Tuberculosis deaths rise for first time in over a decade due to impact of Covid pandemic, says WHO

Global deaths from tuberculosis have risen for the first time in more than a decade due to the disruptive impact of Covid-19 on testing and treatment services, the World Health Organisation has said.

Years of progress in tackling TB – the second deadliest infectious killer on the planet, after Covid – have been reversed as a result of the pandemic, according to a new WHO report.

Some 1.5 million people died from the disease in 2020, up from 1.4 million in the previous year. New diagnoses fell from 7.1 million to 5.8 million over the same period – though estimates for undiagnosed patients living with TB rose. And the number of people accessing preventative treatment decreased by 21 per cent, to 2.8 million.

“This is alarming news that must serve as a global wake-up call to the urgent need for investments and innovation to close the gaps in diagnosis, treatment and care for the millions of people affected by this ancient but preventable and treatable disease,” said Dr Tedros Adhanom Ghebreyesus, director-general of the WHO.

Caused by a bacterium called Mycobacterium tuberculosis, the infection is spread through inhaling tiny droplets from the coughs or sneezes of an infected person. TB typically affects the lungs, but can attack other parts of the body, such as the kidney or brain.

© AFP via Getty Images: Some 1.5 million people died from TB in 2020, up from 1.4 million in the previous year

Prior to the emergence of Covid-19, it was the deadliest infectious disease in circulation among humans. Approximately 90 per cent of those who fall sick with TB each year live in just 30 countries, including India, Nigeria, South Africa and Vietnam.

As a result of disruption from Covid-19, the global targets for tackling TB “appear increasingly out of reach,” the WHO said. The organisation’s “End TB Strategy”, set in 2015, aims for a 90 per cent reduction in TB deaths and 80 per cent reduction in infections by 2030.

Even before Covid, these targets were off track. Globally, the number of annual TB deaths reported between 2015 and 2020 fell by just 9.2 per cent, while cases dropped by 11 per cent.

The WHO said the impact of the pandemic on TB services in 2020 had been “particularly severe”, with far fewer people being diagnosed and treated. Global investment into tackling the disease also dropped off last year.

As part of its report, the WHO outlined two main challenges that had emerged throughout the 2020 in tackling the infection: the movement of human and financial resources away from TB services to the Covid response; and the inability of people to seek and regularly access care in during lockdowns.

The increase in deaths occurred mainly in the 30 countries with the highest burden of TB, the WHO said. Of the 1.5 million fatalities reported last year, 214,000 were among HIV patients, who are particularly vulnerable to TB.

Modelling projections suggest the number of people who develop and die from the disease could further rise in 2021 and 2022.

Currently, an estimated 4.1 million people suffer from TB but have not been diagnosed with the disease or officially reported to national authorities, the WHO’s report added. This figure is up from 2.9 million in 2019.

Along with a reduction in the provision of preventive treatment, the number of people treated for drug-resistant TB fell by 15 per cent, from 170, 000 to 150, 000 – equivalent to only about 1 in 3 of those in need.

Global spending on testing, treatment and prevention services fell, too, from £4.2bn to £3.8bn, according to the WHO’s research.

Having plagued humanity for thousands of years, TB was first shown to be curable in the late 1950s. About 85 per cent of people who develop the disease can be successfully treated with a six-month drug programme. This also curtails onward transmission of the infection.

The international charity Medecins Sans Frontieres (MSF) said it was unacceptable that millions of people are continuing to die each year from a curable disease “because they do not have access to the diagnostics and drugs that can save their lives”.

Stijn Deborggraeve, a diagnostics advisor at MSF, added: “With the alarming increase in TB deaths in 2020 due to the Covid-19 pandemic, much more needs to be done to close the deadly testing gap and ensure that many more people with TB are diagnosed and treated.” 

Reference: Independent: Samuel Lovett 

Woman denied liver transplant because she refuses Covid vaccine

Everything you need to know about urinary tract infections in old age

Former US president Bill Clinton has been admitted to hospital for complications reportedly relating to a urinary tract infection (UTI), but what does that mean for him and others like him?

What is a UTI and who is most at risk? 

Mild UTIs are common – particularly among younger women – but in people over 60 they can become surprisingly severe, requiring in-patient treatment. Professor Roger Kirby is a retired prostate surgeon, co-founder of The Urology Foundation and a former president of the Royal Society of Medicine. “Most people are treated at home for UTIs, but Bill Clinton must have a severe infection,” he says. “This requires higher doses of intravenous antibiotics, to guard against the advance to septicaemia – a serious and potentially fatal blood infection.” 

A UTI can affect any part of the urinary system, including the kidneys, bladder, ureter (the duct which connects the kidney to the bladder) and the urethra (the pipe connecting the bladder to the outside of your body). The infection is caused by the bacteria E. coli. The typical symptoms are: a burning feeling when urinating; a frequent or intense urge to wee (though not passing much urine when you go); cloudy, dark, bloody or strange-smelling urine; feeling tired; having a temperature. You should seek urgent medical help if you have a temperature over 39 degrees, you are shaking or you feel generally very unwell as this can be a sign the infection has spread for example to the kidneys. “The faster we get antibiotics into you, the better,” says Professor Kirby.

In younger age groups, they are more common in women. A woman’s lifetime risk of having a UTI is one in two – and many have repeat infections. “Cystitis is a common infection, mainly due to E. coli being spread by sexual activity and the fact that some women have a shorter urethra,” says Professor Kirby. It can also be caused by women “wiping from back to front” when she goes to the loo, which transfers bacteria from the colon to the urethra.

UTIs in younger men are unusual, except for rare cases of prostate enlargement or kidney stones. Sexually transmitted infections can have similar symptoms (pain on urination).

© Martin BUREAU / AFP Former US President Bill Clinton has been admitted to UCI Medical Center for treatment - Martin BUREAU / AFP

Why do they become more common with age? 

The risk of contracting a UTI can be increased by hormonal changes and frailty, a weakened immune system or any condition that affects urine flow such as a stroke, kidney stones or spinal cord injury. 

“Sixty per cent of males over-60s have a condition called benign prostatic hyperplasia, or enlargement of the prostate gland,” says Professor Kirby. “Ninety per cent of men over 90 have it. It’s almost ubiquitous if you live long enough.” The condition raises the risk of a urinary infection, as it does the infection prostatitis, kidney stones and prostate cancer, so it’s important to have these ruled out if you’re suffering with regular UTIs. In mature women, kidney stones and bladder cancer need to be discounted, especially if painful urination is accompanied by blood in the urine.

Patients who spend longer periods in hospital where they are catheterised are also at higher risk of infection. Older adults often limit their fluid intake due to mobility problems and avoiding needing to go to the toilet, or concerns over incontinence, and dehydration is another UTI risk factor. 

In older people, the symptoms of a UTI can be quite different and easily misdiagnosed – including confusion. “UTIs can cause sudden confusion in older people and people with dementia,” says a spokesperson for the Alzheimer’s Society. “If your relative has a sudden and unexplained change in their behaviour, such as increased confusion, agitation or withdrawal, this may be because of a UTI.” 

However, confusion alone is not a sign of a UTI. Two of the following need also be present: fever, an increase of urinary frequency and urgency, sudden pain with urination, or tenderness in the lower abdomen.

How should you treat and prevent them?  

Mild UTIs often pass on their own – aided by the patient drinking lots of fluids. “We’ve only had antibiotics since the 1920s and the body will eventually have natural resistance,” says Professor Kirby. Many patients swear by cranberry juice, he says. “There haven’t been any clinical trials on cranberry juice as treatment for a UTI and there is no firm evidence. But it can’t do you any harm.”

For more troublesome cases, a call or trip to the GP is probably a good idea. “Your doctor will take a urine sample, which will get sent off to the lab for analysis,” says Professor Kirby. “In 24 to 48 hours, you’ll receive a report on whether E. coli is present. However, a GP will normally start oral antibiotics immediately: normally ampicillin, amoxycillin or ciprofloxacin.”

It’s important to finish the course, because of the rise of increasing antibiotic resistance in many infections, including the urinary variety.

A fifth of women suffer from chronic UTI infections. People who suffer repeated UTIs – more than three a year – might be sent for an ultrasound, CT scan or MRI to investigate further. A doctor will consider a low-dose antibiotic over a longer period, or antibiotics for one or two days after symptoms appear. 

If you are experiencing serious symptoms as detailed above, call 999. You may need admission to hospital, and intravenous antibiotics.

To avoid UTIs, the advice is to drink lots of fluids, especially water, practise good personal hygiene and wipe from “front to back” if you are a woman, empty your bladder immediately after sex to help flush out bacteria, and avoid potentially irritating feminine products such as deodorant sprays. 

Reference: The Telegraph: Miranda Levy  

New treatment destroys head and neck cancer tumours in trial

A new cancer treatment can wipe out tumours in terminally ill head and neck cancer patients, scientists have discovered.

In a landmark trial, a cocktail of immunotherapy medications harnessed patients’ immune systems to kill their own cancer cells and prompted “a positive trend in survival”, according to researchers at the Institute of Cancer Research (ICR), London, and the Royal Marsden NHS foundation trust.

One patient, who was expected to die four years ago, told the Guardian of the “amazing” moment nurses called him weeks after he joined the study to say his tumour had “completely disappeared”. The 77-year-old grandfather is now cancer-free and spent last week on a cruise with his wife.

Scientists found the combination of nivolumab and ipilimumab medications led to a reduction in the size of tumours in terminally ill head and neck cancer patients. In some, their cancer vanished altogether, with doctors stunned to find no detectable sign of disease.

Combining the two immunotherapy drugs could prove an effective new weapon against several forms of advanced cancer, experts believe. Results from other trials of the drug combination have previously suggested similar benefits for terminally ill kidney, skin and bowel cancer patients.

As well as boosting the long-term survival chances of patients, scientists said, the immunotherapy treatment also triggered far fewer side-effects compared with the often gruelling nature of “extreme” chemotherapy, which is the standard treatment offered to many patients with advanced cancer.

The results from the phase 3 trial, involving almost 1,000 dying head and neck cancer patients, were early and not statistically significant but were still “clinically meaningful”, the ICR said, with some patients living months or years longer and suffering fewer side effects.

“These are promising results,” Prof Kristian Helin, the ICR chief executive, told the Guardian. “Immunotherapies are kinder, smarter treatments that can bring significant benefits to patients.”

About 12,000 people in the UK are diagnosed with head and neck cancer every year and many will be diagnosed at advanced stages. There is an urgent need for better, kinder treatments for these patients that can keep them alive longer than the current standard of care.

When Barry Ambrose, 77, from Bury St Edmunds, was diagnosed with throat cancer in 2017, he was told that it had already spread to his lungs – and that hospital palliative care was his only option.

But in a turn of events that saved his life, Ambrose was offered the chance to join the new study. “When I was told about the trial … I didn’t hesitate to join – what did I have to lose? It turned out to be a lifeline.

“Although I had to make biweekly trips from Suffolk to the hospital for the treatment, I had virtually no side-effects and was able to carry on as normal doing the things I love: sailing, cycling, and spending time with my family.”

Within about eight weeks of starting the treatment, scans revealed the tumour in his throat had been eradicated.

“When the research nurses called to tell me that, after two months, the tumour in my throat had completely disappeared, it was an amazing moment,” said Ambrose. “While there was still disease in my lungs at that point, the effect was staggering.”

He later underwent chemotherapy, followed by surgery. He currently has no evidence of disease.

“The treatment I’ve received at the Royal Marsden has been second to none and I’m so fortunate they’ve continued to find treatment that works for me – they’re the gift that keeps on giving,” said Ambrose. Last week he enjoyed a cruise off the coast of the UK with his wife, Sue.

The results of the trial show the immunotherapy combination enjoyed a particularly high success rate in a group of patients whose tumours had high levels of an immune marker called PD-L1.

Survival rates in those with high levels of PD-L1 who received the immunotherapy cocktail were the highest ever reported in a firstline therapy trial of relapsed or metastatic head and neck cancer.

These patients lived an average of three months longer than those having chemotherapy. The median overall survival for these patients was 17.6 months, the highest average ever reported in this group of patients.

Researchers said they hoped future findings from the CheckMate 651 trial, funded by Bristol Myers Squibb, will show further benefits of the therapy in patients with advanced head and neck cancers.

“Despite the lack of statistical significance, these results are clinically meaningful,” said Prof Kevin Harrington, professor of biological cancer therapies at the ICR and consultant clinical oncologist at the Royal Marsden, who led the CheckMate 651 trial. “We will need to do longer follow-up to see whether we can demonstrate a survival benefit across all patients in the trial.”