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.

Global status of TBTB is the second leading infectious cause of death in

the world, after the HIV

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

Cont’d…80 % of all cases worldwide occur in S S Africa and

SE Asia

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

The burden of illnessThe 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

Prevalence RatePrevalence Rate

Development lagging behind…WHY?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.

Tuberculosis- The BasicsTuberculosis- 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.

Tuberculosis - The Basics (continued)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

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



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

BactèriologieBactèriologie

Phénomène de résistance

Les examens – Direct – ZN- Détection des bacilles Acido-

Alcoolo Résistants

Culture- Antibiogramme

I. Lowenstein – Jensen- Milieu solide lecture aprés 4 – 6

semaines

II. Middlebrook- Milieu gélosé- lecture aprés 3 semaines

III. Bactec- Milieu liquide- Méthode radioactive- lecture ā partir

de 8 jours

IV. PCR- Méthode Génétique- amplification géonomique- lecture

24-48 heures

Drug Resistance

Résistance Secondaire ou Acquise Traitement Inadéquat

Résistance Primaire Contamination par un porteur de bacilles

résistants

Résistance Naturelle

Phenomene Fall & RisePhenomene Fall & Rise

100

104

106

108

Bacilles

sensibles

Bacilles

résistants

4 8 12 16 2418

Traitement par INH seul

Semaines de traitement

Is TB curable ?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.

Treatment

(1)Les médicaments antituberculeux Majeurs(1)Les médicaments antituberculeux Majeurs

On associe toujours au moins 3 anti TB

(2)Les médicaments anti-tuberculeux mineures

Ethionamide Prothionamide Kanamycine Cycloxerine Capreomycine Viomycine PAS Thiacetazone Fluoroquinolones

MDR TB XDR TB

What is MDRTB?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 the two most important anti-TB drugs, isoniazid and rifampicin + resistance to an injectable aminoglycoside + esistance to a Fluoroquinolone

Why is MDRTB a problem?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.

MDR TB – some figuresMDR 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

What causes MDRTB?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.

How is MDRTB prevented?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.

How do we know if a patient has MDRTB?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.

Products in the pipelineProducts in the pipeline

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

ReferenceLab

PeripheralLab

Clinic HealthPost

Medecines

Vaccines

Diagnostics

Urinar

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Optimising sputum microscopy

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What is in TB pipeline?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)

What is in the TB pipeline?What is in the TB pipeline?

PRECLINICAL Dipiperidine (SQ-609) Synthase inhibitor FAS200313 Translocase I inhibitors

Discovery Stage Quinolones AstraZeneca Portfolio

What is in the TB pipeline (continued)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


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


New Anti-TB vaccines VIRAL VECTORED VACCINES

MV A85A Aeras-402

MODIFIED-RECOMBINANT BCG M72 HyVac 4 Hybrid-1

BACTERIA-VECTORED VACCINES Aeras-X05

The call to stop TBThe call to stop TB

Because each year nearly 2 million people die and 9 million people become sick with TB, and because TB infects one-third of the world’s population.

Because TB is a global pandemic and an emergency in Africa and the European region.

Because TB is the biggest killer of people with HIV/AIDS and multi-drug resistant forms of TB are a threat around the globe

Because TB is curable.

The Call to stop TBThe Call to stop TB

Because the Stop TB strategy is getting results

Because 14 million more lives can be saved over the next 10 years

Because treating and curing people with tuberculosis prevents the spread of the disease, reduces poverty, strengthens health systems, engages all care providers and empowers those affected.

Because new vaccines, drugs and diagnostics to stop TB are urgently needed.

The Call to stop TBThe Call to stop TB

Because access to TB treatment is a human right.

Because TB can be eliminated by 2050 if we take action now

For these 10 reasons, we commit ourselves, through our actions, to a world free of TB.

Thank you

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

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