Dengue vaccine – still a long way off says World Health Organization (WHO)

New York, NY, United States (IRIN) – Dengue fever is classed by the World Health Organization (WHO) as a “major international public health concern”. WHO estimates that it infects 50-100 million people a year; it is a leading cause of death among children in Asia and Latin America, and it is now spreading outside its traditional heartlands to Africa and the Middle East.

But dengue is difficult to deal with. There is no cure, only treatment for the symptoms. And although there are effective vaccines against related viruses, like yellow fever and Japanese encephalitis, no one has yet succeeded in making a safe, effective vaccine against dengue.

Now a team of researchers working with the French drug company Sanofi Pasteur has carried out a randomized trial of a possible vaccine, involving more than 4,000 schoolchildren in northern Thailand, and have produced some interesting results. Their vaccine was only partly effective but the team’s findings – reported in the British medical journal, the Lancet – suggest that the development of a useful vaccine is getting closer.

Derek Wallace of Sanofi-Pasteur, one of the authors of the report, hailed their results as an important step. “Our study constitutes the first ever demonstration that a safe and effective dengue vaccine is possible,” he says. “Further trials [of the vaccine] are currently under way in a number of different countries, and we hope that the positive results of this trial will be confirmed by these larger studies.”

The trial took place in Thailand’s Muang District, based at Ratchaburi Regional Hospital, and involved researchers from Bangkok’s Mahidol University. Children aged 4-11 from 35 local schools were enrolled in the trials. Two-thirds of them were given three doses of the vaccine, known as CYD-TDV (a recombinant, live, attenuated tetravalent vaccine, based on yellow fever 17D vaccine strain, produced in Vero cells). The control group received either rabies vaccine or a placebo.

The children were vaccinated three times, at six-monthly intervals, and the researchers looked at the presence of dengue antibodies in their blood, as well as checking all cases of fever, mild or serious, and recording which were due to dengue.

The results were mixed. While the vaccine appears to be safe and well tolerated, it had only a limited effect. It gave useful protection against three strains of the disease, those known as DENV 1, 3 and 4. But although the vaccinated children produced antibodies to DENV 2, they still caught the disease just as often as the children in the control group. And unfortunately DENV 2 is the most common strain of dengue fever in northern Thailand.

Caveats

Scott Halstead of the International Vaccine Institute in Seoul, points out that even these results were made less useful by the fact that they did not test the vaccine on teenagers, who are more likely to get the severe form of the disease. He said: “Results from this vaccine trial provide hard evidence of protection against DENV 1, 3 and 4 mild disease but insufficient data to calculate vaccine efficacy rates for severe disease. Future dengue vaccine trials should provide robust evidence of efficacy against severe disease by selecting populations weighted to assure inclusion of sufficient numbers of at risk children.”

Bill Messer, clinical assistant professor at the Division of Infectious Diseases in the University of North Carolina School of Medicine, is blunter, pointing out that Sanofi Pasteur has been trying to refine the vaccine for the past decade (it started presenting papers on it in about 2001) but that the vaccine still cannot produce a “robust” response.

“This [study] is an encouraging first step, but far from where we need to be. It did not show the vaccine can prevent severe cases. That is an important endpoint [for a dengue vaccine]. You need to show recipient populations protection against severe dengue in order to encourage [vaccination],” he said.

While most dengue patients do not have symptoms or only mild pain and a rash, up to 10 percent develop a lethal “severe” form of the disease (previously known as dengue haemorrhagic fever). Only five children in the study had severe dengue, too few to analyse, a limitation the authors noted was being corrected in ongoing studies with 30,000 adults and children in dengue-endemic countries.

Messer also said the number of people tested thus far in Thailand is insufficient to prove the vaccine will not cause severe dengue. Health experts have expressed concern that complications from a dengue vaccine may result in infection rather than confer protection.

Despite some positive results from the trials, it seems that a dengue vaccine is still a long way off.

(gantdaily.com)

Bali Tempat Pertemuan Menteri Asia Timur Bahas Sanitasi

Jakarta – Indonesia menjadi tuan rumah seminar internasional bidang kesehatan. Kali ini adalah konferensi 3rd East Asia Ministerial Conference on Sanitation and Hygiene (EASAN-3) yang akan digelar di Bali, mulai 10-12 September 2012 besok.

Pertemuan EASAN-3 mengagendakan komitmen dan usaha mencapai target MDG, memperkuat kerjasama diantara negara-negara Asia Timur dan regional lainnya, menggali sumber pendanaan untuk pembangunan sanitasi dan memperkuat upaya mengarahkan negara Asia Timur mencapai target MDG’s.

“EASAN-3 merupakan pertemuan dua tahunan Menteri di bidang sanitasi dan higiene negara Asia Timur,” tutur Direktur Penyehatan Lingkungan Kemenkes, Wilfried H Purba di Kementerian Kesehatan, belum lama ini.

Rencananya, acara ini dihadiri para menteri kesehatan dari negara-negara Asia Timur seperti Kamboja, Mongolia, Myanmar, Malaysia, Thailand, dan Timor Leste. Konferensi dua tahun sekali ini digelar untuk kali pertama di Beppu, Jepang dan Manila.

“Deklarasi Manila menekankan kerjasama negara-negara regional Asia Timur dalam pencapaian target MDG bidang sanitasi. Untuk deklarasi Bali nanti akan lebih membahas action plan yang lebih detail dalam usaha pencapaian MDG tahun 2015 dan upaya sesudahnya,” tuturnya. (tribunnews.com)

Asia fails to take up rotavirus vaccine

Bangkok, Thailand (IRIN) – Most countries in Asia have yet to make the rotavirus vaccine part of their national immunization programme (NIP), despite a World Health Organization (WHO) recommendation to do so.

“Timely vaccination with one of the two effective rotavirus vaccines [Rotarix and Rotateq] can prevent many cases of [rotavirus] illness and hospitalizations,” WHO’s Manila office said in an email to IRIN on 7 September. “WHO recommends the inclusion of rotavirus vaccine in the national immunization schedules of all countries.”

According to WHO, rotavirus is the most common cause of severe diarrhoeal disease in young children, with more than 500,000 children under the age of five dying worldwide each year. Highly contagious, the virus causes vomiting and severe diarrhoea that can lead to dehydration and potential death.

Children aged six months to two years are particularly vulnerable to infection. Worldwide, rotavirus accounts for 37 percent of all diarrhoea deaths in children under five with 95 percent of those deaths occurring in developing countries.

While the virus is treatable by providing fluids and salts, health experts note that it has a devastating and deadly impact in areas where people cannot access medical care. There are no antibiotics or any other drug to fight the infection and since 2009 WHO has recommended the global use of the rotavirus vaccine.

“For rotavirus vaccine the main aim is to prevent or reduce the severity of the first one or two infections in young children,” Tony Nelson, professor of paediatrics at the Chinese University of Hong Kong and member of the Rotavirus Organization of Technical Allies (ROTA council), told IRIN. “It is these first infections that are the most severe and most likely to cause life-threatening dehydration.”

The international health NGO PATH reports that in Asia 42 percent of all hospital admissions of children under five with diarrhoea are the result of rotavirus, while 188,000 children under five die each year.

“As many of these deaths and admissions could be prevented by vaccination, it is sad that very few countries in Asia have announced plans to include rotavirus vaccines in their NIPs,” Nelson said.

As of September 2012, 41 countries worldwide have introduced rotavirus vaccines in their NIPs. Four African countries – Botswana, Ghana, Rwanda and Sudan – have fully introduced the oral vaccine in their NIPs, while South Africa and Zambia introduced rotavirus vaccination on a regional basis.

However, only two countries in Asia – Philippines and Thailand – are vaccinating (or are about to) children against rotavirus: “Price continues to be an important barrier to introducing rotavirus vaccine,” WHO explained.

In July, Philippines started vaccinating an estimated 700,000 children each year aged 1.5-3.5 months from the poorest communities.

In the same month Thailand announced it will vaccinate regionally, but has yet to provide an actual launch date. (gantdaily.com)

Jakarta Berpeluang Jadi Pusat Medical Tourism

Sayangnya, rumah sakit yang ada di Indonesia belum mampu memenuhi standar kesehatan yang diinginkan oleh masyarakat modern.

Jakarta berpeluang menjadi pusat medical tourism dengan rumah sakit berteknologi tinggi dan pelayanan yang berkualitas. Demikian dikatakan Rizal Sini, Komisaris Utama PT Bundamedik.

“Kesadaran masyarakat khusus nya yang tinggal di kota-kota besar Indonesia terhadap kesehatan begitu tinggi sehingga menuntut tersedianya fasilitas kesehatan dan kedokteran berkualitas yang dapat memenuhi kebutuhan mereka. Ini peluang besar bagi rumah sakit di Jakarta, sekaligus menjadikan kota ini sebagai pusat medical tourism,” kata Rizal Sini di Jakarta, Rabu (5/9).

Dia menjelaskan, kesadaran kesehatan di masyarakat modern saat ini sudah tak sekadar tindakan pasif semata yaitu mengobati bila sudah terkena suatu penyakit ter tentu saja, namun telah berevolusi menjadi sebuah tindakan aktif dalam bentuk preventif.

“Mereka melakukan pemeriksaan-pemeriksaan rutin demi memantau riwayat kesehatan hingga terdeteksi lebih dini penyakit yang mungkin ada,” lanjut Rizal.

Sayangnya, lanjut Rizal, sepertinya rumah sakit yang ada di Indonesia terutama di Jakarta belum mampu memenuhi standar kesehatan yang diinginkan oleh masyarakat modern.

Akibatnya, sesal Rizal, mereka memilih berobat ke luar negeri, seperti Singapura, Malaysia, dan China, yang dianggap memiliki fasilitas kesehatan dan kedokteran terlengkap dengan didukung dokter-dokter berpe- ngalaman.

Indonesia, kata Rizal, telah kehilangan triliunan rupiah per tahun atas biaya medis yang dikeluarkan masyarakatnya di luar negeri. Menurut WHO, tahun 2010 angka ini berkisar sekitar Rp 7 triliun per tahun.

Fenomena ini mendasari Bundamedik Healthcare System segera meresmikan RSU Bunda Jakarta di Menteng, Jakarta Pusat, pada 12 September mendatang.

Peresmian rumah sakit yang menerapkan Robotic Surgery yang pertama di Indonesia ini akan dilakukan oleh Gubernur DKI Jakarta Fauzi Bowo dan Menteri Kesehatan RI Nafsiah Mboi.

Pada kesempatan ini juga sekaligus diresmikan kawasan Menteng Healthcare Boulevard Sentra diagnostik yaitu Bunda Philips International Radiodiagnostic Center yang akan dibuka oleh HE Ambassador Belanda.

“Sudah selayaknya kota Jakarta menjadi ikon baru dalam pelayanan perumahsakitan yang berkualitas dan menjadi sebagai pusat medical tourism seperti layaknya negara-negara tetangga, terutama untuk pasar domestik/nasional,”ujar Rizal. (Beritasatu.com)

SEA health ministers agree better policies on the elderly

Health ministers from the 11 member states of the World Health Organization Southeast Asia Regional Office (WHO SEARO) agreed on Tuesday to adopt the Yogyakarta Declaration on Aging and Health, and committed to improving national responses to the health of aging populations.

The declaration comes at an important juncture in history as 142 million people or 8 percent of the population of the region are above the age of 60. The figure is estimated to double by 2025 and treble by 2050.

“The WHO follows a life-course approach to promoting healthy, active aging. People who get the right start in life, follow healthy lifestyles and take good care of their health can expect to remain active during their eighth, ninth and even 10th decades of life,” WHO director general Margaret Chan said.

The adoption was made during the 30th health ministers meeting and the 65th session of the WHO regional committee for Southeast Asia in Yogyakarta, opened by Indonesian Vice President Boediono on Tuesday.

WHO SEARO groups together Bangladesh, Bhutan, South Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor Leste.

The declaration underscores concern that the economic effects of aging will impact on health care and social support systems and will require the attention of policy makers, NGOs and the private sector.

The ministers also recognized that healthy aging should optimize opportunities for the physical, social and mental health of older persons to enable them to take an active part in society and to enjoy an independent life without discrimination.

Health Minister Nafsiah Mboi said in her remarks at the meeting that the declaration “will force governments of [Southeast Asia region] member states to commit on building partnerships among various stakeholders to strengthen health qualities and services for aging populations.”

Providing an example, Nafsiah said that Singapore had implemented a policy that prioritized housing facilities for families who were willing live together with their respective aged parents.

“In this case, each of the states has to look for the right policy for its respective country,” she said. (Thejakartapost.com)

11 Menteri Kesehatan se ASEAN Lahirkan Deklarasi Yogyakarta

Sleman – Tiga puluh delegasi Menteri Kesehatan dari 11 negara di Asia Tenggara gelar pertemuan di Royal Ambarrukmo, Yogyakarta pada hari Selasa (04/9/2012). Mereka berkumpul untuk membahas komitmen peningkatan kesehatan bagi manula terutama di negara – negara berkembang di wilayah Asia Tenggara.

Melalui pertemuan bertajuk 30th Health Ministers Meeting of Countries of The WHI South East Asian Region tersebut, Menteri Kesehatan RI, Nafsiah Mboi memastikan bahwa langkah tersebut dinilai sangat penting, mengingat populasi manula di kawasan ASEAN kini sudah mencapai jumlah yang tak sedikit yakni hingga lebih dari 142 juta orang. Adapun di Indonesia sendiri, jumlah manula sudah mencapai 19 juta lebih atau 8,2 % dari seluruh penduduk Indonesia.

“Di tahun 2025 nanti, akan menjadi 13,2 %, dan pada tahun 2050 mendatang akan meningkat lagi hingga seperempat penduduk Indonesia,” ungkapnya.

Kondisi tersebut, menurut Nafsiah karena angka harapan hidup sudah semakin panjang seiring dengan keberhasilan program kesehatan. Namun, hal itu tidak menutup kemungkinan akan memicu terjadinya ledakan jumlah manula sebagaimana yang akan terjadi beberapa puluh tahun mendatang. Oleh karena itu, dalam pertemuan yang juga dihadiri Wapres Boediono tersebut, mereka membahas isu tentang penuaan dan kesehatan (aging and health) serta pada masalah jaminan kesehatan yang terangkum dalam program kebijakan yang disebut Yogyakarta Declaration on Ageing and Health (Deklarasi Yogyakarta-Red).

“Sekarang memang belum semua tercover jaminan kesehatan, namun pada tahun 2019 mendatang kami targetkan semua penduduk Indonesia sudah memeroleh jaminan kesehatan,” paparnya.

Adapun hingga kini, baru sekitar 63 % penduduk Indonesia yang sudah memeroleh jaminan kesehatan, sedangkan sisanya masih belum terjangkau. Pihaknya akan mulai melaksanakan penuntasan masalah jaminan kesehatan mulai 1 Januari 2014 mendatang dengan target selesai pada tahun 2019 dimana seluruh penduduk Indonesia sudah memeroleh jamina kesehatan baik itu melalui Askes, Jamkesmas maupun Jamkesda.

Namun begitu, capaian tersebut memeroleh apresiasi dari Direktur WHO Kawasan Asia Tenggara Samlee Plianbanchang. Menurutnya, jaminan kesehatan tersebut sudah cukup baik, terlebih pihaknya tak menemukan lagi kasus polio di Indonesia. Terakhir, kasus polio ditemukan di India tepatnya sekitar bulan Januari 2011 silam. Paling tidak, setiap negara harus bisa memastikan tidak ada polio hingga tahun 2014 untuk memeroleh label bebas polio.

“Saya memuji Indonesia, jaminan kesehatan masyarakat meningkat dan sudah mencakup 60 persen dari sekitar 240 juta penduduk,” katanya.

Hal lain yang juga mereka bahas yakni terkait implementasi regulasi kesehatan internasional tahun 2005 (International Health Regulation). Terkait hal itu, Nafsiah menegaskan bahwa Indonesia berkomitmen untuk menerapkannya pada tahun 2014 mendatang. Serta akan menindaklanjuti Jaipur Declaration on Antimicrobial Resistance dengan cara melakukan berbagai upaya untuk mempromosikan penggunaan obat rasional, terutama antibiotik termasuk di rumah sakit.

“Kerjasama global harus didasari tanggung jawab bersama sesuai dengan kapabilitas masing-masing negara. Juga harus memberdayakan negara miskin dan berkembang untuk mengatasi tantangan kesehatan global,” jelas Wapres Boediono saat mengomentari penyelenggaraan pertemuan tersebut. (Tribunnews.com)

Idealnya Jaminan Kesehatan Bisa Dipakai di Negara Tetangga

Jakarta – Program Sistem Jaminan Sosial Nasional (SJSN) untuk Jaminan Kesehatan secara nasional mulai 1 Januari 2014 mendatang dirasa belum bisa berpihak di masyarakat di wilayah perbatasan.

Pasalnya, banyak penduduk yang tinggal di wilayah itu lebih suka berobat ke negara tetangga karena kedekatan jarak layanan kesehatan dibandingkan dengan layanan di tanah air.

“Idealnya Jaminan Kesehatan Nasional tidak hanya berlaku di seluruh Indonesia tapi juga dengan RS wilayah tetangga. Tujuannya mengakomodasi masyarakat yang berada di wilayah perbatasan,” tutur Hasbullah Thabrany

dari Center for Health Economics and Policy

School of Public Health, Universitas Indonesia di Jakarta, Senin (3/9/2012).

Jika jaminan bisa berlaku di rumah sakit di negara tetangga, masyarakat akan bisa terbantu karena mendapatkan layanan yang sama saat berada di wilayah RI.

Terkait dengan penduduk yang berpindah atau sedang bepergian terserang penyakit, ia menilai tidak ada masalah. Satu-satunya BPJS Kesehatan hanya satu, sehingga mudah penagihannya.

Pemerintah secara resmi akan menjalankan program SJSN mulai 1 Januari 2014 mendatang. Sistem Jaminan Sosial Nasional (SJSN) menganut sistem asuransi sosial di mana perserta wajib beriuran kecuali orang miskin dan tidak mampu iurannya ditangggung pemerintah sebagaimana diatur dalam pasal 17 ayat 4 UU No 40/2004 tentang SJSN. Tahap pertama yang dibayarkan pemerintah adalah program jaminan kesehatan. (tribunnews.com)

China’s latest revolution: Basic health care for all

BEIJING: In a little over three years, China has managed to extend basic health-care access to more than 95 percent of its 1.35 billion population.

“This was mainly done by extending health insurance coverage and improving access to reformed and reinforced health-care facilities and services nationwide”, said Aidi Hu, a Senior social security expert from China, who works for the ILO.

The aim of the reform – which had a total cost of 850 billion Chinese Yuan (CNY) or about 133.5 billion US-dollars – was to achieve universal health-care coverage for the entire population by 2020. However, the scope and pace of changes seem more akin to a revolution than a reform.

Only a decade back, health insurance coverage was mainly for those working in urban areas under a formal employer-employee relationship. In 2003 and again in 2007, the government launched two schemes to extend coverage to rural populations and to non-working urban residents. First, the health-care budget was increased by 30 percent each year between 2008 and 2011. A large proportion of these resources were invested in staff training and enhancement of local health services.

The government also invested CNY 63 billion in rural areas to support the construction or improvement of over 2,200 county-level hospitals, some 6,200 central township clinics and 25,000 village clinics. CNY 4.15 billion was also invested in urban areas to support the construction and improvement of almost 2,400 community health-care centers.

The government also provided technical assistance to 127 training centers where 36, 000 health-care staff received training as general practitioners. More than 10,000 medical students were admitted by various medical colleges for training – free of charge. These students went on to work in township clinics in the less-developed central and western regions of China.

In addition, basic medicines are now sold at the same price across the country.This practice prevents hospitals from overcharging its patients. Pharmaceutical companies were also asked to start bidding for contracts, which led to a 30 percent reduction in the price of basic medicines.

Helping the “Three No” people

The new system is aimed especially at people with no resources, no ability to work and no one to support them (the so-called “Three No” people). It also entitles them to equal access to basic health care.

The old system was unaffordable for most rural and non-working urban residents, as well as for old and disabled people. Local governments now fully cover the individual health-insurance contributions of the latter group.

The rapid extension of health insurance in China can also be attributed to the 2010 Social Insurance Law, to which the ILO provided technical assistance.

“Due to the extension of health insurance in the most populous country in the world, the global social security gap has been significantly reduced”, said Hu.

“The Chinese experience shows that political will and financial commitments play a key role in extending health insurance schemes to vulnerable social groups. It can serve as an example for good practice to other countries in a similar situation”, concluded Hu.

But the ILO expert cautions that “some insured people – despite receiving government subsidies – are still unable to benefit from coverage as they still bear an important part of the costs for medical treatment and have limited access to good-quality health services. This is particularly true for the rural areas, where there are only 1.32 health workers per 1,000 people, compared to more than 8 and 20 per 1,000 in Brazil and Switzerland, respectively”.

Another challenge is China’s rapidly aging population. The share of the population aged 65 years and older will increase from 8 percent today (about 100 million) to about 14 percent in 2025 (some 200 million). The number of frail and sick elderly people will increase accordingly and with it, the costs for the health insurance system.

A new partnership agreement between the ILO and China was signed in June 2012. Under the agreement, the ILO and China will work more closely together. This partnership will also extend to the field of social insurance, thus contributing to the extension of social security worldwide. (bikyamasr.com)

“Masalah Kesehatan Harus Jadi Prioritas Utama”

Jakarta – Masalah kesehatan seharusnya masih menjadi perhatian penting di Indonesia, mengingat masih banyaknya birokrasi yang menjadi kendala sehingga fasilitas kesehatan belum memadai.

Hal itu diungkapkan Dwi Rianta Soerbakti, MBA Pendiri dan Ketua yayasan Dwi Rianta Soerbakti Foundation dalam rangkaian acara pengobatan gratis dan penyediaan obat- obatan bagi 400 warga masyarakat di Lapangan serba guna Peninggaran, Bendi Besar, Jakarta Selatan beberapa waktu lalu.

Rianta menjelaskan, pengobatan gratis dan pengadaan obat memang sudah seharusnya menjadi prioritas utama yayasan untuk memfasilitasi pengobatab gratis yang memang menjadi program dari pemerintah daerah.

“Untuk kegiatan pengobatan yang bersifat terus menerus ini pihaknya telah menyiapkan obat-obatan untuk 500 orang, lebih banyak dari target yang ditetapkan sebagai langkah antisipasi,” jelas Rianta.

Tak hanya itu, pihknya juga akan memberikan pelayanan pengobatanlanjutan bagi warga yang membutuhjab hingga tuntas.

Menurut Rianta yang juga anggota DPRD DKI Jakarta, bersama yayasan Obor Berkat Indonesia dan Dwi Rianta Soerbakti Foundation juga menyediakan pengobatan gratis yang meliputi pemeriksaan kesehatan secara umum dan pemeriksaan gigi.

“Dalam aksinya kali ini yayasan kami telah menyiapkan tim tenaga medis terlatih sebanyak 10 orang dokter umum, 10 orang dokter gigi serta 6 orang apoteker,” ungkap Rianta.

Pengobatan gratis ini, sambung Rianta diperuntukan bagi seluruh lapisan masyarakat dan selalu mendapat respon yang positif. ” Ini bukti yang menunjukkan adanya apresiasi dari warga terhadap kegiatan sosial yayasan kami,” urai Rianta. (Gayahidup.inilah.com)

WHO Warns About Drug-Resistant TB Outbreak

The World Health Organization warned people on Thursday that a drug-resistant TB outbreak threatens worldwide nations. According to the Associated Press the study was carried out on more than eight nations and results have shown that many cases of TB were resistant to first and second line medicines.

Humanity could be in danger of dealing with another tuberculosis epidemic, according to the findings reported by a new study published in “The Lancet”. Scientists have gathered 1,278 patients from several countries, including Estonia, Latvia, Peru, the Philippines, Russia, South Africa, South Korea, and Thailand. Respondents were carefully studied from 2005 to 2008 while they were given various treatments. Scientists have thus, discovered that patients were suffering from highly resistant TB cases whose occurrence could increase in the future unless officials do something to prevent them.

The study’s main goal was to identify the factors that have contributed to the resistance of the disease. In addition, scientists tried to find new methods and treatments that could help cure patients with multi-drug resistant TB before the illness becomes a worldwide epidemic.

Patients who were included in the study reported high levels of XDR-TB. Their affection did not respond to the first line treatment that was given to them, namely, isoniazid and rifampin, but also to the second-line fluoroquinolone drugs. TB patients were also treated with injectable drugs, such as, amikacin, capreomycin, or kanamycin, but their state did not improve at all.

The most resistant cases of TB were the ones of the patients who underwent medical treatment without curing completely. Socioeconomic factors, such as, unemployment, alcohol abuse, and smoking represent the other reasons why patients developed highly resistant cases of tuberculosis. In researchers’ opinion, these factors should be taken into account if health organizations want to prevent this disease from spreading towards other unaffected areas. As in the case of the less resistant TB, a correct hygiene is considered essential to prevent similar epidemics in the future. (dailygossip.org)