Multidrug resistant leprosy, Tuberculosis costs; Clinical trial problems; Milk formula mispercetions, Rheumatoid arthritis drug unavailable

Doctors in Shandong have reported China's first cases of multidrug resistant leprosy. Testing 85 samples of the causative bacteria Mycobacterium leprae, doctors found that some were resistant to  standard antibiotic treatments including dapsone, rifampin and ofloxacin.

In theory, tuberculosis treatment is free in China, but in reality patients  still face enormous out-of-pocket costs for treatment, a study from Jiangsu show. In a survey of treatment costs for people in the province, researchers from Nanjing Medical University found that the average cost per patient was as high as 19,000 yuan (US$3000). Even for patients who could claim back medical costs on their health insurance, out of pocket costs were still around 14,000 yuan ($2260) a year for clinic visits, hospital stays, tests and drug therapy.

Clinical trials are difficult to set up and run in China due to a lack of qualified and experienced clinical research staff and poor research infrastructure, an experts says. Dr Wu Yangfeng Wu of the Peking University Clinical Research Institute (PUCRI) said clinical trials required a pool of many hundreds of clinicians who were educated and well versed in basic research techniques - something which China lacked. He told Forbes that China's medical institutions also lacked  basic infrastructure and research management systems to conduct trials. There were also few allowances or rewards for doctors who took part in research, he added.

As many as one in five village doctors have latent tuberculosis, according to a study carried out in the Chinese province of Inner Mongolia. Dr He Guangxue and colleagues at the Chinese Center for Disease Control and Prevention, Beijing, surveyed 880 village doctors and found that 19.5% had positive tuberculin skin reactions. Latent tuberculosis risk was highest in doctors who had been in practice for a long time and for doctors who had more exposure to patients, they showed in PLOS One.

About 90% of Chinese mothers opt for milk formula within a month of giving birth, often driven by misguided beliefs and fears, a study from Sichuan has found. In a survey of 695 new mothers, 88% had initiated formula within 4 weeks of giving birth, often believing that babies slept better after fed with formula, and many believing they had insufficient breastmilk.

One of the best drug treatments for rheumatoid arthritis is out of reach for many Chinese patients because of cost, rheumatologists say. Chinese clinical experience with tocilizumab (Actemra) showed that it was highly effective and safe.  However, the high cost of the drug limits its prescribing in China, according to Dr Wang Geng of the Department of Rheumatology and Immunology, Changzheng Hospital, The Second Military Medical University, Shanghai.

Tropical diseases in China: one down, ten to go

by Michael Woodhead
China has eliminated one tropical disease - lymphatic filiarisis - but has ten others that are still affecting millions of people and some of which are becoming endemic again, according to a new report.
The good news from a review of China's tropical diseases published in The Lancet Infectious Diseases is that the country is on track to eradicate five major diseases (schistosomiasis, leishmaniasis, leprosy, rabies and trachoma) in the next five to ten years.  However, the not-so-good news is that some diseases are still uncontrolled and affect millions of people in poorer provinces of the south and west. The most problematic diseases are dengue fever, food-borne parasitic diseases such as liver flukes and Echinococcosis, according to the article by researchers at the Wuxi branch of the Ministry of Health. Professor Yang Guo Jing and colleagues from the Key Laboratory for Parasitic Diseases say that lymphatic filiarisis was eliminated from China in 2007 after a long campaign to remove it from 16 provinces by using mass drug administration techniques.
Tropical diseases in the 'near-elimination' stage include schistosomiasis, which has been successfully controlled in most parts of the country and numbers reduced from 12 million to 287,000 in 2011. The disease is spread by cattle and water buffalo, and thus changes in farming techniques are needed to help eliminate the disease. Similar improvements in control have been seen for leishmaniasis, the sandfly-spread protozoal infection which used to be common around the Yangtze river basin but now affects only about 2500 people a year. The bacterial infection trachoma that causes blindness is also close to elimination due to implementation of mass campaigns that apply WHO strategies such as facial cleanliness. Rabies has also been controlled, but still causes 2000-3000 cases a year. Immunisation of 70% of dogs at risk should break the cycle of infection, but currently only about 20% are vaccinated. Leprosy was reported to affect about 6000 people in China in 2010, of which about 1300 were new cases. Better surveillance and multi-drug treatment regimens should help eradicate the infection by 2020, the report suggests.
China has has less success with soil-transmitted helminthiasis, and there are about 85 million Chinese affected by roundworm and whipworm. De-worming of schoolchildren seems to have only modest efficacy, and so new strategies such as curbs on the use of human waste as fertiliser are needed, the report says.
The most problematic tropical diseases for China include dengue fever, with outbreaks of the mosquito-borne infection rapidly emerging as a major public health problem. Climate change is worsening the problem, which requires better monitoring and mosquito management strategies as there is no drug or vaccine for the disease.
Another major problem tropical disease for China are the food-borne parasitic zoonoses, such as liver flukes, lung flukes, and other trematodes that may be transmitted by fish, snails and freshwater plants. There are tens of millions of cases in China, which has the dubious honour of having 80% of the 15 million cases globally. New programs are needed to identify high risk disease areas and to address transmission of infection through occupational risk (eg farmers) and also consumption of high risk foods.
Control of these many tropical diseases will require huge  resources to build and design  programs specific for each disease and the high risk locations and populations they affect, the authors conclude.

Act early to stop leprosy, Guizhou expert urges

translated by Michael Woodhead
Leprosy is still a problem in some parts of China, but it can be controlled if detected and treated early enough, an infectious diseases expert from Guizhou has said.
Speakin in International Leprosy Action Week, Dr Li Jinlan of the Guizhou Centre for Disease Control and Prevention said leprosy is still present in poor districts parts of southern China where hygiene standards were low. He said leprosy needed warm and humid conditions to thrive, but it could be controlled if the symptoms were detected early and chemotherapy give. According to Guangming Daily, he urged Chinese citizens to remember the 'Three roots' to leprosy.  The first root is awareness of the the possibility of leprosy, especially in people who have a long-lasting rash, skin lumps, white spots and numbness of the skin. The second factor is to have experienced clinics that can recognise and treat leprosy in a timely way. The third root is to be not afraid of seeking diagnosis and treatment due to stigma. Dr Li said leprosy was often transmitted within families and relatives should arrange for anyone they suspect to have leprosy to be checked out.