Court order keeps Canadian TB patient in hospital
By, Leah Schnurr, Reuters, January 29, 2007
TORONTO - Canadian health officials have won a court order to keep a patient with a new, highly drug-resistant strain of tuberculosis in hospital, while the national health agency says it will start tracking rates of the disease this year.
Health officials in Toronto say the person has been confined to treatment for 11 months.
"Basically, this is someone who dropped in and out of treatment over a number of years," Elizabeth Rae, associate medical officer of health with the tuberculosis program at Toronto Public Health, said on Monday.
A court order was considered necessary given the person's history of sporadic care, Rae said. Although not currently infectious, the patient will likely stay in hospital under strict watch for another year.
Officials are monitoring a second person that had the strain, which is dangerous because conventional drugs don't work to contain it.
Tuberculosis, a bacterial disease that most commonly affects the lungs, and is passed on through coughing or sneezing, can develop into a resistant strain if the patient is treated incorrectly or erratically due to a lack of necessary drugs, or if the patient refuses or is unable to complete the treatment.
The first strain, multi-drug resistant (MDR) tuberculosis, is immune to the most common antibiotics. If improper treatment continues, it can become extensively drug-resistant (XDR), which is extremely difficult to treat and has a high mortality rate.
The Public Health Agency of Canada plans to begin tracking cases of XDR and will publish their findings this year.
The agency believes the number of XDR cases accounts for a small fraction of MDR cases. The number of MDR cases was in a range of 13 to 23 people a year from 1998 to 2005.
According to the U.S. Centers for Disease Control and Prevention, out of 17,690 tuberculosis cases around the world from 2000 to 2004, 2 percent were XDR.
Successful treatment of XDR depends on the severity of the drug resistance and usually involves giving patients large amounts of drugs to see what works.
"That becomes quite a cocktail and they all have their own side-effects," said Dr. Edward Ellis, manger of tuberculosis prevention and control at the Public Health Agency of Canada.
Putting patients into isolation to stop them from infecting others is a crucial part of treatment. However, officials note that court-ordered confinement raises ethical concerns over patient rights.
"The ethical principle of autonomy ... is certainly being violated," said Ellis.
"But the most important one in this case is social justice, because if you have infectious TB and are at large in the community, you are basically exposing (others) to risk which is involuntary."
Experts say most XDR cases in Canada are seen in foreign-born people who develop the disease in another country before traveling to Canada.
An outbreak in South Africa has caused alarm because the disease is a danger to people with HIV-AIDS, whose weakened immune systems make it more difficult to fight XDR.
Experts say people may refuse treatment out of fear, an inability to stick to a lengthy regimen of antibiotics, or because of the stigma still attached to tuberculosis.
"People shy away from you, they're afraid of you. You're sent away to hospital, sometimes you never come back," said Ellis. "It's a bad word."
TORONTO - Canadian health officials have won a court order to keep a patient with a new, highly drug-resistant strain of tuberculosis in hospital, while the national health agency says it will start tracking rates of the disease this year.
Health officials in Toronto say the person has been confined to treatment for 11 months.
"Basically, this is someone who dropped in and out of treatment over a number of years," Elizabeth Rae, associate medical officer of health with the tuberculosis program at Toronto Public Health, said on Monday.
A court order was considered necessary given the person's history of sporadic care, Rae said. Although not currently infectious, the patient will likely stay in hospital under strict watch for another year.
Officials are monitoring a second person that had the strain, which is dangerous because conventional drugs don't work to contain it.
Tuberculosis, a bacterial disease that most commonly affects the lungs, and is passed on through coughing or sneezing, can develop into a resistant strain if the patient is treated incorrectly or erratically due to a lack of necessary drugs, or if the patient refuses or is unable to complete the treatment.
The first strain, multi-drug resistant (MDR) tuberculosis, is immune to the most common antibiotics. If improper treatment continues, it can become extensively drug-resistant (XDR), which is extremely difficult to treat and has a high mortality rate.
The Public Health Agency of Canada plans to begin tracking cases of XDR and will publish their findings this year.
The agency believes the number of XDR cases accounts for a small fraction of MDR cases. The number of MDR cases was in a range of 13 to 23 people a year from 1998 to 2005.
According to the U.S. Centers for Disease Control and Prevention, out of 17,690 tuberculosis cases around the world from 2000 to 2004, 2 percent were XDR.
Successful treatment of XDR depends on the severity of the drug resistance and usually involves giving patients large amounts of drugs to see what works.
"That becomes quite a cocktail and they all have their own side-effects," said Dr. Edward Ellis, manger of tuberculosis prevention and control at the Public Health Agency of Canada.
Putting patients into isolation to stop them from infecting others is a crucial part of treatment. However, officials note that court-ordered confinement raises ethical concerns over patient rights.
"The ethical principle of autonomy ... is certainly being violated," said Ellis.
"But the most important one in this case is social justice, because if you have infectious TB and are at large in the community, you are basically exposing (others) to risk which is involuntary."
Experts say most XDR cases in Canada are seen in foreign-born people who develop the disease in another country before traveling to Canada.
An outbreak in South Africa has caused alarm because the disease is a danger to people with HIV-AIDS, whose weakened immune systems make it more difficult to fight XDR.
Experts say people may refuse treatment out of fear, an inability to stick to a lengthy regimen of antibiotics, or because of the stigma still attached to tuberculosis.
"People shy away from you, they're afraid of you. You're sent away to hospital, sometimes you never come back," said Ellis. "It's a bad word."
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