2015 StopTB - Informational Toolkit

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

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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.

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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

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