posted on Dec, 6 2009 @ 12:43 PM
Excerpts from the Lancet
The Lancet Volume 373, Issue 9681, Page 2108, 20 June 2009
Defining priorities: swine-origin H1N1 and the MDR-TB epidemic
Giovanni Battista Migliori a , Giovanni Sotgiu b, Christoph Lange c, Gavin Macgregor-Skinner d
In the response to the emergence of a novel H1N1 influenza virus and its subsequent spread worldwide, we would like to ensure that existing global
health priorities are not neglected.
Tuberculosis is a respiratory pandemic priority, affecting an estimated 9•27 million people and killing 1•77 million worldwide in 2007.1
Multidrug-resistant tuberculosis (MDR-TB; 511 000 cases, 150 000 deaths estimated in 2007) has a case—fatality rate of 294 per 1000 affected
individuals, and extensively drug-resistant tuberculosis (XDR-TB; 50 000 cases and 30 000 deaths estimated in 2007) has a case—fatality rate of 600
per 1000 affected cases.2
This means 1•13 daily deaths in Mexico and 0•1 in the rest of the world for influenza H1N1 and 410•9 and 82•2 daily deaths, respectively, for
MDR-TB and XDR-TB. In the given situation, vigilance is important but the fight against the true priorities should continue.
While the media reported extensively on the novel influenza virus, WHO and the US Centers for Disease Control and Prevention stopped using the term
“swine flu” to prevent the collapse of the swine products market, WHO declared phase 5 (the current definition does not consider mortality), and
the World Health Assembly was shortened, rescheduling and then reintroducing the planned discussion on the MDR-TB emergency. It seems that under media
pressure, the scientific community has lost its capacity to keep priorities in check and to manage the new challenge in a collaborative and
The global tuberculosis network is composed, largely, of pulmonologists and infectious disease and public health specialists, well distributed around
the world, and covering urban as well as rural territories. This network is able to support influenza control specialists in implementing effective
prevention, diagnosis, and, when necessary, treatment of the novel H1N1 influenza virus infection.
Much ink and paper has been and will be devoted to discussing this burning issue. Our contribution is mainly focused at calling for a wiser use of the
available surveillance data. Public health interventions should be guided by facts (not by emotions), and should always take their cost-effectiveness
This text reflects the opinions of the authors, and not necessarily those of their affiliated organisations. We declare that we have no conflicts of
1 WHO. Global tuberculosis control: epidemiology, strategy, financing. Geneva: World Health Organization, 2009.
2 Sotgiu G, Ferrara G, Matteelli A, et al. Epidemiology and clinical management of XDR-TB: a systematic review by TBNET. Eur Resp J 2009; 33: 871-881.
a Fondazione S Maugeri, Tradate, Varese 21049, Italy
b University of Sassari, Sassari, Italy
c Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
d USAID, Washington, DC, USA