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University of Toronto Scarborough
Mark Hunter

December 17 2008 1Geographies of DiseaseExam ReviewDecember 17 2008 9 AM12 PMExam Review Outline I Short Answer Questions II Multiple Choice Questions III Long Answer Questions10 Short Answer Questions What is the difference between MDR and XDR TB st MDR is when a strain of TB is resistant to 2 or more 1 line drugsXDR extreme Drug resistance ndo Resistant to 3 or more 2 line drugsPeople can catch MDR and XDR from one anotherXDR in South Africao XDR is extremely difficult to treat o Worldwide there are 347 cases of XDR and 53 are in one small hospital in KZN o KZN is the worst affected region for HIV in South Africa with prevalence rates of 40MDRTB Multidrug Resistant TB describes strains of tuberculosis that are resistant to at least the two main firstline TB drugsisoniazid and rifampicin XDRTB or Extensive Drug Resistant TB also referred to as Extreme Drug Resistance is MDRTB that is also resistant to three or more of the six classes of secondline drugs Why do specialists think that a Bird Flu epidemic among humans is inevitable An inevitable flu pandemic is believed to come from a mutated bird flu virusAs many as seven million people could be killedIt is only a matter of timewe have gone beyond wondering whether there will be one the stage now is trying to forecast when a pandemic will hitThe next pandemic will most likely come from a mutation of the bird avian flu virusThe H5N1 bird flu strain the most dangerous has hit Thailand and Vietnam hardMillions of poultry have had to be destroyed30 people have diedThe virus only kills humans who have close contact with infected poultryThe concern among health experts is that the virus could mutate and spread from human to humanIf the virus were to infect a pig the jump mutation from pig to human would be much more likelyIf the strain were to mutate and have the ability to spread among humans nobody would be immunethe consequences could be catastrophicWHO experts say that countries in Asia which have the weakest health systems are precisely the ones that need the most support as they are the most likely places to host the beginnings of a pandemicWhat could be done about it There is more information and resources available today than we did when the last flu pandemic occurred more than 30 years agoHealth officials around the world are working together to try to make sure that bird flu doesnt spreadand to keep people safe if it doesExperts believe only about 387 people have contracted the disease in the last 5 yearsIn an effort to keep bird flu from spreading authorities in countries that have experienced outbreaks have destroyed hundreds of millions of birdsThree countries Japan Korea and Malaysia have controlled their outbreaks of the H5N1 strain and officials report there is no more virus in these nations December 17 2008 2 Countries that have not had any outbreaksincluding the United Stateshave stopped importing poultry from countries that have had avian flu outbreaksScientists are working on a vaccine to keep people from getting the avian fluThe World Health Organization WHO is closely monitoring the countries where there have been outbreaks to see if the virus spreads or mutates in a way that makes it more threatening to people o The organization has created an emergency plan to handle a pandemic including stockpiling antiviral medications to help people if they do become infected Although antiviral medicines dont cure the infection they can make an infected persons symptoms less severeDespite these reassurances we must not ignore the possibility of an H5N1 pandemicEven if it does not materialize the planning and development of effective interventions will provide the necessary preparations in the event that another avian strain jumps the species barrier or a known human pathogen like H2N2to which large segments of the population lack immunity reemergesOne of the most important and relevant observations made in recent years is that the number of avian strains now recognized as human pathogens is relatively largePreparation for the next pandemic will enhance our ability to cope with annual epidemics and their substantial tollConversely wider use of vaccines and antiviral drugs during the interpandemic period will provide the foundation for responding to the next pandemicIn this regard greatly expanding national health care institutional and perhaps even personal stockpiles of antiviral agents makes good sense in the near term especially until n immunogenic H5 vaccine for humans has been developedThe Infectious Diseases Society of America has recommended that the United States have sufficient ostseltamivr to treat up to 50 of the population at present we are not even close to that goal What is the difference between parallel importing and generic drugs Parallel imports are imports of a patented or trademarked product from a country where it is already marketed For example in Mozambique 100 units of Bayers ciprofloxacin 500mg costs US740 but in India Bayer sells the same drug for US15 owing to local generic competition Mozambique can import the product from India without Bayers consentAccording to the theory of exhaustion of intellectual property rights the exclusive right of the patent holder to import the protected product is exhausted and thus ends when the product is first launched on the market When a state or group of states applies this principle of exhaustion of intellectual property rights in a given territory parallel importation is authorized to all residents in the state in question In a state that does not recognize this principle however only the patent holder who has been registered has the right to import the protected productSometimes referred to as grey market imports parallel imports often takes place when there is differential pricing of the same producteither brandname or generic drugsin different markets usually owing to local manufacturing costs or market conditions The TradeRelated Aspects of Intellectual Property Rights TRIPS agreement explicitly states that this practice cannot be challenged under the World Trade Organization WTO dispute settlement system and so is effectively a matter of national discretionParallel imports can reduce the price of health products and pharmaceuticals by introducing competition However they can also affect the negotiation of tiered pricing regimes with pharmaceutical companies If a private pharmaceutical company agrees to sell a product at a lower price in poor countries it will need some assurance that the cheaper product will not be imported back into its rich country markets undercutting its profits product diversionParallel importing occurs because pharmaceutical products are sold at different prices in different parts of the world
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