2015 stoptb - informational toolkit

Stop Tuberculosis

Reach. Treat. Cure. Everyone.

Contents

Message from IVSA, IFMSA and IPSF

Multidrug resistant tuberculosis

Collaboration w Event registration

More Resources

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Under the umbrella of the Stop TB Campaign’s call to "Reach, Treat, Cure Everyone" for Stop TB Day 2015, we are linking forces to raise awareness and advocate for better treatment.

The International Veterinary Students’

Association (IVSA) is the largest veterinary

student association in the world, representing

around 30,000 students in more than 40

countries. The International Federation of

Medical Students’ Associations (IFMSA)

represents more than a million medical

students in 116 countries. Finally, the

International Pharmaceutical Students’

Federation (IPSF) represents 350,000

pharmacy students and recent graduates in

70 countries worldwide.

IVSA, IFMSA, and IPSF have a short but

vibrant history of collaboration. There are

formal and informal partnership agreements

between each of the three organisations to

acknowledge and make plans for

multidisciplinary collaboration. While

attending the recent WHO Executive Board

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Meeting, representatives from all three

organizations met with the goal of developing

a stronger vision for future multidisciplinary

collaboration.

For Stop TB Day 2015, we are encouraging

YOU, our members, to join the fight to

“Reach, Treat, Cure Everyone” by focusing on

multidrug resistant TB (MDR-TB). Globally in

2013, an estimated 480,000 people

developed MDR-TB. About half died from the

disease. The primary cause of MDR-TB is

inappropriate treatment or the use of poor

quality drugs, as MDR bacteria do not

respond to at least isoniazid and rifampicin,

the two most powerful first line drugs.

Treatment for MDR-TB is not always available

and requires up to two years of treatment.

A complicating factor is the presence of

Mycobacterium bovis. M. bovis causes bovine

tuberculosis, which is one of the seven

neglected tropical diseases. As a zoonotic

disease, this bacteria causes disease in cattle

and humans. The contribution of M. bovis to

the human TB epidemic is on the rise,

reported in Tanzania to be the cause of 4-10%

of human TB cases. M. bovis and the more

common bacterial cause of human TB,

Mycobacterium tuberculosis, often present

very similar clinical pictures. However, they

can require different treatment. Few hospitals

have the diagnostic capacity to distinguish

between them.

Dear IVSA, IFMSA, and IPSF members,

We are encouraging YOU to join the fight to

“Reach, Treat, Cure Everyone.”

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Dear IVSA, IFMSA, and IPSF members,

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Patients with M. bovis often do not respond

to drugs that are commonly used to treat TB,

which can have fatal results. Just like with

MDR-TB, more expensive or less available

drugs are needed. In addition, inappropriate

use of drugs can accelerate the development

of MDR-TB.

Recent collaboration between veterinary and

medical professionals researching bovine and

human tuberculosis in Tanzania has resulted

in joint research on other zoonotic diseases,

the establishment of a

zoonoses group at the

livestock ministry, and a

series of meetings

between that group and

representatives from the

ministries of human

health and livestock

production (WHO,

2006). The breadth of this collaboration has

the potential to increase access to

appropriate diagnosis and treatment,

reducing the number of TB cases both locally

and worldwide. This is the kind of work we

can start doing right now, together!

Experience in this kind of multidisciplinary

collaboration should start at university training

level. When we achieve this, multidisciplinary

collaboration within the next generation of

healthcare workers will be even more

successful than it already is. On a global level,

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more attention is being given to the One

Health initiative, the concept that animal,

human, and environmental health are

inextricably linked. As three student

organization partners, IVSA, IFMSA, and IPSF

recognize that we are not working by

ourselves but are seeking and promoting

interprofessional collaboration to “Reach,

Treat, Cure Everyone.” To do this, we are

contacting you, members in countries with

cross-organizational reach, to develop

multidisciplinary teams and projects.

Together we will not

only educate, promote

appropriate diagnosis,

and raise awareness

about treatment

protocols that will heal

even more people,

prevent MDR-TB, and

help accelerate the decline of tuberculosis,

but build strong bonds between the

professions that will last into the future.

Love, Sarah (IVSA Chair of the Standing

Committee on One Health)

Skander (IFMSA Chair of the Standing

Committee on Public Health)

Barbara (IPSF Chair of Public Health)

Together we will not only educate, but build strong bonds between

the professions.

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Multidrug resistant tuberculosis has

become a major public health issue,

causing a huge threat for the progress

made in the global tuberculosis care,

control and treatment success.

Resistance can occur through improper

use of antimicrobials and is often a result

of inadequate treatment regimens as

well as a lack of patients' compliance to

finish their antimicrobial course. Drug

resistant tuberculosis can be transmitted

from one patient to other individuals

and is mainly emerging in areas with

weak tuberculosis surveillance.

multidrug-resistant Tuberculosis

● Multidrug-resistant tuberculosis

(MDR-TB ) is caused by bacteria that

do not respond to at least isoniazid

and rifampicin, the two most

powerful, first-line anti-TB drugs.

● Extensive drug resistant tuberculosis (XDR-TB ) is a form of

multidrug-resistant tuberculosis that

does not respond to the most

effective second-line anti-TB drugs

such amikacin, kanamycin and

fluoroquinolones, which are even less

available.

WHO Definitions

Resistance

Current and Future

WHO Poster

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Development of Resistance

Resistance to effective first-

line drugs requires a

combination with second line

drugs, thus the treatment

might take longer, cost more

and there are possibly more

severe side effects. There is a

significant correlation

between the development of

drug resistance and global

antimicrobial overuse. Some

tuberculosis strains are

already resistant to second

line drugs. In 2013 multidrug

resistant tuberculosis was

approximately responsible

for the death of 210 000

people worldwide.

Consequences of multidrug-resistance

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An estimated 480 000 people developed

MDR-TB in 2013. Extensively drug-resistant

tuberculosis (XDR-TB) has been reported in 100

countries, while an estimated 9.0% of people

with MDR-TB have also XDR-TB.

Analysis comparing data of former years

show that the proportion of new cases with

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MDR-TB remains unchanged, but there is a

severe risk of MDR-TB epidemics in quite some

countries. Furthermore there is still a major

diagnostic gap, thus an estimate of 55% of

reported tuberculosis patients who have MDR-

TB were not detected.

Situation Current

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1. Set prevention of multidrug

resistance as a first priority by

ensuring high quality and

evidence based treatment of

drug-susceptible tuberculosis;

2. Scale up rapid testing and

detection of all MDR-TB;

3. Provide prompt access to

effective treatment and proper

care, including adequate supplies

of quality drugs and a scaled up

country capacity to deliver

services;

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4. Prevent transmission through

infection control by implementing

appropriate infection control

measures and quickly enroll

diagnosed patients in effective

treatment plans to minimize the

risk of disease transmission; and

5. Underpin and sustain the MDR-

TB response through high level

political commitment, strong

leadership across multiple

governmental sectors and ensure

adequate financing for care and

research.

In order to control drug-resistant tuberculosis, the implementation of a global

surveillance system is needed, which requires a strong contribution of every

country. The WHO further set a list of five priorities in order to combat the

crisis:

Future Perspectives

Recently two new drugs, bedaquiline and delamanid, were presented for the use in

the treatment of MDR-TB and an interim guidance on their use was developed by

the WHO. However in order to tackle this severe threat for public health, people of

the world whether they are health professionals, politicians or patients need to work

hand in hand - to ensure antimicrobials will stay powerful weapons against diseases

and further provide access to this lifesaving treatment to everyone in need.

There is hope

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© World He a lt h Org aniza t ion 2 0 1 4

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Collaboration

Groups of veterinary, pharmacy, and medical students are joining forces all over the world to tackle Tuberculosis! The World Health Organization outlines basic steps of inter-organizational collaboration: Check out the Framework for Action at:

w https://www.uea.ac.uk/documents/4006821/4007300/FMH+-+CIPP+-+Framework+for+Action.pdf/6e15515c-0744-45cd-97b4-15fcc344113d

Register your campaign HERE: w https://docs.google.com/forms/d/1vzQoxUNcQS1LPi-

iXPYplpKW8JwRSu4eCS5NYCEed-4/viewform?c=0&w=1

Links: w Drug-Resistant TB - Surveillance and Response, WHO, 2014.

http://www.who.int/tb/challenges/mdr/MDR_TB_2014.pdf?ua=1

w Seven Neglected Endemic Zoonoses, WHO, 2015.

http://www.who.int/zoonoses/neglected_zoonotic_diseases/en/

w The Control of Neglected Zoonotic Diseases, WHO, 2006.

http://www.who.int/zoonoses/Report_Sept06.pdf?ua=1

w Tuberculosis, WHO, 2015.

http://www.who.int/mediacentre/factsheets/fs104/en/

w What is multidrug-resistant tuberculosis and how do we control it?

WHO, 2014.

http://www.who.int/features/qa/79/en/

w cdc.gov

w ecdc.europa.org

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IVSA 2015 Stop Tuberculosis Informative Leaflet

Guidance Manual World Rabies Day 2014 – How to Plan an Event

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Other Resources

Veterinary Significance: Excerpt from IVSA 2015 Stop Tuberculosis Informative Leaflet

Bovine tuberculosis (TB) is a chronic and serious disease of animals caused by bacteria

called Mycobacterium bovis which is closely related to the bacteria that cause human

and avian tuberculosis. This disease can affect practically all mammals, causing a

general state of illness, coughing and eventual death.

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Importance Today TB remains an important disease of

cattle, wild animals, and is a significant

zoonosis (a disease of animals which can

also infect humans). Tuberculosis today

remains an epidemic in much of the world,

causing the deaths of nearly one-and-a-

half million people each year, mostly in

developing countries.

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Where is it found? TB is found throughout the world. The

disease is more prevalent in most of Africa,

some parts of Asia and America.

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Transmission The disease is contagious

and spread by contact with

infected domestic and wild

animals. The usual route of

infection is by inhaling

infected droplets which are

expelled from the lungs by

coughing. Calves and

humans can also become

infected by ingesting raw

milk from infected cows.

Transmission of M.bovis can

occur between animals,

from animals to humans and

more rarely, from humans to

animals and between

Clinical Signs in Cattle TB usually has a prolonged

course, and symptoms take

months or years to appear. The

usual clinical signs include:

w Weakness,

w Loss of appetite

w Weight-loss

w Fluctuating fever

w Intermittent hacking

cough

w Diarrhea

w Large prominent lymph

nodes

However, the bacteria can also

lie dormant in the host without

causing disease

Symptoms in Humans Symptoms of respiratory TB

include weight loss, night

sweats, fever and a persistent

cough which may contain blood

or pus. Infection acquired

through consuming dairy or

other food products containing

M.bovis may affect any part of

the body.

Diagnosis The standard method for detection of TB is the tuberculin test,

where a small amount of antigen is injected into the skin, and

the immune reaction is measured. Definitive diagnosis is made

by growing the bacteria in the laboratory, a process that takes

at least eight weeks.

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humans. Transmission to

people can occur through

consumption of unpasteurized

milk and unpasteurized milk

products from infected

animals.

It is also possible to contract

M.bovis infection by inhaling

the bacteria shed by infectious

animals in respiratory and

other secretions, or through

contamination of unprotected

cuts or abrasions in the skin

while handling infected

animals or their carcasses,

although this is rare.

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A Veterinarian’s Role

What should you do as a VET to prevent and control bovine tuberculosis?

The standard control measure applied to TB

is test and slaughter:

w Post-mortem meat inspection to look for

tubercles in the lungs and lymph nodes.

o Prevents unsafe meat from

entering the food chain and allows

veterinary services to trace the

herd of the infected animal, which

can then be tested and eliminated

if needed.

w Intensive surveillance including on-farm

visits

w Systematic individual testing of cattle

w Removal of infected and in-contact

animals

w Movement controls and quarantine

Pasteurisation of milk of infected animals to a

temperature sufficient to kill the bacteria has

prevented the spread of disease in humans.

Treatment of infected animals is rarely

attempted because of the high cost, lengthy

time and the larger goal of eliminating the

disease.

Vaccination is practiced in human medicine,

but it is not widely used as a preventive

measure in animals: the efficacy of existing

animal vaccines is variable and it interferes

with testing to eliminate the disease. A

number of new candidate vaccines are

currently being tested.

The role of veterinarians is to reduce the risk of exposure to bovine TB bacteria, especially on farms. A veterinarian should

have a good knowledge about bovine TB

transmission routes and available control

measures to raise awareness of possible risks

from contaminated aerosols in areas

frequented by farm workers and the

importance of good hygiene. Working with

livestock may involve close contact with

carrier animals or animals with active

tuberculosis. Relevant regulations require

farmers to adopt appropriate measures to

minimize exposure of employees and farm

visitors to infections that can be transmitted

to humans from animals.

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A veterinarian should advise people to:

w Wash hands thoroughly several times a day

and always before eating, smoking and after

finishing work for the day.

w Wash skin wounds immediately with soap and

running water and cover with a waterproof

dressing.

w Avoid drinking milk that has not been

pasteurised or boiled, or eating dairy products

made with raw milk.

w Do not drink, eat, or smoke in animal areas.

w Where possible, minimise handling of infected

cattle. If you must touch a potentially infected

animal, gloves and a facemask should be worn.

w Inform a veterinarian if there is a possibility that

an animal has the symptoms of tuberculosis.

w Inform a doctor if you have been in contact with

an infected animal or someone suffering from

tuberculosis.

Veterinarians and

doctors are working

together to make people

aware of the importance

of prevention.

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Event Ideas and Instructions: Excerpt from Guidance Manual World Rabies Day 2014 – A One Health Challenge

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1. Team Set up a team– a minimum of 2 and

maximum of 5 members, with at least

one veterinary student or one medical

student. Democratic decision-making

and nourishing of the team spirit are

important, but it should be clear who is

responsible for each part of the plan and

what each team member expects from

the event.

2. Ideas Brainstorm ideas and possibilities. There

are some examples of other events in

Ideas for One Health Challenge Events in

this manual and at:

http://rabiesalliance.org/world- rabies-

day/ideas/

3. Your activity Once you’ve decided on your activity, as

a team you need to determine the scope

of the event, the targeted beneficiaries,

your budget and partners.

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4. Set up a detailed action plan Initial meeting: at a convenient time and

place for all of you, discuss your event –

you may find the event checklist

(appendix 3) useful for this – and create a

detailed list of actions, a budget, a

timeline, and clearly identify who is

responsible for what. Prepare work

tables/sheets with specific tasks and go

through the plan one step at the time.

Be clear about what you expect each

team member to do. To avoid

misunderstandings and possible

resentments, make sure you all

understand what others are doing too.

Repeat the most important things more

than once – people tend to forget.

Continue to be transparent in your work

and communicate updates among

yourselves on a regular basis (at least

once a week), so that you all stay in the

loop. Organize other meetings according

to need.

Setting Up An Event

There are steps that will help you to organise your event – but please don’t forget to have a good time in the process!

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5. Fundraising

Before you start fundraising carefully

consider exactly what you need. Then

determine who can help you and how

they can help you. Make sure you clearly

ask for specific things. The kind of

fundraising you do obviously depends

on what is acceptable in your country but

some examples are given below:

w Holding a cake (or bake) sale,

w Asking for sponsorship to complete

a task – e.g. a sponsored run, bike

ride or swim,

w Holding a raffle (local businesses

may supply prizes or you could

consider a 50/50 format where the

raffle winner takes 50% of the target

amount and your team takes the

other 50%.)

6. Extra volunteers If you need extra volunteers for your

event, start with a general call among

students at your university – it helps (but

is not essential) if they are from different

sectors, particularly if they are going to

be part of the team. Advertise in places

that students gather (mess hall,

dormitory, library, computer room,

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departmental notice boards, favourite

café or bar), as well on the university

email network or website, if one is

available to you. If you find it difficult to

recruit volunteers, try approaching local

NGOs or youth centres.

7. Externals Whether you’re coordinating the One

Health Challenge locally or nationally, do

some research on institutions, services,

governmental and non-governmental

organizations or special programs that

deal with rabies – these are called

externals. They can support your event

by providing other contacts, writing

letters of support, sharing their

publications and materials, providing

additional volunteers, facilities,

equipment or professionals (lecturers,

designers, etc.) and financial support.

Businesses may support you by either by

directly donating to your project

(sometimes in return for advertising at

your event) or by providing services in

kind (e.g. providing refreshments for

your volunteers, covering printing costs,

helping with sterile waste services, etc.)

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pictures, video and comments from

attendees. Otherwise this is easily

forgotten and you need it for the report

and your own social media efforts.

Remember also to collect any press

clippings.

12. Debrief Have a final meeting after the activity to

evaluate how it went. What went well?

What could have been better? This is

valuable feedback for organizing events

in the future.

13. Thank you Remember to thank those who

supported the activity, especially if they

donated money or materials–a nice thank

you note goes a long way! It may make

people more willing to support you in

the future.

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8. Training It is always best to set aside at least 2

hours to discuss rabies (see All about

rabies – appendix 1, and

http://rabiesalliance.org/rabies/what-is-

rabies-and-frequently-asked- questions/,

how to best approach people or answer

questions when approached, and How to

handle the media (appendix 4). This

session will make your group more

cohesive, and give you the time and

opportunity to express your concerns or

ask questions.

9. Media Work with the media to maximise the

reach and impact of your activity. Issue a

press release. You could even consider

organizing a press conference! Again,

this is covered in How to handle the

media (appendix 4).

10. Review How are things going? Do you need to

make adjustments to your plan?

11. Conduct the event Use the checklist (appendix 3) – or your

modified version –to stay on track and

make sure nothing is overlooked. Make

one person responsible for taking

Remember to thank those who supported

your activity.

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Ideas for One Health Challenge activities

w Organize World Rabies

Day information stands at

a community event or

centre

w Mobile team units /

outreach – distributing

materials in places where

you don’t have a

information stand, or

holding workshops in

remote communities

w Indoor stands in

pharmacies or drug stores

w Art performance /

installations – in the street

or following other

organised events

w Play or skits

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w Posters, photographs or

drawing exhibits

w Graffiti, creative writing or

art contests – for young

people

w Video airing – with or

without facilitated

discussions afterwards

w Joint efforts – candlelight

walk, ringing bells, holding

hands

w Together Against Rabies

theme parties or concerts

w National sport events –

have a short speech about

rabies and hand out

leaflets

w Local sport events –

organize a team Together

Against Rabies

tournament

Troubleshooting

All of the steps can be used anywhere in the world for the One Health Challenge, with

modifications according to your local/national situation. Some steps can be done in parallel,

while others really need to wait until the previous step is successfully completed. If you find

things aren’t going to plan, adapt and change them a bit to make it work.

Some ideas – like organizing community education workshops, having an information stand at

the university with educational materials and posters from http://rabiesalliance.org/resources/,

or organising a theme party – can be done with relatively few resources. Something can always

be done; be creative!

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w Peer education workshops

– for students from other

fields to increase

awareness about the

need for rabies

vaccinations

w Organize interactive

lectures or round table

discussions with externals

w Organise a mass dog

vaccination event with

your local clinic or animal

welfare group

w Organise sessions in

schools to teach about

dog bite prevention,

rabies and responsible

pet care - we have a lot of

resources for children –

http://rabiesalliance.org/re

sources/teaching-children/

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Sharing your activities Remember to share your wonderful work with everyone – put it on your website, if you have one,

post it on your Facebook page, send emails to your friends, families and supporters (if you’re part

of an organisation), add it to your newsletter, put it on the community notice boards, ask

journalists to cover the event in your local newspaper or magazines, speak on a radio show, write

an article for a student magazine, hold a press conference – these are just examples – there are

many other ways to share your work with your community and beyond.

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Using social media More and more people are using

social media to find information

about health and you can use

social media to promote your One

Health Challenge activities. This

document provides an outline of

how to get results from social

media for those who are not

familiar with these networks.

How to get results: Partner, Promote, Cross-Promote The interactive nature of social

media provides an ideal

opportunity to share your World

Rabies Day messages with current,

new, and emerging audiences.

Reaching these audiences across

social media involves three steps:

partner, promote, cross-promote.

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Partner - Establish relationships with organizations involved

in rabies prevention and overlapping issues

w Health departments, colleges of public health and

veterinary medicine, human health care, animal

welfare organizations

w Like:

o facebook.com/thescoh

o facebook.com/ifmsa

o facebook.com/GlobalAllianceforRabiesControl

w Follow

o @rabiesalliance

o @IvsaScoh

o @ifmsa

Promote - Distribute your messages to them

w Send messages or tweets about rabies to friends,

post educational or awareness messages, update

your status to include a countdown to World Rabies

Day

Cross-promote - Interact with audiences to create links

between different rabies resources and messages

w Retweet, follow media outlets and watch for

opportunities to alert them to events


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How to handle the media Contacting the media may seem daunting at

first but journalists are always looking for new

stories. Every year World Rabies Day makes

the news and more news means greater

awareness about rabies.

What are you going to say? New press releases that you can modify will

be available on rabiesalliance.org from

September 1, 2014. These will include the

latest facts and figures about rabies and

quotes from leading figures. You can also

include references to other events taking

place in your country, comments from

relevant government departments (health,

agriculture and/or animal health), and rabies

statistics.

When are you going to contact them? We recommend that you send your press

release to the media one week before your

event. Follow up again with a telephone call

later in the week.

Who are you going to contact? Finding the best person to contact is

sometimes challenging. It is often worth

making enquiries about who to contact as

part of your planning. Study the publications

you plan to approach. These could be local or

national newspapers, relevant magazines and

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websites, and TV and radio news channels.

Note the names of journalists who have

covered other public health related issues.

Most press releases are sent via email and this

is quickest and cheapest. However,

sometimes a traditional letter can stand out as

something different and attract a journalist’s

attention long enough to engage them in

your story. Whatever you do, follow up with a

telephone call later in the week to see if they

have had a chance to read the press release

and ask if they want more information.

Why will they be interested in your story? This is an important question to ask yourself.

To answer it you need to think about whom

you are contacting, who their audience is, and

how you can tailor your approach. It may

sound obvious but local outlets will be

interested in local stories, national outlets will

require details of national significance,

publications aimed at young people will want

a story that appeals to their audience, and so

on. You can use appendix 1, All About

Rabies, and other documents on

rabiesalliance.org to help you to add relevant

details.

The Amnesty International Campaigning

Manual has a press conference guide list.

"Mycobac t e rium t ube rculos is " Pho t o Cred it : Janice Carr Cont e nt Providers (s ) : CDC/ Dr. Ray But le r; Cent e rs for Dis eas e Cont rol and Prevent ion' s Public Hea lt h Image Library (PHIL) "Gruzlica pluc2 " by Krzys zt ofM at p l.wikipe dia. Lice nsed unde r CC BY-SA 2 .5 via Wikimedia Commons "Mycobac t e rium t ube rculos is MEB" by NIAID on Flickr. - Lice nse d under Public Domain via Wikimedia Commons "VariousPills " by Morgue File : se e [1 ] . Licensed under CC BY-SA 3 .0 via Wikimed ia Commons “Tube rculos is Med icat ion” from: ht t p :/ / sc it echdaily.com/ t uberculos is -res is t ance-t o-backup-drugs-increases / “Hand milking a cow” By St at e Library of Sout h Aus t ralia (Flickr:) via Wikime dia Commons By De part ment of Fore ign Affairs and Trade , Aus t ralia , via Wikimedia Commons

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