Prevention is better than cure - Thematic Session (Leopoldina) 19.11.2011
If you think research is expensive try disease – thus Stefan H. Kaufmann, an immunologist from Germany, speaker of this thematic session quoted the words of Mary Lasker, an American health activist talking on the re-emerging threat of tuberculosis. This is one of several infectious diseases that threaten public health even today.
On a global scale, every third patient dies of infectious diseases. This is especially true of the tropical regions, where Malaria and other parasites play an important role. Invited by the German Leopoldina Academy, microbiologists and virologists analysed the patterns of spreading and the possibilities for stopping some of the most serious infections threatening public health in the 21st century. Chaired by Mr Volker ter Meulen, the German Academy's thematic section on emerging and re-emerging infections on WSF's Day 1 took a dive into a sea of health troubles.
TB problems resemble an iceberg – as 2.2 billion people on earth are latently infected by TB bacteria. There are 22 million cases with ten million newly infected people annually – and two million sick patients die. 171 countries account for 20 per cent of all tuberculosis cases, 80 percent of TB patients live in 22 countries. Some recent developments in London are worrying – the number of multidrug resistant patients has doubled in the past 5 years. In the European Union 23% of the treatment fails, 26% of the infected people are lost in the follow up. Successful treatment occurs only in 32% of the cases.
Our inability to control TB is due to our neglect in the last quarter in the last century. Better measures are needed if we increase our research said Mr Stefan H. E. Kaufmann. As diagnosis comes from the late 19 century also the testing method, and the several decades old preventive BCG vaccination protects only the infants and not their parents research should do something in this area.
The aim of the researchers is to reduce prevalence and mortality by half till 2015 and eliminate TB to 1 in 1 million that is to 8 thousand new cases a year by 2050. This can be achieved at least helped by pre-exposure vaccines. As new vaccines are urgently needed good news that 12 candidates are in the laboratories. A seemingly highly efficient and safe model is in pre-clinical trial. Another phase I trial is completed and a phase II trial has been started in newborns. In highly endemic area phase III efficacy and safety trial is being done over several years. Goal of the scientists is to find an answer to the reason of the fact that about 2 billion infected never develop the disease and why it is so, that at the same time about ten million annually got seriously ill.
The financial burden of TB is high – it costs 50 million euros in Germany, ten million in Hungary, 750 million in the EU countries. As treatment is so costly it is worth comparing the expenses of research – 2 billion US dollars are spent on finding new drugs annually. So if you think research is expensive ... well, do not try disease.
Another emerging infection is zoonoses. Influenza A caused the death of 400 people out of the 600 infected between 2003-11 in the period when 25 million birds had to be killed.
Pandemic preparedness plan is introduced globally, influenza surveillance system exists for man and animal but prevention can be awaited from vaccines and drugs. Lessons learned from the 2009 pandemic are less preoccupation, more flexibility and ducation of the misinformed and insecure public – summarized Mr Hans D. Klenk (Philipps University, Marburg). The virologist emphasised the different tasks for future R and D: eludication of the mechanism underlying the infection, enhancing current vaccine efficacy, improve manufacturing and implement universal surveillance for human, animal, wild-life health.
The same goes for preventing spread of HIV, AIDS infections as Mr Peter F. Zipfel states. After causatives agents are identified, sensitive diagnostic tests are available research should further investigate the dynamics of HIV of virus formations.
The global view of infection: in 2009 there were 2.6 million new infections, reaching with this the total of 33.3 million. That year there were 1.8 million AIDS deaths (totalling 30 million so far). Implementation of new treatments reduces the number of AIDS related deaths.
The elimination of HIV mother-to-child-transmission is feasible, though science has to face that AIDS is a poverty related disease where 30% of patients on therapy change their medication regime within the first year due to side effects or drug resistance.
Alternative solutions and approaches should be found in the future preventing new infections – and this is true with stopping the spreading of fungi.