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IVSA Informative Leaflet

Discover  Bovine TB  Vet’s Role


Introduction by IVSA Standing Committee on One Health

Dear students, As the Chairman of the IVSA Standing Committee on One Health and also the ExCo Veterinary Public Health Director, I am glad to present you our World Tuberculosis Day leaflet which is a starter informative publication for our IVSA SCOH Tuberculosis Awareness Campaign “Stop TB”. The purpose of this Campaign as well as this publication is to inform students about the Tuberculosis (TB) as a worldwide dangerous disease and especially about the Veterinarian’s Role in TB and the importance of collaboration not only in a local level but also globally. I need to express many thanks to our former IVSA Tunisia President, former Chief Exchange Officer, SCOH member and Trustee: Ines Ben Jebara for the whole co-ordination of SCOH’s project on WTD. In addition, I would like to thank all the creative and active Member Organizations of IVSA which run to help and participate in SCOH’s global projects! Finally, I would like to inform you that IVSA became partner with the organization STOP TB (Turkey Symposium 2014, GA approved) and to thank also the IPSF Chairperson of Public Health Sheena Patel (International Pharmaceutical Students’ Federation) and the IFMSA SCOPH Director Petar Velikov (International Federation of Medical Students’ Associations) to introduce this leaflet in order to show the importance of collaboration for coming up against difficult situations and conditions related to public health and also to show our upcoming collaborations mood. So, entertain yourself. Learn about TB. Spread the information and use your knowledge to eliminate it. Theofanis K. Liatis ExCo Veterinary Public Health Director 2013/2014 Chairman of IVSA Standing Committee on One Health 2013/2014

24 March 2014

Dear IVSA members around the world, As you may all know, on 24 March, World Tuberculosis Day is celebrated. This year, SCOH plays an important role to enhance the mission of veterinarians as an active member working in the public health field. IVSA SCOH strives to show you veterinary, medical related students and health professionals how simple it is to eradicate TB if we will work hand in hand for a healthier world. I’m pleased to be a coordinator of the IVSA campaign to fight Tuberculosis and help you organizing an awareness campaign in your country. There are interesting informations in this leaflet that the general public is unaware of it and it’s our duty as future veterinarians to share it and make people aware that simple acts can prevent them. This year, many IVSA chapters and partners agreed to think globally and act locally to STOP TB. Thank you in advance for your contribution and remember that fighting Tuberculosis is not only for a day but it’s a mission for every year of your carrier as a vet.

Ines Ben Jebara IVSA Tuberculosis Awareness Campaign Co-ordinator Member of IVSA Standing Committee on One Health 2013/2014 Trustee 2013/2014

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Introduction by IPSF Chairperson on Public Health According to the World Health Organization, Tuberculosis is the second greatest killer worldwide due to a single infection. This fact among many others motivates us as an organization to fight this disease. Hello everyone, my name is Sheena Patel, and I am the current Chairperson of Public Health of the International Pharmaceutical Students’ Federation (IPSF). IPSF is a Federation that represents more than 270,000 pharmacy students and recent graduates in 67 countries worldwide. Our goal as a Federation is to improve public health through provision of information, education, networking, and a range of publication and professional activities. We are an organization of Pharmacists that play one of many key roles in preventing the spread of this disease. Patients who have Tuberculosis have to deal with many medications and complex medication regimens. If they do not follow this treatment plan, not only will patient be at risk for Multidrug-resistant Tuberculosis (MDR-TB), but also an increased risk of death. Our goal as a Pharmacist is to protect our patients. This goal comes in varying degrees as Pharmacy is not practiced the same in every country. For example, in developing countries access to medications for treatment of Tuberculosis is very limited. Even if the resources are available the treatment regimens are too complex for many patients to following which will lead to MDR-TB. MDR-TB is a common occurrence not only in developing countries, but also in developed countries. This is an occurrence where patients take the medications but do not comply or follow the regimens to a ‘T.’ When patients want to restart their Tuberculosis treatments, the disease may become resistant to our standard medications. Then what happens? We as Pharmacists begin to dispense medications that are not as effective in fighting the disease and may cause more side effects for the patients. This is a lose-lose situation for patients because the disease begins to worsen until there are limited treatment options for the patients. So how do we as Pharmacists fight this problem? Well there are multiple things we can do, but the big one is: COUNSEL. We have a duty to protect our patients and the best way to do this is through counseling. Pharmacists, when dispensing these medications, will discuss with the patient in depth on the risks of not following the medication regimens. They will discuss how to take the medications, how long, and the side effects that may come from

taking these medications. In USA, for example, patients are followed by their local health department to ensure compliance with medications. The goal of monitoring patients is to prevent the spread of the disease, but also to protect the patient. Now how does this relate to IVSA? Simple: education. We as IPSF members can provide resources and tools that can help educate not only our patients but our colleagues. Members of IVSA can learn about TB and our focus on the medication aspect of treating Tuberculosis. Both organizations can hold education sessions through videos, webinars, handouts and so much more. Also group projects and initiatives can be created that not only educate our respective members but also our patients. This is a unique opportunity to really become one with the healthcare team you work with on a day to day basis. Collaboration creates an atmosphere that can be seen in practice, which will help not only our patients but other healthcare professionals. Hopefully after reading this article you have gained a little bit of an insight on the role of Pharmacists and how they help combat the spread of Tuberculosis. You have also seen how working with each other can really help improve quality of care for everyone. We as an organization are Pharmacy based, but with collaborative efforts can learn and impact a wider range of people. Thank you,

Sheena Patel Chairperson of Public Health 2013/2014 International Pharmaceutical Students’ Federation

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Introduction by IFMSA Director of SCOPH Dear members and friends of SCOPH and IFMSA,

I write to you as we are all amidst planning and preparations for an intense week of activities around the 2014 World Tuberculosis Day – themed “Reaching the three million people with TB who are missed by health systems”. On occasion of this significant Day, we would like to extend our own message: In accordance with the World Tuberculosis (TB) Report, TB remains a major global health issue. In 2012, an estimated 8.6 million people developed TB and 1.3 million died from the disease. The number of TB deaths is unacceptably large given that most are preventable. Nearly 20 years after the WHO declaration of TB as a global public health emergency, major progress has been made towards 2015 global targets set within the context of the Millennium Development Goals (MDGs). Two years ahead of the deadline, the Global Tuberculosis Report 2013 and accompanying supplement Countdown to 2015 assess progress towards the 2015 targets and identified the top priority actions needed to achieve and/or move beyond them: 1. Reach the missed cases. About 3 million people who developed TB in 2012 are missed by the national notification systems. It is of great importance to detect people with the illness and ensure that that they get the right treatment and care by their health systems while also being supported nongovernmental organizations, community workers and volunteers to diagnose and report cases; in addition intensified collaboration with public hospitals and private health facilities who are treating patients but not reporting; instituting mandatory notification of cases in more countries; and better data compilation are needed. 2. Address Multi Drug Resistant - TB as a public health crisis. In high MDR-TB burden countries, increased capacity to diagnose MDR-TB must be matched with supplies of quality drugs and scaled-up country capacity to deliver effective treatment and care. This will require high-level political will and leadership and more collaboration among partners, including drug regulatory authorities, donor and technical agencies, civil society and the pharmaceutical industry.

3. Accelerate the response to TB/HIV. One of the top priorities include complete coverate of HIV-positive patients with TB. Preventive treatment among people living with HIV is the second priority. 4. Increase financing to close all resource gaps. An estimated US$ 7–8 billion per year is required for a full response to the TB epidemic in low- and middleincome countries in 2014 and 2015 (excluding research and development for new TB diagnostics, drugs and vaccines). Funding in 2013 is about US$ 6 billion. Increases in both domestic and donor financing are needed to close the gap of up to US$ 2 billion per year, including via the full replenishment of the Global Fund in 2013. Progress remains fragile and could be reversed without adequate funding. 5. Ensure rapid uptake of innovations. The fast uptake of new tools and strategies for better diagnosis, treatment and prevention of all forms of TB can be accelerated by country-specific operational research and translation of findings into policy and practice.

International Federation of Medical Students’ Associations

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Introduction by IFMSA Director of SCOPH “Imagine a world free of poverty. A world, where quality of life guarantees human dignity. A world, where everyone exercises basic human rights. A world, where all children will live to their fullest potential. That, is the dream the World Bank shares with all member nations. But, that dream will remain a mere dream, unless we join hands to overcome major global threats to the poor and the marginalized people around the world. Without question, tuberculosis is one such threat, and its control must be on the global development agenda.” Ms Mieko Nishimizu, Stop TB Partnership In the words of Ms. Nishimizu it is our belief that each person is to be made aware of the issue of spread of TB and receive access the proper ways to protect oneself and ones’ family from this burden. Good-quality primary health care and good quality public health services that are easily accessible are of vital importance. Prevention, early recognition and adequate treatment of TB must remain an integrated part of health care systems. All doctors must constantly be aware of the fact that TB is not an uncommon. They should be especially alert when they are dealing with immuno-compromised patients, patients from other countries or patients from the population of the homeless. Member Organizations of IFMSA have always been deeply involved in tackling Tuberculosis as a Public Health concern and annually organize an array of activities related to: • • •

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Screening for TB Educating the general public through awareness campaigns about TB Educating fellow students through peer education methods Advocating for development of improved strategies for earlier recognition of infection Contributing to making scientific advances that will enable earlier diagnosis as well as better therapies or vaccines

Malaria on occasion of the World TB Day 2014 related to how we can address the issue. http://www.stoptb.org/assets/documents/resources/publi cations/acsm/WORLD_TB_DAY_BROCHURE_14March .pdf The International Federation of Medical Students’ Associations (IFMSA) representing medical students from 110 countries, envisions a world in which all medical students unite for global health and are equipped with the knowledge, skills and values to take on health leadership roles locally and globally. Our mission is to unite medical students worldwide to lead initiatives that impact positively the communities we serve. IFMSA represents the opinions and ideas of future health professionals in the field of global health, and works in collaboration with external partners. IFMSA builds capacity through training, project and exchanges opportunities, while embracing cultural diversity so as to shape a sustainable and healthy future. As one of the 6 Standing Committees of the Federation, the Standing Committee On Public Health (SCOPH) works towards ensuring a healthy global society that is empowered through its knowledge, skills and opportunities to live a life of complete physical, mental and social well-being. By developing its’ members skills and knowledge though personal involvement and by engaging in and promoting population-based activities on an array of topics related to the Publics’ Health, we gain a global overview of the health issues and methods that are needed to solve these cross-cutting issues. Warmest of Regards, Petar Velikov Director on Public Health International Federation of Medical Students’ Associations

In order to better understand the issue of reaching out to the people with TB missed by the health systems we provide you with The Joint Brochure of the WHO, Stop TB Partnership and Global Fund to fight AIDS, TB and

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IVSA “Stop TB� Campaign 2014

What is Bovine Tuberculosis? 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 of Bovine Tuberculosis 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-ahalf million people each year, mostly in developing countries.

Understand TB

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Save Animal and Human Lives

Where the disease is 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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How is the disease transmitted? 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 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.

How is the Disease diagnosed? 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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What are the clinical signs in Cattle? TB usually has a prolonged course, and symptoms take months or years to appear. The usual clinical signs include: • Weakness, • Loss of appetite • Weight-loss • Fluctuating fever • Intermittent hacking cough • Diarrhea • Large prominent lymph nodes However, the bacteria can also lie dormant in the host without causing disease

Symptoms of TB 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 affects any part of the body.

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Tuberculosis Awareness Campaign “Stop TB” What should you do as a VET to prevent and control this disease? The standard control measure applied to TB is test and slaughter.  Disease eradication programs consisting of post mortem meat inspection  intensive surveillance including on-farm visits  systematic individual testing of cattle and removal of infected and in-contact animals as well as movement controls have been very successful in reducing or eliminating the disease.

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ďƒź Post mortem meat inspection of animals looks for the tubercles in the lungs and lymph nodes.

Detecting these infected animals prevents unsafe meat from entering the food chain and allows veterinary services to trace-back to the herd of origin of the infected animal which can then be tested and eliminated if needed. ďƒź 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.

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x 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. ďƒź The role of Veterinarians doctors to reduce the risk of exposure to bovine TB bacteria A veterinarian should have a good knowledge about the Bovine TB transmission routes and available control measures to raise the awareness of people and especially farmers in order to fight Tuberculosis.

ďƒź Reducing the risk of human M.bovis infection on farms Working with livestock may involve close contact with undetected infected 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. These include awareness of possible risks from contaminated aerosols in areas frequented by farm workers and awareness of the importance of a good hygiene.

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A veterinarian should advice people to:  Wash hands thoroughly several times a day and always before eating, smoking and after finishing work for the day

 Wash skin wounds immediately with soap and running water and cover with a water proof dressing  Avoid drinking milk that has not been pasteurised or boiled, or eating dairy products made with raw milk.  Do not drink, eat or smoke in animal areas  Where possible, minimise handling of reactor cattle or other suspect animals, particularly around their head area. If you will touch a suspect animal, you should wear gloves and face mask.  Inform your veterinarian if you have any doubt that your animal has the symptoms of Tuberculosis and doctor if you have been in contact with a suspect animal or someone suffering from Tuberculosis.  Veterinarians and doctors are working together to make people aware about the importance of prevention.

bibliography www.oie.int www.defra.gov.uk www.publications.parliament.uk

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Support by Stop TB Partnership The Stop TB Partnership is leading the way to a world without tuberculosis (TB), a disease that is curable but still kills three people every minute. Founded in 2001, the Partnership's mission is to serve every person who is vulnerable to TB and ensure that high-quality treatment is available to all who need it. With nearly 1000 partners Stop TB is a collective force that is transforming the fight against TB in more than 100 countries. They include international and technical organizations, government programmes, research and funding agencies, foundations, NGOs, civil society and community groups and the private sector. Stop TB operates through a secretariat hosted by the World Health Organization (WHO) in Geneva, Switzerland and seven working groups whose role is to accelerate progress on access to TB diagnosis and treatment; research and development for new TB

diagnostics, drugs and vaccines; and tackling drug resistant- and HIV-associated TB. The secretariat is governed by a coordinating board that sets strategic direction for the global fight against TB. The Partnership is recognized as a unique international body with the power to align actors all over the world in the fight against TB. The participation of a wide range of constituencies gives us credibility and the broad range of medical, social and financial expertises needed to defeat TB. IVSA became an official partner of Stop TB this year by the approval of the General Assembly in the 62nd IVSA Symposium in Ankara, Turkey.

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IVSA Member Organizations event holders directed by Local Veterinary Public Health Officers

11 IVSA Member Organizations

IVSA Thessaloniki IVSA India IVSA Nepal IVSA Bangladesh IVSA (SAVMA) Grenada IVSA Tunisia IVSA Indonesia IVSA Palestine IVSA Thessaly IVSA Kosovo IVSA Portugal

The WTD Event Leaflet is

Coming Soon!

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It’s a project of IVSA Standing Committee on One Health (SCOH) and IVSA Local Veterinary Public Health

Officers (LoVPHOs)

Supported by Stop TB Partnership

© 2014 I V S A S TA N D I N G C O M M I T T E E O N O N E H E A LT H

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IVSA Thessaloniki

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IVSA Stop TB Campaign 2014 | Informative Leaflet