15 MAY

Donald Kaye, Section Editor

News
Drug-Resistant Tuberculosis
Threatens to Kill 75 Million
People by 2050, Cost $16.7
Trillion

Copyright 2015 Reuters Limited. All rights reserved.

Gilead Shares Dip After

Warning About Hepatitis
C Drug Interaction
23 March 2015 (Reuters Health [Bill
Berkrot])Gilead Sciences Inc shares
slid 2% on Monday after the company
warned about potentially fatal risks for
patients being treated with its top-selling

hepatitis C drugs who also take the potent

heart drug amiodarone.
Gilead said it sent cautionary emails to
healthcare providers on Friday to notify
them of 9 cases in which patients treated
with its Harvoni or Sovaldi, while also
taking amiodarone, suffered symptomatic
bradycardia. One of the patients died.
The condition was seen almost immediately in 6 of the patients. Three of the 9
required the placement of a pacemaker
and 7 had also been taking a beta blocker.
The labels on the hepatitis C drugs
already contain a warning against coadministration with amiodarone and
particularly in patients also taking beta
blockers. AbbVies rival hepatitis C treatment Viekira Pak carries a similar warning.
We believe this disclosure will have
little or no effect on demand for Harvoni
and Sovaldi, Sanford Bernstein analyst
Geoffrey Porges said in a research note.
First, the underlying patient numbers
on amiodarone are relatively small. Second, there is no inherent reason that
hepatitis Cinfected individuals should
have much higher rates of treatment
with amiodarone, so the exclusion of
co-administration is unlikely to materially
affect the dynamics of the market, he said.
Sovaldi had fourth quarter sales of $1.7
billion, while the newer combination
treatment Harvoni, which includes Sovaldi, had sales of $2.1 billion for the period.
Gilead, in a statement, said it remains
condent in the safety proles of Sovaldi
and Harvoni and will continue to monitor their safety in collaboration with health
regulators and the medical community.
Amiodarone is an older drug used to
keep the heart beating normally in patients with life-threatening rhythm disorders, such as ventricular tachycardia or
ventricular brillation. It has a history
of potentially dangerous toxicities.

NEWS

CID 2015:60 (15 May)

Downloaded from http://cid.oxfordjournals.org/ by Carlos Abuhadba on May 6, 2015

24 March 2015 (Reuters Health [Astrid

Zweynert])Over the next 35 years,
multidrug-resistant tuberculosis will kill
75 million people and could cost the global
economy a cumulative $16.7 trillionthe
equivalent of the European Unions annual output, a UK parliamentary group
said on Tuesday.
If left untackled, the spread of drugresistant tuberculosis superbugs threatens
to shrink the world economy by 0.63%
annually, the UK All Party Parliamentary
Group on Global Tuberculosis (APPG
TB) said, urging governments to do more
to improve research and cooperation.
The rising global burden of multidrugresistant tuberculosis and other drugresistant infections will come at a human
and economic cost which the global community simply cannot afford to ignore,
economist Jim ONeill said in a statement.
ONeill, a former chief at investment
bank Goldman Sachs, was appointed last
year by British Prime Minister David
Cameron to head a review into antimicrobial resistance.
The bacteria that cause tuberculosis can
develop resistance to drugs used to cure the
disease. Multidrug-resistant tuberculosis
fails to respond to at least isoniazid and
rifampicin, the 2 most powerful antituberculosis drugs, according to the World
Health Organization (WHO).
The UK parliamentary groups cost projections are based on a scenario in which
an additional 40% of all tuberculosis

cases are resistant to rst-line drugs, leading to a doubling of the infection rate.
The WHO said last year multidrugresistant tuberculosis was at crisis levels,
with about 480 000 new cases in 2013.
It is a man-made problem caused by
regular tuberculosis patients given the
wrong medicines or doses, or failing to
complete their treatment, which is highly
toxic and can take up 2 years.
The group urged governments to set up
a research and development fund, target
investments into basic research, and increase support for bilateral tuberculosis
programs.
We need better tools to deal with this
new threat, but since tuberculosis primarily
affects the poorest and most vulnerable in
society, there is little commercial incentive
to develop new drugs, said Nick Herbert,
co-chairman of the APPG TB.
The ght against tuberculosis, the
worlds second deadliest infectious disease
after human immunodeciency virus, is
also hampered by a lack of an effective vaccine, the APPG TB said. The only tuberculosis vaccine, BCG, protects some children
from severe forms of tuberculosis
including one that affects the brainbut
is unreliable in preventing tuberculosis in
the lung, which is the most common
form of the disease.
Tuberculosis killed 1.5 million people
worldwide in 2013, according to the WHO.

The new hepatitis C drugs represent a

major breakthrough as they can cure well
over 90% of patients who have the liver-destroying virus, with virtually none of the
troubling side effects of older treatments.
Copyright 2015 Reuters Limited. All rights reserved.

WHO Urges Mass Vaccination

Against Measles, Other
Diseases in Ebola Areas

ii

CID 2015:60 (15 May)

NEWS

Copyright 2015 Reuters Limited. All rights reserved.

Kansas High School Finds 27

Latent Tuberculosis Infections
20 March 2015 (Reuters Health [David
Bailey])Twenty-seven people have tested

positive for tuberculosis at a suburban

Kansas City high school where a student
was recently found to have an active case,
Kansas state and county health ofcials
said on Wednesday.
Health ofcials have tested more than
300 students and staff at Olathe Northwest High School after possible exposure to tuberculosis since the active
case was reported 2 weeks ago, ofcials
said.
Lougene Marsh, the director of the
Johnson County Department of Health
and Environment, said the number of
people with tuberculosis infection does
not exceed expectations.
Early identication and treatment of
tuberculosis infection is the key to preventing progression to tuberculosis disease, Marsh said in a statement.
Those who tested positive will receive
chest X-rays and antibiotics paid for by
the state and county to kill the bacteria
and stop the disease from developing, ofcials said. They were notied starting on
Monday.
People whose tests were negative for
tuberculosis will be notied by letter,
they said. They will be retested on May
5 because it can take up to 8 weeks for
the bacteria to show up in a test after
exposure.
People with latent tuberculosis infection are not contagious, do not feel sick,
and do not have symptoms, health ofcials said. Without treatment, 5% to
10% develop tuberculosis disease, which
is infectious, according to the US Centers
for Disease Control and Prevention.
Symptoms of the disease include fever,
night sweats, cough, and weight loss.
Copyright 2015 Reuters Limited. All rights reserved.

Published by Oxford University Press on behalf of the Infectious

Diseases Society of America 2015.
DOI: 10.1093/cid/civ268

Downloaded from http://cid.oxfordjournals.org/ by Carlos Abuhadba on May 6, 2015

20 March 2015 (Reuters Health [Kate

Kelland])The World Health Organization (WHO) warned on Friday
of a risk of outbreaks of measles, whooping cough, and other diseases in West
African countries hit by Ebola and
urged a rapid intensication of routine
immunizations.
The Ebola epidemic has killed more
than 10 200 people, mostly in Guinea, Liberia, and Sierra Leone, and has reduced
vaccination coverage as health clinics and
healthcare workers focused on ghting
the unprecedented outbreak.
In recent months, Ebola has started to
wane with the number of cases falling signicantly, though a spike in Guinea this
week has also highlighted the risk of
complacency.
The epidemic has disrupted delivery of
routine childhood vaccines against measles, polio, and tuberculosis, and of a
combined shot against meningitis, pneumonia, whooping cough, tetanus, hepatitis B, and diphtheria.
Jean-Marie Okwo-Bele, the WHOs
vaccines director, told a brieng in Geneva that the health agency wanted an intensication of immunization services,
and mass measles vaccination campaigns
in all areas where feasible.
Campaigns will only be conducted
in areas that are free of Ebola virus
transmission, he said, stressing that clinics and health workers administering

vaccines would be required to ad here

to very strict infection control measures.
The WHO sent a warning note to affected countries this week saying: Any
disruption of immunization services,
even for short periods . . . will increase
the likelihood of vaccine-preventable disease outbreaks.
A study published last week by researchers at Johns Hopkins Bloomberg
School of Public Health in the United
States warned that measles cases could almost double in countries hardest hit by
the Ebola outbreak.
The researchers calculated that for every
extra month that healthcare systems were
disrupted, up to 20 000 children aged between 9 months and 5 years were put at risk.
Measles is a viral disease which killed
around 146 000 people globally in 2013,
mostly children under 5, according to latest data. That equated to almost 17 deaths
every hour.
One of the most transmissible diseases,
outbreaks of measles often follow humanitarian crises as vaccination campaigns
falter and populations are displaced and
impoverished.
Okwo-Bele said the WHO had received reports of around 500 measles
cases so far this year in the 3 countries,
with at least 3 deaths.
Edward Kelley, the WHOs director of
service delivery and safety, said the focus
on boosting vaccination coverage rates
was part of the early recovery work (as
the Ebola outbreak wanes) and one of
the very pressing recovery pieces that
needs to get done.