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• World AIDS day 2006: Stop AIDS – keep the promise
  
• Focus on Tuberculosis, annual surveillance report 2006
  
  

World AIDS day 2006: Stop AIDS – keep the promise

World AIDS day is commemorated annually on 1 December around the world. This years theme is ‘Accountability’ with the slogan Stop AIDS – keep the promise.

Globally, the epidemic continues to grow with some countries experiencing resurgence in incidence where numbers had previously stabilised or declined. Although increases in infection rates have been seen in many countries, some countries have, however, been successful in reducing transmission.

According to the UNAIDS/WHO AIDS Epidemic Update: December 2006 [1], there are presently 39.5 million people living with HIV across the globe, with 4.3 million new infections occurring in 2006. The majority (65%) of infections are still in sub-Saharan Africa, with 2.8 million new infections in 2006, although substantial increases are also being seen in Eastern Europe and Central Asia.

Highlighted within the report is the ongoing importance of expanding HIV prevention programmes and targeting groups at high risk of infection such as sex workers, gay and bisexual men, women and girls, young people, injecting drug users and ethnic and cultural minorities.

Within the United Kingdom (UK), recent annual figures suggest that numbers of new diagnoses may be stabilising, with a total of 7450 new diagnoses of HIV in 2005 reported so far. Overall within the UK an estimated 63,500 adults aged between 15 and 59 years were living with HIV at the end of 2005, of whom 20,100 (32%) were unaware of their infection. Numbers of individuals newly diagnosed with HIV who acquired their infection through heterosexual sex in Africa, have declined slightly, with 3554 seen in 2003, 3374 in 2004, and 2760 in 2005. In contrast, the total of 2356 new diagnoses in men who have sex with men diagnosed in 2005 was the highest ever, due to increased testing and continued transmission.

A Complex Picture [2] is a report on HIV and STIs in the UK and was published by the Health Protection Agency and collaborators in time for World AIDS Day. To see a full copy of the report, see <http://www.hpa.org.uk/publications/PublicationDisplay.asp?PublicationID=55>.

References
1. UNAIDS/WHO. AIDS Epidemic Update: December 2006. Geneva: UNAIDS, 2006. Available at <http://www.unaids.org/en/HIV_data/epi2006/>.

2. UK Collaborative Group for HIV and STI Surveillance. A complex picture. HIV and other sexually transmitted infections in the United Kingdom: 2006. London: Health Protection Agency, 2006. Available at <http://www.hpa.org.uk/publications/PublicationDisplay.asp?PublicationID=55>..

Focus on Tuberculosis, annual surveillance report 2006

The Health Protection Agency has published its annual surveillance report on tuberculosis in England, Wales, and Northern Ireland [1]. Focus on Tuberculosis is the first report that brings together surveillance information on tuberculosis from multiple sources. It provides a comprehensive overview of current trends in the numbers of tuberculosis cases, drug susceptibility, treatment outcome, and outbreak surveillance. It provides a baseline for the assessment of the effectiveness of the measures being implemented to strengthen control of tuberculosis in this country.

Key findings of the report include:

• Tuberculosis continues to increase in England, Wales, and Northern Ireland. A total of 8113 tuberculosis cases were reported in 2005, a rate of 14.7 per 100,000 population. The number of cases increased by 11% in comparison with 2004. As in previous years, this increase continues to be predominantly among individuals born outside the United Kingdom (UK), the majority of these cases occurring among people who have been in the country for two years or longer. The large increase in the number of cases reported in 2005 is likely to be a continuation of recent trends, but may also include year to year variation. In addition, the contribution of other factors such as increasing awareness among the public and professionals can not be excluded. The continuing increase reinforces and highlights the importance of working towards the goals outlined in the Chief Medical Officer’s (CMO) Tuberculosis Action Plan [2].
  
• Drug resistant tuberculosis is more difficult and expensive to treat. The proportion of cases with tuberculosis resistant to isoniazid remained within the target of 7% set in the CMO’s Action Plan. The proportion of cases in 2005 with multi-drug resistant disease was 0.9%.
  
• Treatment completion for all cases who had an outcome reported has remained stable since 2001 at around 78 to79%, but remains below the 85% target set out in the CMO’s Action Plan. Although the target of 85% has not been achieved, current levels of treatment completion are comparable to other countries with a similar occurrence of tuberculosis. The high mortality rates observed among the elderly who may die with, rather than of, tuberculosis, make the achievement of the target challenging in many parts of the UK.
  
• Despite the increase in tuberculosis in cattle (bovine tuberculosis), relatively few human cases of Mycobacterium bovis disease are reported. Continued vigilance and collection of risk factor information on all these cases should, nevertheless, continue to allow the investigation of future changes in the epidemiology of tuberculosis caused by M. bovis.
  
• The timeliness of national tuberculosis surveillance data has recently improved. This should allow surveillance data to contribute to the prevention and control of the disease providing the information required at local, regional and national level to identify outbreaks, monitor trends, inform policy, and monitor the success of the tuberculosis programme.

References
1. HPA. Focus on TB. Annual surveillance report 2006 - England, Wales and Northern Ireland. London: HPA, November 2006. Available at <http://www.hpa.org.uk/publications/PublicationDisplay.asp?PublicationID=62>.
2. Stopping tuberculosis in England – an action pan from the Chief Medical Officer. Gateway reference: 1176. London, Department of Health, 2004.