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Rudi Coninx

WHO, ERM, Coordinator

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Papers by Rudi Coninx

Drug resistant tuberculosis in prisons in Azerbaijan: case study

BMJ, May 9, 1998

Objectives: To document the existence of drug resistance in a tuberculosis treatment programme th... more Objectives: To document the existence of drug resistance in a tuberculosis treatment programme that adheres strictly to the DOTS principles (directly observed treatment, short course) and to determine the extent of drug resistance in a prison setting in one of the republics of the former Soviet Union. Design: Case study. Setting: Central Penitentiary Hospital in Baku, the referral centre for tuberculosis patients from all prisons in Azerbaijan. Subjects: Prisoners with tuberculosis: 28 selected patients not responding clinically or bacteriologically to the standard treatment (group 1) and 38 consecutive patients at admission to the programme (group 2). Main outcome measures: Drug resistance of Mycobacterium tuberculosis strains grown from sputum. Results: All the non-responding patients (group 1) had strains resistant to at least one drug. 25 (89%) of the non-responding patients and nine (24%) of the consecutive patients had M tuberculosis strains resistant to both rifampicin and isoniazid. A further 17 patients in group 2 had strains resistant to one or more first line drugs. Conclusions: Drug resistant M tuberculosis strains are common in prisons in Azerbaijan. Tuberculosis problems tend to be worse in prisons, but prisoners and former prisoners may have an important role in the transmission of tuberculosis, particularly of drug resistant forms, in the community. National programmes to control tuberculosis will have to take into account and address the problems in prisons to ensure their success.

Tuberculosis in prisons

The Lancet, Nov 1, 1995

10000 to 100000 times more sensitive than double immunodiffusion (DID) and 100 to 1000 times less... more 10000 to 100000 times more sensitive than double immunodiffusion (DID) and 100 to 1000 times less sensitive than PCR. However, in contrast to PCR, RHA detects only those virions which can bind to the receptor molecule. In the early recovering phase of erythema infectiosum, 2 patient samples bearing antibodies against B19 were positive by PCR but negative by RHA. When we examined donor samples by PCR, we did not find any PCR-positive and RHA-negative samples. To determine the specificity and sensitivity of RHA, we tested 329 of selected donor samples (table). These findings suggests that RHA has enough sensitivity and specificity to detect viraemic blood donors. In 1992, when erythema infectiosum was prevalent in Japan, we found 13 cases of viraema among 187 187 blood donors (0-007%) with DID. In 1993, when erythema infectiosum was not prevalent, we found 2 cases of viraemia among 181003 (0°001%) donors. From April to July 1995, when erythema infectiosum was again not prevalent, we screened 45 735 blood donor samples with both DID and RHA. We detected no viraemic samples by DID, whereas 27 samples were positive by RHA; of which seven were confirmed to be positive by PCR (0-015%). The rate of nonspecific reaction of RHA was calculated to be 0-044% in random donor samples. Donors with the B19 virus should be identified by a method such as RHA to prevent bloodborne infection.

Tuberculosis in prisons in countries with high prevalence

BMJ, Feb 12, 2000

Report on health in Kunar : Nov. 18-Dec. 10, 1989 / Rudi Coninx

Overwhelming Consumption in Prisons: Human Rights and Tuberculosis Control

Health and Human Rights, 1999

Tuberculosis is thought to be the single biggest cause of death among the world's prisoners, but ... more Tuberculosis is thought to be the single biggest cause of death among the world's prisoners, but a human rights approach to tuberculosis control has not yet been applied. We propose that existing guidelines for the control of HIV be adapted and applied to tuberculosis. Tuberculosis control in prisons provides a platform to develop these concepts. De part le monde, la tuberculose est consideree comme la cause principale de mortalite chez les incarceres, mais il n'existe encore pas de methode de contr6le de la tuberculose qui prend en compte les droits de la personne. Nous proposons que les directives internationales qui s'appliquent a' la lutte contre le VIH soit adaptees a celle contre la tuberculose. La lutte contre la tuberculose dans les prisons peut servir de modee pour developper ces idees. La tuberculosis es considerada como la principal causante de muerte entre los prisioneros del mundo, pero a pesar de ello, el control de esta enfermedad ain no se aborda con un enfoque de derechos humanos. Proponemos que las actuales directrices internacionales para el control del VIH sean adaptadas y se apliquen a la tuberculosis. El control de la tuberculosis en las prisiones proporciona un espacio para desarrollar estos conceptos.

Pitfalls of tuberculosis programmes in prisons

BMJ, Nov 29, 1997

On 20 August 1947 Gerhard Rose, one of Germany's most respected physicians, stood in the prisoner... more On 20 August 1947 Gerhard Rose, one of Germany's most respected physicians, stood in the prisoner's dock at the Palace of Justice in Nuremberg, Germany, awaiting his sentence for "murders, tortures, and other atrocities committed in the name of medical science." Dr Rose, the department head for tropical medicine of the Robert Koch Institute, was on trial along with 22 of his medical colleagues, for perpetrating "ghastly" and "hideous" experiments on concentration camp prisoners during the war. 1 At one point in the trial when the chief prosecution witness, Dr Andrew C Ivy of the medical school of the University of Illinois, underscored the basic principle "that human experimental subjects must be volunteers," Dr Rose and his defence counsel vigorously objected, arguing that the United States was guilty of similar medical practices and giving several examples to support this contention. 1 Summary points From the early years of this century, the use of prison inmates as raw material for medical experiments became an increasingly valuable component of American scientific research Testimony by American medical experts at Nuremberg allowed American physicians and researchers to believe that the Nuremberg Code was directed only at Nazi scientists Postwar American research grew rapidly as prisoners became the backbone of a lucrative system predicated on utilitarian interests Uneducated and financially desperate prisoners "volunteered" for medical experiments that ranged from tropical and sexually transmitted diseases to polio, cancer, and chemical warfare

Essential Drugs: A Cornerstone to Refugee Health Care

Disasters, Dec 1, 1989

Primary Health Care in Alma Ata in 1978, the Essential Drug Programme was recognized as an essent... more

Strongyloidiasis on the Thai—Cambodian border

Transactions of The Royal Society of Tropical Medicine and Hygiene, May 1, 1993

A series of children's deaths at a Cambodian refugee camp in Thailand prompted an investigation o... more A series of children's deaths at a Cambodian refugee camp in Thailand prompted an investigation of children suffering from bloody diarrhoea and severe abdominal pain. Microscopical stool and blood examinations of 15 cases aged 1-7 years revealed hyperinfective strongyloidiasis as the cause of illness. Nine of 14 cases were infected with Strongyloides stercoralis, and 6 (42%) had concurrent infection with hookworm. Examination of 958 outpatients at the camp's daily clinic showed that mixed infections of S. stercoralis and hookworm were present in only 4.8% of the outpatients of the same age group.

Tuberculosis in complex emergencies

Bulletin of The World Health Organization, Aug 1, 2007

This paper describes the key factors and remaining challenges for tuberculosis (TB) control progr... more This paper describes the key factors and remaining challenges for tuberculosis (TB) control programmes in complex emergencies. A complex emergency is "a humanitarian crisis in a country, region or society where there is total or considerable breakdown of authority resulting from internal or external conflict and which requires an international response that goes beyond the mandate or capacity of any single agency and/or the ongoing United Nations country programme." Some 200 million people are believed to live in countries affected by complex emergencies; almost all of these are developing countries that also bear the main burden of TB. The effects of complex emergencies impact on TB control programmes, interfering with the goals of identifying and curing TB patients and possibly leading to the emergence of MDR-TB. There are many detailed descriptions of aid interventions during complex emergencies; yet TB control programmes are absent from most of these reports. If TB is neglected, it may quickly result in increased morbidity and mortality, as was demonstrated in Bosnia and Herzegovina and in Somalia. TB is a major disease in complex emergencies and requires an appropriate public health response. While there is no manual to cover complex emergencies, the interagency manual for TB control in refugee and displaced populations provides valuable guidance. These programmes contribute to the body of evidence needed to compile such a manual, and should ensure that the experiences of TB control in complex emergencies lead to the establishment of evidence-based programmes.

Health care and food aid for Somalia

The Lancet, Sep 1, 1992

First-line tuberculosis therapy and drug-resistant Mycobacterium tuberculosis in prisons

The Lancet, Mar 1, 1999

Background We assessed a programme of tuberculosis control in a prison setting in Baku, Azerbaija... more Background We assessed a programme of tuberculosis control in a prison setting in Baku, Azerbaijan. The programme used first-line therapy and DOTS (directly observed treatment, short course). Methods 467 patients had sputum-positive tuberculosis. Their treatment regimens followed WHO guidelines, and they had regular clinical examinations and dietary supplements. Isolates were tested by standard methods for resistance to isoniazid, rifampicin, ethambutol, and streptomycin in three laboratories. Treatment success was defined as three consecutive negative sputum smears at end of treatment. Factors independently associated with treatment failure were estimated by logistic regression. Findings Drug-resistance data on admission were available for 131 patients. 55% of patients had strains of Mycobacterium tuberculosis resistant to two or more antibiotics. Mortality during treatment was 11%, and 13% of patients defaulted. Overall, treatment was successful in 54% of patients, and in 71% of those completing treatment. 104 patients completed a full treatment regimen and remained sputum-positive. Resistance to two or more antibiotics, a positive sputum result at the end of initial treatment, cavitary disease, and poor compliance were independently associated with treatment failure. Interpretation The effectiveness of a DOTS programme with first-line therapy fell short of the 85% target set by WHO. First-line therapy may not be sufficient in settings with a high degree of resistance to antibiotics.

How health can make a contribution to peace in Africa: WHO’s Global Health for Peace Initiative (GHPI)

BMJ Global Health, Oct 1, 2022

Tuberculosis in Complex emergencies/Tuberculose Dans Lens Situations D'urgence complexes/La Tuberculosis En Las Emergencias Complejas

Bulletin of The World Health Organization, Aug 1, 2007

In 2004 there were 9 million new cases and approximately 2 million deaths from tuberculosis (TB).... more In 2004 there were 9 million new cases and approximately 2 million deaths from tuberculosis (TB). Control programmes are difficult at the best of times, but the direct and indirect health and health system effects of complex emergencies complicate these programmes to such an extent that many organizations choose not to implement them. However, as TB is recognized as a major cause of mortality in long-term complex emergencies, several agencies have taken up the challenge of establishing control programmes in these circumstances. They have met the WHO targets for successful programmes (to detect at least 70% of estimated new smear-positive cases and successfully treat at least 85% of all detected smear-positive cases) without increasing the rates of multi-drug-resistant TB (MDR-TB). This paper describes the key factors and the remaining challenges for successful tuberculosis control programmes in complex emergencies. A complex emergency is defined as "a humanitarian crisis in a country, region or society where there is total or considerable breakdown of authority resulting from internal or external conflict and which requires an international response that goes beyond the mandate or capacity of any single agency and/or the ongoing United Nations country programme." (1) These emergencies are characterized by extensive violence and loss of life; massive population displacement; widespread damage to societies and economies; the need for large-scale, multifaceted humanitarian assistance; political and military constraints that hinder or prevent humanitarian assistance; and significant security risks for humanitarian relief workers in some areas. Some 200 million people are believed to live in countries affected by complex emergencies. Almost all of these are developing countries which also bear the main burden of TB: approximately 80% of all TB patients live in sub-Saharan Africa and Asia. (2) Humanitarian aid workers all over the world face the major challenge of controlling TB during complex emergencies that affect entire countries (e.g. Afghanistan, Democratic Republic of the Congo, Somalia, Timor-Leste) or parts of a country (e.g. Darfur, southern Sudan). Situations that affect large civilian populations through war or civil unrest, food shortages and population displacement also result in excess mortality and morbidity. These are caused not only by violence, but also by preventable communicable diseases. (3) Several of the direct and indirect effects (4) of complex emergencies impact on TB control programmes: they interfere with the goals of identifying and curing TB patients, and may lead to the emergence of MDR-TB, thereby compromising--or at least complicating--future control programmes. There are detailed descriptions of aid interventions during complex emergencies in many countries, including Afghanistan, the Democratic Republic of the Congo, (5) Kosovo, (6) Sudan, (7) and Timor-Leste. However, TB control programmes are absent from most of these reports as humanitarian aid workers concentrate on the most obvious killers during the acute phase of a complex emergency: diarrhoeal diseases, measles, acute respiratory infections, malaria and other infectious diseases. (8) As TB is not a visible killer in the acute phase it is rarely a priority in complex emergencies, and often is left for the rehabilitation phase. (9) But complex emergencies include situations of chronic conflict and political instability, often covering entire countries for long periods, and health-care workers are forced to address issues beyond the immediate emergency. If TB is neglected it may quickly result in increased morbidity and mortality, as was demonstrated in Bosnia and Herzegovina (10) and in Somalia. (11) Health-care workers now recognize that TB (also HIV/AIDS) may be responsible for a relatively large proportion of deaths among both adults and children. (12,13) TB is a major disease in complex emergencies (14) and requires an appropriate public health response. …

4 Direct and indirect estimates of mortality changes : A case study in Mozambique

During the past century, the world has witnessed dramatic mortality changes. In Europe and in oth... more During the past century, the world has witnessed dramatic mortality changes. In Europe and in other developed countries, the mortality decline has been continuous and regular, with the exception of major political crises such as the two world wars, and of epidemics highly limited in time, such as the 1918 influenza epidemic. In developing countries, mortality changes were more contrasted. In some cases, mortality decline started late and was very rapid (China, Sri Lanka, Cuba) or less rapid (most of Latin America); in other cases it started early but was slow, though regular (Pakistan; India); in Africa it started late, and was slower than elsewhere; in Russia, it started later than in Europe, was quite rapid between 1945 and 1970, then stopped and even reversed recently (Meslé and Vallin, 1995). In some African countries, mortality is even expected to increase in the near future because of the AIDS epidemic, as exemplified by the case of Abidjan (Garenne et al., 1995), or because of major political crises, such as that described below.

Strongyloidiasis on the Thai-Cambodian border

Transactions of the Royal Society of Tropical Medicine and Hygiene, 1992

A series of children's deaths at a Cambodian refugee camp in Thailand prompted an investigation o... more A series of children's deaths at a Cambodian refugee camp in Thailand prompted an investigation of children suffering from bloody diarrhoea and severe abdominal pain. Microscopical stool and blood examinations of 15 cases aged 1-7 years revealed hyperinfective strongyloidiasis as the cause of illness. Nine of 14 cases were infected with Strongyloides stercoralis, and 6 (42%) had concurrent infection with hookworm. Examination of 958 outpatients at the camp's daily clinic showed that mixed infections of S. stercoralis and hookworm were present in only 4.8% of the outpatients of the same age group.

Epidemic typhus in a prison in Burundi

Transactions of The Royal Society of Tropical Medicine and Hygiene, Mar 1, 1997

The International Committee of the Red Cross investigated an outbreak of fever of unknown origin ... more The International Committee of the Red Cross investigated an outbreak of fever of unknown origin in Ngozi prison, Burundi, which resulted in a crude mortality rate of 2.61% in January 1996. A definite diagnosis of epidemic typhus caused by Rickettsia prowazekii was established by enzyme-linked immunosorbent assay using specific antigens. Control measures included complete cleansing of the prison with cytluthrine, shaving and dusting all prisoners with permethrin 0.5% dusting powder, and replacement of all mattresses and clothes. All prisoners and guards received a single dose of doxycyline (100 mg) simultaneously. The crude mortality rate dropped abruptly to 1.27% in February 1996 and remained at or below 0.5% from March onwards. Health authorities and medical agencies working in Burundi need to consider epidemic typhus in the differential diagnosis of fever of unknown origin in order to be able to take appropriate control measures in time.

Medicine in Cambodian Refugee Camps

Annals of Internal Medicine, 1986

... 6 1 8 Annals of Internal Medicine. 1986;105:618-621. Page 2. ... Although the Royal Thai Arme... more

Underestimating attacks: comparing two sources of publicly-available data about attacks on health care in 2017

Conflict and Health

Background Attacks on health care represent an area of growing international concern. Publicly av... more Background Attacks on health care represent an area of growing international concern. Publicly available data are important in documenting attacks, and are often the only easily accessible data source. Data collection processes about attacks on health and their implications have received little attention, despite the fact that datasets and their collection processes may result in differing numbers. Comparing two separate datasets compiled using publicly-available data revealed minimal overlap. This article aims to explain the reasons for the lack of overlap, to better understand the gaps and their implications. Methods We compared the data collection processes for datasets comprised of publicly-reported attacks on health care from the World Health Organization (WHO) and Insecurity Insight’s Security in Numbers Database (SiND). We compared each individual event to compile a comparable dataset and identify unique and matched events in order to determine the overlap between them. We re...

Report on health in Kunar : Nov. 18-Dec. 10, 1989 / Rudi Coninx

How health can make a contribution to peace in Africa: WHO’s Global Health for Peace Initiative (GHPI)

BMJ Global Health