In the Gulf Region, labor migration is the main source of new Tuberculosis (TB) cases. Dr. Eskild Petersen, a world-renowned TB expert from Denmark, consults in Oman to spearhead the fight against the world's deadliest infectious disease.
With more than 1.5 million deaths in 2018, TB remains the world’s deadliest infectious disease. An estimated 10 million people fall ill with TB per year, and every third person goes untreated. A mere 8 countries represent more than two third of all new cases: India, China, Indonesia, the Philippines, Nigeria, South Africa, Pakistan and Bangladesh.
In a recent case at the Al Rahma TB Hospital, located in the outskirts of Muscat, Oman, Eskild Petersen saw a patient who arrived from India to work in an Omani family household. She suffered cold symptoms for a month before being diagnosed with active TB. "The woman had, of course, been screened for TB when she entered the country, but did not show active signs of the disease,” the Danish TB expert says and adds, “Given that she was in direct contact with the Omani family for weeks before her diagnosis, it’s possible that further infections will occur.”
"Most of the patients are labor migrants from poor countries with a high incidence of TB, accounting for more than 80 percent of active TB cases in Oman."
Dr. Eskild Petersen, Ministry of Health, Oman
The Al Rahma TB Hospital shimmers in the midday heat, its surrounding streets deserted. The parking lot and the small hospital are a few meters apart, but the city’s intense 40°C heat and sweltering humidity make even such a short distance a brutal walk for Dr. Eskild Petersen. The professor of tropical medicine at Aarhus University is internationally renowned for his extensive contributions to global health therapeutic drug monitoring, travel medicine and emerging infections. On the verge of his retirement he was hired by the health ministry of Oman as a senior medical consultant to support local doctors in their fight against tuberculosis. “A challenge I couldn´t resist,” Petersen admits with a smile.
The tall man in his sixties, known for his pleasant demeanor and easygoing humor, became one of the 1.8 million migrant workers in Oman who represent more than 40 percent of the population.
Arriving with the workforce from abroad
Currently, those who travel to the Gulf region for work are tested for active TB with routine X-ray examinations. “But this practice does not allow for the discovery of latent-infected individuals. And once they come into the country, full-blown active TB can emerge at any time, putting others at risk of infection,” says Petersen, as he analyzes x-rays and laboratory results alongside Dr. Farah Jadwad, head physician at Al Rahma Hospital. She explains that people can carry the pathogen for decades and not know it. “Then, perhaps by having a weakened immune system, the pathogen will suddenly develop into an active and thus infectious tuberculosis.”
"If we want to reduce TB infections to zero, we have to act now."
Dr. Farah Jadwad, Head Physician, Al Rahma Hospital
The World Health Organization estimates that a startling one in four people worldwide is infected with tuberculosis. For Eskild Petersen, latent infections are the main reason why even highly developed nations with well-equipped health systems cannot eliminate the disease. One of the tasks in his job in Oman is creating structures for more effective TB treatment and screening in the country. The biggest obstacle, Petersen sees is the “lack of cooperation among different institutions and organizations.”
Oman has built special TB hospitals, like Al Rahma, and several modern national reference laboratories for testing active and latent TB cases. Now, the Omani government is positioned to pioneer a new major program in the Middle East: Theirs will be first in the region to test all expats for latent TB. An estimated two million tests per year using the QuantiFERON®-TB Gold Plus (QFT-Plus) TB blood test are planned. Seif Al-Abri, advisor at the Ministry of Health, notes, "If we want to reduce TB infections to zero, we have to act now. The fight against TB is not just about how many people we treat, but how many we can screen.” The large-scale screening program will be carried out in coordination with all neighboring states, including Qatar, Saudi Arabia and the United Arab Emirates, which also want to follow Oman's example and test for latent TB across the board. Saudi Arabia, for example, is currently planning to initiate more than 10 million tests per year.
One of the most pressing questions for Dr. Farah Jadwad at Al Rahma TB Hospital is how to deal with patients with latent infections from future mass screenings. “The government has promised that none of the people with positive results will be deported. Instead, everyone will be treated here in Oman, free of charge.” She considers such commitments vital to ensure the screenings will continue, as they depend on the cooperation of immigrants. She adds that screenings should not lead to stigma. “We are not fighting against people, but against a bacterium.”
"Treating the latent TB at this early point makes it possible for the patients to experience fewer side effects from the treatment and achieve a better outcome."
Dr. Eskild Petersen, Ministry of Health, Oman
Eskild Petersen is convinced that the fight against tuberculosis can only be won with consistent screening for latent TB. Screening costs are ultimately lower than those for treatments and can help combat the spread of this disease. “A diagnosed latent TB infection can be treated at an early stage with fewer and less-expensive medications in less time, without costly isolation in a hospital,” Petersen explains. Most important is that patients will benefit; experiencing fewer side effects from the treatment and achieving a better outcome.”
Find out more about QuantiFERON-TB Gold Plus
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