DOTS Show the Way to Tackle the Toughest TB.

New research has shown for the first time that the spread of multi drug-resistant TB can be halted through a well executed standard treatment programme.

Bacterial fingerprinting techniques used to track disease transmission in a southern Mexico community revealed that all categories of tuberculosis were controlled when the DOTS strategy was used.

DOTS - directly observed therapy - is the strategic approach which has been used to treat over 17 million people since its adoption by the World Health Organisation in 1991. It is based on; political commitment, accurate diagnosis, standardised drug treatment and monitoring of treatment results.

But until now its ability to control the infectious disease in areas afflicted by multi-drug resistant strains had not been rigorously tested.

TB still kills 2m people a year - one death every 15 seconds - and there are growing levels of multi-drug resistance in Africa and Europe.

This latest study, which comes just a week after World TB Day, was conducted by a bi-national team of researchers from Mexico’s National Institutes and Stanford University, and is published in this week’s edition of the Lancet. It shows that despite a moderate level of multi-drug resistant TB, the DOTS programme interrupted disease transmission in the Orizaba Health Jurisdiction, Veracruz.

At the beginning of the study in 1995, twenty-two per cent of previously untreated patients were carrying drug-resistant strains and 6.7% had multi-drug resistance. By 2000 only 7.8% had drug resistant strains and there were no cases of MDR-TB.

The researchers, who were funded by the Wellcome Trust, The Howard Hughes Medical Institute and the US National Institute of Allergy and Infectious Diseases, also found that the rate of pulmonary TB among their 436 patients fell by 54% from 42 to 19 per 100,000 of the population. Despite DOTS, however, 12% of those with MDR tuberculosis died.

Dr Alfredo Ponce de Leon from Mexico’s National Institute of Medical Sciences and Nutrition, said: “The spread of multi-drug resistant TB is potentially devastating. Our study is great news for the world - in many settings implementing standard TB control can prevent this spread. However, it also amplifies the tragic fact that fewer than half of the world’s TB cases have access to this basic care.”

Dr Peter Small from Stanford University said : “Our data show that DOTS is an essential public health intervention. But even with this programme the number of people dying from multi-drug resistant TB remains unacceptable, highlighting the desperate need for new tools to save the lives of the hundreds of thousands of people who are suffering from it.”

Ends

Notes:

The Wellcome Trust is an independent research-funding charity established in 1936 under the will of tropical medicine pioneer Sir Henry Wellcome.The Trust’s mission is to promote research with the aim of improving human and animal health and it currently spends more than £400m p.a.

NIHAIDis a component of the National Institutes of Health, an agency of the U.S. Department of Health and Human Services. NIAID supports basic and applied research to prevent, diagnose and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria and illness from potential agents of bioterrorism. NIAID also supports research on transplantation and immune-related illnesses, including autoimmune disorders, asthma and allergies.

Stanford University Medical Center integrates research, medical education and patient care at its three institutions - Stanford University School of Medicine , Stanford Hospital & Clinics and Lucile Packard Children's Hospital. For more information, please visit the Office of Communication & Public Affairs site at http://mednews.stanford.edu .

Contacts:

Dr Peter Small,

Bill and Melinda Gates Foundation.

206 709 3224.

peters@gatesfoundation.org

Barry Gardner,

Wellcome Trust Media Office.

00 44 207 611 7329.

b.gardner@wellcome.ac.uk

www.wellcome.ac.uk

NIAID:

Contact Christine Sizemore - cs309s@nih.gov