Texas 75083-3836 U.S.A., fax +1-972-952-9435. AbstractAlthough the incidence of TB is receding in western countries, several factors such as resistance to antibiotics and HIV epidemic have worsened the situation in many low-income countries. Meanwhile, the globalization process has increased the frequency of travel and contacts between individuals from low and high incidence areas, therefore increasing the exposure of non-infected individuals. This is especially true for some of the oil and gas operations e.g. offshore, where the layout of the living quarters is propitious for TB transmission. Although rare, any active case of TB occurring offshore has the potential for a high impact on operations. Recently in spite of a comprehensive screening program in place for high incidence country national employees, an active case occurred on a platform in the Gulf of Mexico. That case triggered a search for a better screening tool to ensure that no detectable active TB cases enter the work place. This paper will describe our findings.

Tetrapal is a Joint Research Project developed within the framework of an original public-private partnership between the Ministry of Defence, the French University of Marseille and Exxon Mobil Corporation. Malaria control policies and their compliance controls are high priorities for both the French army and ExxonMobil. Both organizations are interested in further developing processes that can be used to verify that soldiers or employees are taking their malarial chemoprophylaxis as prescribed. Currently, compliance is enforced and verified by using High-Performance Liquid Chromatography (HPLC) techniques for detecting the presence of mefloquine, doxycycline, chloroquine and proguanil (a component of Malarone) in urine samples. This procedure cannot be performed in the field because it requires special expertise, structures and technology not available in the field. The program is very expensive due to the laboratory analyses and shipping procedures required to ship the samples to a qualified laboratory. There is also a delay of several weeks between sample collection and laboratory verification. Objectives of the Tetrapal project The TETRAPAL project consists of developing a fast-acting immunochemical method to detect anti-malarial drugs such as doxycycline, chloroquine, mefloquine, and proguanil, in the urine of persons taking chemoprophylaxis (Doxycycline, Savarine®, Lariam®, Malarone®, Chloroquine). The idea is to develop a Rapid Diagnostic Test (RDT). This RDT needs to be reliable, simple and easy to use on site by non-medical personnel. An "all in one" test that recognizes all types of anti-malarials is preferable. The final step will be to identify and contract with (an) industrial partner(s) for the commercialization of the method, manufacturing and distribution of the RDT. Technical aspects An RDT is a test using an immunochromatographic capture procedure with monoclonal antibodies that detect antigens (parasite-specific or, in our study, anti-malarial drug-specific) in lysed blood or plasma or urine. It uses a lateral-flow principle: the buffer "flows" along a nitrocellulose strip and passes over the capture and control lines. The researchers chose to develop a test to detect the existence of anti-malarial molecules in urine by immunocapture and competition on strips (lateral flow assay). The justification of the immunologic method is that use of antibody capture techniques can lead to very specific and sensitive tests, when chloroquine, mefloquine and doxycycline and proguanil are not totally metabolized and are eliminated in urine where they can be identified by monoclonal antibodies. Status after one year Antibodies against doxycycline, proguanil and chloroquine have been identified. Those are ready to be produced at an industrial level. Antibodies against mefloquine are still under laboratory research phase. The first experimental strips detecting chloroquine and proguanil (i.e. Malarone®) are expected to be ready for field testing in early 2008.

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Although the incidence of TB is receding in western countries, several factors such as resistance to antibiotics and HIV epidemic have worsened the situation in many low-income countries. Meanwhile, the globalization process has increased the frequency of travel and contacts between individuals from low and high incidence areas, therefore increasing the exposure of non-infected individuals. This is especially true for some of the oil and gas operations e.g. offshore, where the layout of the living quarters is propitious for TB transmission. Although rare, any active case of TB occurring offshore has the potential for a high impact on operations. Recently in spite of a comprehensive screening program in place for high incidence country national employees, an active case occurred on a platform in the Gulf of Mexico. That case triggered a search for a better screening tool to ensure that no detectable active TB cases enter the work place. This paper will describe our findings. Introduction Mycobacterium tuberculosis has infected humans for thousands of years. Fragments of the spinal column from Egyptian mummies from 2400 BC have been found that show definite pathological signs of tubercular decay. In 460 BC Hippocrates identified "phthisis" (a Greek work meaning consumption) as the most prevalent disease of the times. He also observed that it killed nearly everyone it infected. He even went so far as to warn other doctors not to visit patients in late stages of the disease due to the danger of catching it themselves. Mycobacterium tuberculosis was first viewed in 1882 when Robert Koch discovered a special staining technique that allowed him to see the organism. In 1895 Wilhelm Konrad bon Rontgen discovered a radiation (x-ray) that could be used to view the progress and severity of a patient's disease on chest film. In the 1920s, a further development was the Bacille Calmette-Guerin (BCG) vaccine, which is still used widely today. Albert Calmette, a French bacteriologist, and Jean-Marie Camille Guerin were able to lower the virulence of the bovine strain of TB which lead to the creation of the vaccine In 1943 Selman A. Waksman, who had been working for decades to find an antibiotic that was effective against Mycobacterium tuberculosis, was finally successful. Streptomycin purified from Streptomyces griseus was first administered to a human on November 20, 1944. The results were quite impressive. The disease immediately stopped its progression, the bacteria disappeared from his sputum, and he recovered fully. In the years following, more and more anti-TB drugs were developed TB Current Status -USA Tuberculosis (TB), once the leading cause of death in the United States, appeared to be receding into history by the latter part of the 20th century In 1989 the Centers for Disease Control and Prevention (CDC) published A Strategic Plan for the Elimination of Tuberculosis in the United States. This document proposed a national strategy for TB elimination, defined as an incidence rate of less than one TB case per 1 million persons per year. Actions to achieve that goal centered on making better use of existing TB prevention and control methods; creating and evaluating new tools for diagnosing, treating, and preventing TB; and rapidly applying these tools to clinical and public health practice.