Reach. Treat. Cure. Everyone.
Stop Tuberculosis
w
Contents P1
Message from IVSA, IFMSA and IPSF
P3 Multidrug resistant tuberculosis
P8
Collaboration wď ˇ
Event registration
P9 More Resources
1 2
Dear IVSA, IFMSA, and IPSF members, Meeting,
We are encouraging YOU to join the fight to “Reach, Treat, Cure Everyone.”
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
Under
the
umbrella
of
the
Stop
TB
multidrug resistant TB (MDR-TB). Globally in
Campaign’s call to "Reach, Treat, Cure
2013,
Everyone" for Stop TB Day 2015, we are
developed MDR-TB. About half died from the
linking forces to raise awareness and
disease.
advocate for better treatment.
inappropriate treatment or the use of poor
an
estimated
480,000
people
The primary cause of MDR-TB is
quality drugs, as MDR bacteria do not The
International
Students’
respond to at least isoniazid and rifampicin,
Association (IVSA) is the largest veterinary
the two most powerful first line drugs.
student association in the world, representing
Treatment for MDR-TB is not always available
around 30,000 students in more than 40
and requires up to two years of treatment.
countries. Medical
Veterinary
The International Federation of Students’
Associations
(IFMSA)
represents more than a million medical students in 116 countries. International Federation
Finally, the
Pharmaceutical (IPSF)
Students’
represents
350,000
pharmacy students and recent graduates in
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
70 countries worldwide.
the human TB epidemic is on the rise,
IVSA, IFMSA, and IPSF have a short but
of human TB cases. M. bovis and the more
vibrant history of collaboration.
common bacterial
reported in Tanzania to be the cause of 4-10% There are
cause
of
human
TB,
formal and informal partnership agreements
Mycobacterium tuberculosis, often present
between each of the three organisations to
very similar clinical pictures.
acknowledge
for
can require different treatment. Few hospitals
While
have the diagnostic capacity to distinguish
multidisciplinary
and
make
collaboration.
plans
attending the recent WHO Executive Board
However, they
between them. 1
1 2
Dear IVSA, IFMSA, and IPSF members, Patients with M. bovis often do not respond
more attention is being given to the One
to drugs that are commonly used to treat TB,
Health initiative, the concept that animal,
which can have fatal results. Just like with
human,
MDR-TB, more expensive or less available
inextricably
drugs are needed. In addition, inappropriate
organization partners, IVSA, IFMSA, and IPSF
use of drugs can accelerate the development
recognize that we are not working by
of MDR-TB.
ourselves but are seeking and promoting
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 of
meetings
between that group and representatives from the ministries health
of
and
production
environmental linked.
interprofessional
human livestock
As
health
three
are
student
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, but build strong bonds between the professions.
livestock ministry, and a series
and
(WHO,
Together we will not only educate, promote appropriate
diagnosis,
and
awareness
raise
about
treatment
protocols that will heal even
more
people,
prevent MDR-TB, and
2006). The breadth of this collaboration has
help accelerate the decline of tuberculosis,
the
but
potential
appropriate
to
increase
diagnosis
access
and
to
treatment,
build
strong
bonds
between
the
professions that will last into the future.
reducing the number of TB cases both locally and worldwide. This is the kind of work we can start doing right now, together!
Love, Sarah (IVSA Chair of the Standing
Experience in this kind of multidisciplinary
Committee on One Health)
collaboration should start at university training
Ska nder (IFMSA Chair of the Standing
level. When we achieve this, multidisciplinary
Committee on Public Health)
collaboration within the next generation of
Barbara (IPSF Chair of Public Health)
healthcare
workers
will
be
even
more
successful than it already is. On a global level, 2
P4 Resistance P5 Current and Future P7 WHO Poster
multidrug-resistant
Tuberculosis
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
WHO Definitions â—? Multidrug-resistant
tuberculosis
( M D R - T B ) is caused by bacteria that do not respond to at least isoniazid and
rifampicin,
the
two
most
powerful, first-line anti-TB drugs. â—? Extensive
drug
resistant
tuberculosis ( X D R - T B ) is a form of multidrug-resistant tuberculosis that does
not
respond
to
the
most
effective second-line anti-TB drugs such
amikacin,
kanamycin
and
and is mainly emerging in areas with
fluoroquinolones, which are even less
weak tuberculosis surveillance.
available.
3
Development of Resistance Consequences of multidrug-resistance Resistance to effective firstline
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
approximately
was
responsible
for the death of 210 000 people worldwide.
4
1 2
Current
Situation
An estimated 480 000 people developed
MDR-TB remains unchanged, but there is a
MDR-TB in 2013. Extensively drug-resistant
severe risk of MDR-TB epidemics in quite some
tuberculosis (XDR-TB) has been reported in 100
countries. Furthermore there is still a major
countries, while an estimated 9.0% of people
diagnostic gap, thus an estimate of 55% of
with MDR-TB have also XDR-TB.
reported tuberculosis patients who have MDR-
Analysis comparing data of former years
TB were not detected.
show that the proportion of new cases with
5
1 2
Future Perspectives 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: 1. Set
prevention
of
multidrug
4. Prevent
transmission
through
resistance as a first priority by
infection control by implementing
ensuring
high
appropriate
evidence
based
quality
and
treatment
of
up
rapid
testing
and
control
quickly
enroll
diagnosed patients in effective
drug-susceptible tuberculosis; 2. Scale
measures
infection
and
treatment plans to minimize the risk of disease transmission; and
detection of all MDR-TB; to
5. Underpin and sustain the MDR-
effective treatment and proper
TB response through high level
care, including adequate supplies
political
of quality drugs and a scaled up
leadership
country
governmental sectors and ensure
3. Provide
prompt
capacity
services;
access
to
deliver
commitment, across
strong multiple
adequate financing for care and research.
There is hope 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.
6
Š Wo rld He a lt h Org an iz a t io n 2 0 1 4
7
8
Collaboration Group s of veterinary, pharmacy, and medical students are joining forces all over the world to tackle Tuberculosis! The World Health Organization outlines basic steps of interorganizational collaboration: Check out the Framework for Action at: w https://www.uea.ac.uk/documents/4006821/4007300/FMH++CIPP+-+Framework+for+Action.pdf/6e15515c-0744-45cd97b4-15fcc344113d Register your campaign HERE: w https://docs.google.com/forms/d/1vzQoxUNcQS1LPiiXPYplpKW8JwRSu4eCS5NYCEed-4/viewform?c=0&w=1 L ink s: 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
9
Other
Resources
P11
IVSA 2015 Stop Tuberculosis Informative Leaflet
P15
Guidance Manual World Rabies Day 2014 – How to Plan an Event
10
1 2
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.
Importance
Where is it found?
Today TB remains an important disease of
TB is found throughout the world. The
cattle, wild animals, and is a significant
disease is more prevalent in most of Africa,
zoonosis (a disease of animals which can
some parts of Asia and America.
also infect humans). Tuberculosis today remains an epidemic in much of the world, causing the deaths of nearly one-and-ahalf million people each year, mostly in developing countries.
11
1 2
Veterinary Significance: Excerpt from IVSA 2015 Stop Tuberculosis Informative Leaflet Transmission
Clinical Signs in Cattle
The disease is contagious
humans.
and spread by contact with
people
to
TB usually has a prolonged
through
course, and symptoms take
infected domestic and wild
consumption of unpasteurized
months or years to appear. The
animals. The usual route of
milk and unpasteurized milk
usual clinical signs include:
infection
products
is
by
inhaling
infected droplets which are
Transmission can
occur
from
infected
w Weakness,
animals.
w Loss of appetite
expelled from the lungs by and
It is also possible to contract
humans can also become
M.bovis infection by inhaling
infected by ingesting raw
the bacteria shed by infectious
milk from infected cows.
animals
coughing.
Calves
in
respiratory
w Weight-loss w Fluctuating fever w Intermittent hacking cough
and
w Diarrhea
other secretions, or through Transmission of M.bovis can
contamination of unprotected
occur
cuts or abrasions in the skin
between
animals,
from animals to humans and
while
handling
more rarely, from humans to
animals
or
animals
although this is rare.
and
between
their
w Large prominent lymph nodes
infected
However, the bacteria can also
carcasses,
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
Diagnosis
pus.
Infection
acquired
through consuming dairy or other food products containing
The standard method for detection of TB is the tuberculin test,
M.bovis may affect any part of
where a small amount of antigen is injected into the skin, and
the body.
the immune reaction is measured. Definitive diagnosis is made by growing the bacteria in the laboratory, a process that takes at least eight weeks. 12
Veterinary Significance: Excerpt from IVSA 2015 Stop Tuberculosis Informative Leaflet
Treatment of infected animals is rarely
A Veterinarian’s
attempted because of the high cost, lengthy
Role
time and the larger goal of eliminating the disease.
What should you do as a VET to prevent and control bovine tuberculosis?
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
The standard control measure applied to TB
with testing to eliminate the disease. A
is test and slaughter:
number of new candidate vaccines are
w Post-mortem meat inspection to look for
currently being tested.
tubercles in the lungs and lymph nodes. o Prevents
unsafe
meat
from
The role of veterinarians is to reduce the
entering the food chain and allows
risk of exposure to bovine TB bacteria,
veterinary services to trace the
especially on farms. A veterinarian should
herd of the infected animal, which
have a good knowledge about bovine TB
can then be tested and eliminated
transmission routes and available control
if needed.
measures to raise awareness of possible risks
w Intensive surveillance including on-farm visits
from
contaminated
frequented
by
aerosols
farm
in
workers
areas
and
the
w Systematic individual testing of cattle
importance of good hygiene. Working with
w Removal of infected and in-contact
livestock may involve close contact with
animals w Movement controls and quarantine
carrier
animals
or
animals
with
active
tuberculosis. Relevant regulations require farmers to adopt appropriate measures to
Pasteurisation of milk of infected animals to a
minimize exposure of employees and farm
temperature sufficient to kill the bacteria has
visitors to infections that can be transmitted
prevented the spread of disease in humans.
to humans from animals.
13
Veterinary Significance: Excerpt from IVSA 2015 Stop Tuberculosis Informative Leaflet
A veter inarian should advise peo ple 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
Veterinarians and doctors are working together to make people aware of the importance of prevention.
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.
14
1 2
Event Ideas and Instructions: Excerpt from Guidance Manual World Rabies Day 2014 – A One Health Challenge
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! 1.
Team
4. Set up a detailed action plan
Set up a team– a minimum of 2 and
Initial meeting: at a convenient time and
maximum of 5 members, with at least
place for all of you, discuss your event –
one veterinary student or one medical
you
student.
decision-making
(appendix 3) useful for this – and create a
and nourishing of the team spirit are
detailed list of actions, a budget, a
important, but it should be clear who is
timeline, and clearly identify who is
responsible for each part of the plan and
responsible
what each team member expects from
tables/sheets with specific tasks and go
the event.
through the plan one step at the time.
Democratic
2. Ideas
may
find
for
the
event
what.
checklist
Prepare
work
Be clear about what you expect each team
member
to
do.
To
Brainstorm ideas and possibilities. There
misunderstandings
are some examples of other events in
resentments,
Ideas for One Health Challenge Events in
understand what others are doing too.
this manual and at:
Repeat the most important things more
http://rabiesalliance.org/world- rabies-
than once – people tend to forget.
day/ideas/
Continue to be transparent in your work
3. Your activity
and
make
communicate
and
avoid
sure
updates
possible you
all
among
yourselves on a regular basis (at least
Once you’ve decided on your activity, as
once a week), so that you all stay in the
a team you need to determine the scope
loop. Organize other meetings according
of the event, the targeted beneficiaries,
to need.
your budget and partners. 15
1 2
Event Ideas and Instructions: Excerpt from Guidance Manual World Rabies Day 2014 – A One Health Challenge 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:
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
w Holding a cake (or bake) sale,
Health Challenge locally or nationally, do
w Asking for sponsorship to complete
some research on institutions, services,
a task – e.g. a sponsored run, bike
governmental
and
non-governmental
ride or swim,
organizations or special programs that
w Holding a raffle (local businesses
deal with rabies – these are called
may supply prizes or you could
externals. They can support your event
consider a 50/50 format where the
by providing other contacts, writing
raffle winner takes 50% of the target
letters
amount and your team takes the
publications and materials, providing
other 50%.)
additional
of
support,
sharing
volunteers,
their
facilities,
equipment or professionals (lecturers, 6. Extra volunteers
designers, etc.) and financial support.
If you need extra volunteers for your event, start with a general call among
Businesses may support you by either by
students at your university – it helps (but
directly
is not essential) if they are from different
(sometimes in return for advertising at
sectors, particularly if they are going to
your event) or by providing services in
be part of the team. Advertise in places
kind (e.g. providing refreshments for
that students gather (mess hall,
your volunteers, covering printing costs,
dormitory, library, computer room,
helping with sterile waste services, etc.)
donating
to
your
project
16
2 1
Event Ideas and Instructions: Excerpt from Guidance Manual World Rabies Day 2014 – A One Health Challenge
pictures, video and comments from
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-israbies-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).
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.
Remember to thank those who supported your activity. 13. Thank you Remember
to
thank
those
who
supported the activity, especially if they donated money or materials–a nice thank
10. Review How are things going? Do you need to make adjustments to your plan? 11.
attendees.
you note goes a long way! It may make people more willing to support you in the future.
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
17
1 2 3
Event Ideas and Instructions: Excerpt from Guidance Manual World Rabies Day 2014 – A One Health Challenge 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!
Ideas for One Health
fields to increase
Organize World Rabies
art contests – for young
Day information stands at
awareness about the
people
need for rabies
Video airing – with or
vaccinations
w
w
centre
without facilitated
Mobile team units /
discussions afterwards
lectures or round table
Joint efforts – candlelight
discussions with externals
w
Organize interactive
walk, ringing bells, holding
you don’t have a
hands
vaccination event with
Together Against Rabies
your local clinic or animal
theme parties or concerts
welfare group
w
holding workshops in remote communities
w
National sport events –
w
w
Organise a mass dog
Organise sessions in
Indoor stands in
have a short speech about
pharmacies or drug stores
schools to teach about
rabies and hand out
Art performance /
dog bite prevention,
leaflets
rabies and responsible
Local sport events –
pet care - we have a lot of
or following other
organize a team Together
organised events
resources for children –
Against Rabies
http://rabiesalliance.org/re
Play or skits
tournament
sources/teaching-children/
installations – in the street
w
w
materials in places where information stand, or
w
Peer education workshops
Graffiti, creative writing or
outreach – distributing
w
w
– for students from other
a community event or w
Posters, photographs or drawing exhibits
Challenge activities w
w
w
18
1 2
Event Ideas and Instructions: Excerpt from Guidance Manual World Rabies Day 2014 – A One Health Challenge 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.
Using social media
Partner - Establish relationships with organizations involved
More and more people are using
in rabies prevention and overlapping issues
social media to find information
w
veterinary medicine, human health care, animal
about health and you can use social media to promote your One Health Challenge activities. This
welfare organizations w
o facebook.com/ifmsa
how to get results from social familiar with these networks.
o facebook.com/GlobalAllianceforRabiesControl w
Promote, Cross-Promote The interactive nature of social provides
an
Follow o @rabiesalliance o @IvsaScoh
How to get results: Partner,
media
Like: o facebook.com/thescoh
document provides an outline of media for those who are not
Health departments, colleges of public health and
ideal
o @ifmsa Promote - Distribute your messages to them w
post educational or awareness messages, update
opportunity to share your World
your status to include a countdown to World Rabies
Rabies Day messages with current, new, and emerging audiences. Reaching these audiences across social media involves three steps: partner, promote, cross-promote.
Send messages or tweets about rabies to friends,
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
19
1 2
Event Ideas and Instructions: Excerpt from Guidance Manual World Rabies Day 2014 – A One Health Challenge How to handle the media
websites, and TV and radio news channels.
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
Note the names of journalists who have covered other public health related issues. Most press releases are sent via email and this
awareness about rabies.
is
What are you going to say?
something different and attract a journalist’s
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,
and
cheapest.
However,
sometimes a traditional letter can stand out as
New press releases that you can modify will be
quickest
comments
from
relevant government departments (health, agriculture and/or animal health), and rabies
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
statistics.
you are contacting, who their audience is, and
When are you going to contact them?
sound obvious but local outlets will be
how you can tailor your approach. It may
We recommend that you send your press release to the media one week before your event. Follow up again with a telephone call
interested in local stories, national outlets will require
details
of
national
significance,
publications aimed at young people will want
later in the week.
a story that appeals to their audience, and so
Who are you going to contact?
Rabies,
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
on. You can use appendix 1, All About and
other
documents
on
rabiesalliance.org to help you to add relevant details. The
Amnesty
International
Campaigning
Manual has a press conference guide list.
national newspapers, relevant magazines and
20
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