TB declared a national emergency in Mozambique

By, Mail & Guardian Online, February 27, 2007

The Mozambican government has declared tuberculosis (TB) as a national emergency, Vista News reported on Monday.

The Health Minister, Ivo Garrido, in an interview with the national radio service, Radio Mozambique, said public hospitals had limited capacities to treat the more than 35 000 cases that were recorded in the country last year.

Only 20% of public hospitals countrywide had the capacity to diagnose the disease.

The disease would continue to be a problem for the next 15 years, said Garrido.

The World Health Organisation (WHO) estimates that in sub-Saharan Africa nearly 400 people in every 100 000 have TB, which killed nearly seven million people in Africa in 2004.

The global health agency also noted that the high prevailing rate of TB infections in the region were pushed by the high rate of HIV/Aids.

"Both the highest number of deaths and the highest mortality per capita [of TB] are in the WHO Africa region, where HIV has led to rapid growth of the TB pandemic, and increases the likelihood of dying from TB," said WHO in a fact sheet on the disease. -- Sapa


Source: http://www.mg.co.za/articlepage.aspx?area=/breaking_news/breaking_news__africa/&articleid=300254

HIV, drug-resistant TB a deadly combo: The death rate among infected South Africans is reported to be 85%

By, Jia-Rui Chong, Los Angeles Times, February 26, 2007

A highly drug-resistant form of tuberculosis has killed about 85% of South African HIV patients who have become infected, presenting one of the most worrisome problems in HIV and tuberculosis control, researchers reported Sunday.

About 330 cases of so-called extensively drug-resistant, or XDR, tuberculosis have been verified in South Africa over the last year, said Karin Weyer of the South African Medical Research Council in Pretoria.

The outbreak began in KwaZulu-Natal province last year and is now found throughout the country, she said.

Dr. Paul Nunn, coordinator of tuberculosis and HIV at the World Health Organization, called the 85% mortality rate "completely egregious."

The South African findings were presented at the opening of the Conference on Retroviruses and Opportunistic Infections in Los Angeles. It is the largest scientific gathering for AIDS researchers.

XDR tuberculosis is resistant to most drugs but can be treated with four antibiotics if caught early enough.

"This creates a huge challenge in terms of infection control, especially in settings where high numbers of HIV-positive individuals are converging," such as hospitals, Weyer said.

Doctors have seen sporadic cases of XDR tuberculosis for decades, but it gained attention after the outbreak in KwaZulu-Natal province.

The WHO has reported that the number of countries with XDR tuberculosis has increased from 17 in March to 28 today.

The hardest-hit areas include South Africa, South Korea and parts of Eastern Europe, according to the U.S. Centers for Disease Control and Prevention.

The disease can kill quickly, particularly among HIV patients, whose immune systems are weakened.

Researchers reported last year that median survival time for patients was 25 days after their diagnosis.

Weyer said the disease appeared in about 10% of patients who had been diagnosed with multi-drug-resistant TB, a less severe form.

XDR tuberculosis has appeared in the U.S., but at much lower levels — 47 cases since 1993, resulting in 13 deaths, said Dr. Kevin Fenton, director of the CDC's National Center for HIV, STD and TB Prevention.

The death rate is six times higher than the rate for typical tuberculosis, he said.

Resistance testing is widespread in the U.S., but Fenton said the South African cases were a "wake-up call" for strengthening TB surveillance and prevention.

He noted that there were large numbers of multi-drugresistant TB cases in China, Russia and India, providing more opportunities for the development of XDR tuberculosis.

"We increasingly live in a small world," he said. "With foreign travel and migration to the U.S., we have to be very much aware of emerging threats of XDR TB."


Source: http://www.latimes.com/news/science/la-sci-aids26feb26,1,4849682.story?track=rss

TB that kills HIV patients is spreading: South Africa, 27 other nations hit by highly drug-resistant strain, experts say

By, Sabin Russell, SFGate.com, February 26, 2007

Los Angeles -- A meeting of international AIDS researchers opened here Sunday amid growing concerns about a deadly strain of tuberculosis that has been killing HIV-infected patients in South Africa and has been spotted in 27 other countries around the world.

Known as XDR-TB, or extensively drug-resistant tuberculosis, the bug first drew wide attention in August at the 16th International AIDS Conference in Toronto. Fifty-two of 53 HIV-positive patients who had this type of tuberculosis at South African hospitals had died of it.

Researchers reported on Sunday they have found an estimated 600 cases of XDR-TB in South Africa, most of them among patients already infected with HIV, the virus that causes AIDS -- and 85 percent of those patients have died.

"XDR-TB is a wake-up call," said Dr. Paul Nunn, coordinator for tuberculosis control programs at the World Health Organization in Geneva, during the 14th annual Conference on Retroviruses and Opportunistic Infections.

The meeting has drawn 3,800 of the world's leading AIDS researchers to report the latest scientific news on the spread of the epidemic, which has killed an estimated 25 million people worldwide since it first emerged 25 years ago.

Nunn said that XDR-TB has now been reported in 28 countries. The WHO estimates that each year, 27,000 people are infected with XDR-TB and about 16,000 of those people die.

Nunn said it is important to tell the world about XDR-TB "but without causing undue alarm."

He said the international community needs to spend $650 million a year on efforts to control various strains of multidrug resistant tuberculosis, of which XDR-TB is only the most recent and most deadly.

Ordinary tuberculosis remains a much larger threat on a global scale, responsible for 8.8 million cases, and 1.6 million deaths, every year.

The drug-resistant strain does not appear to spread easily, but it does represent a threat to both patients and health care workers who are HIV positive.

Karin Weyer, director of tuberculosis research at the South African Medical Research Council, told researchers at the Los Angeles meeting that roughly 30 percent of health care workers in her country are believed to be HIV positive.

Weyer said that six cases of suspected XDR-TB have been reported among South African health care workers. The disease was confirmed in four of them, who also had HIV. All four died.

Weyer said that XDR-TB has been found in 40 hospitals, and in every province in the country. Her team's estimate of 600 cases is based on studies showing it is turning up in about 10 percent of the 6,000 cases of multidrug-resistant TB found in the country last year.

There is mixed evidence as to the transmissibility of XDR-TB. In one study, 1,694 relatives and friends of patients with XDR-TB were tested. Among them, only 12 cases of multidrug-resistant tuberculosis were found, but there were no cases of XDR-TB.

A study of guinea pigs whose cages were placed in the ventilation stream from rooms housing XDR-TB patients was more of a concern. Eighty percent of the animals tested positive. "Most public health facilities in the developing world lack airborne infection control procedures," she said.

According to Nunn, XDR-TB is a form of tuberculosis that withstands not only first-line antibiotic therapies, but also at least two types of second-line antibiotics used to treat drug-resistant strains. Those second-line therapies include a class of antibiotics called fluoroquinolones as well as a variety of injectable treatments.

Those therapies are much more costly than conventional tuberculosis treatments, but drug-resistant strains crop up when the simpler therapies are not properly managed. Similarly, XDR-TB appears to be not so much a spreading strain as a type of mutant tuberculosis that now readily forms when second-line TB treatment is poorly managed as well.

The federal Centers for Disease Control and Prevention has tracked cases in the United States that meet the XDR-TB definition as far back at 1993. In March, it said that there had been 17 such cases from 2001-04. Since 1993, U.S. patients with XDR-TB were 64 percent more likely to die of the disease than patients with drug-resistant TB.


Source: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/02/26/MNGQ3OB6VV1.DTL&feed=rss.news

New Research May Overturn Conventional Wisdom On Drug-resistant Tuberculosis

By, Infectious Diseases Society of America, February 21, 2007

Science Daily — A newly released study suggests that the majority of cases of drug-resistant tuberculosis (TB) among patients undergoing treatment for the disease may be due to new infections, not acquired resistance. If confirmed in future studies the research, in the March 15 issue of The Journal of Infectious Diseases, may drive a major shift in strategy for controlling TB.

A major difficulty in treating patients with pulmonary TB is that the organism can become progressively resistant to standard therapy. This resistance was long thought to be acquired through mutations in the infecting strain when the treatment regimen was inadequate or the patient did not comply with it. More recently, studies of the genetic make-up of Mycobacterium tuberculosis (M. tuberculosis) strains have shown that resistance can also result from re-infection with a new strain that is already drug-resistant, sometimes against multiple drugs.

The authors of the new study, Qian Gao, PhD, and coworkers in Shanghai, China and elsewhere, used molecular genetics and drug susceptibility testing to investigate patients with TB who were treated in Shanghai hospitals during 1999-2004. They focused on 38 patients from whom samples were available before and during treatment. The researchers found that the strains of TB in the samples taken before treatment were genetically different from those taken during treatment in 87 percent (33 out of 38) of patients.

To determine the relative proportion of drug resistance caused by re-infection or mutation, the authors excluded six patients who were initially infected with resistant TB and then became drug-susceptible or resistant to fewer drugs. In the remaining 32 patients, the initial sample was drug-susceptible or resistant to at least one drug and the subsequent sample resistant to one or more drugs. Of these patients, 84 percent (27 patients) had before-and-during samples with different genetic patterns and only 16 percent (5 patients) had identical patterns. Thus, there were more than 5 times as many cases caused by re-infection compared to mutation.

"It was surprising to find a high rate of primary drug-resistant strains among treated patients," said Dr.Gao. "This overturned the common belief that drug resistance among treated patients is always acquired."

The investigators also noted that two patients in the study had multidrug-resistant strains in both their first and second sample, and that 10 others had multidrug-resistant strains in their second sample; genetic testing showed that 9 of the 10 patients had a different strain in the second sample. The most serious kind of drug-resistant disease therefore accounted for about a third of patients with drug resistance.

Limitations of the study included the exclusion of many patients without sample results, reliance on previously collected data in which some patients might have been misclassified, use of computerized drug susceptibility data, and the unknown contribution of mixed infections. Nevertheless, the findings are a warning. Although better diagnostics, drugs, and effective vaccines for TB are clearly needed, the authors said, "Our findings highlight the urgency of accelerating efforts to interrupt the transmission of drug-resistant tuberculosis." The research shows improved methods of preventing TB transmission may be needed in the very facilities and communities where TB patients are treated.

Fast Facts

Tuberculosis (TB) is one of the world's top killer diseases, claiming roughly 2 million lives each year.

Drug-resistant TB is a growing problem worldwide. Most resistance is believed to derive from inefficient treatment, leading to mutations.

This study found that 33 of 38 patients had a different strain of TB during treatment than before treatment.

Improved methods of preventing TB transmission may be needed in the very facilities and communities where TB patients are treated.

Note: This story has been adapted from a news release issued by Infectious Diseases Society of America.


Source: http://www.sciencedaily.com/releases/2007/02/070220132018.htm

TB patients misdiagnosed

By, Tash Reddy, IOL.co.za, February 24, 2007

South Africa's desperate tuberculosis epidemic can only get worse as thousands of infected people have been sent back into their communities because of inadequate testing.

The World Health Organisation in October last year advised the South African national Department of Health to adopt more expensive screening methods.

Before this thousands of TB infected people went undetected as screening methods used - a standard, smear-sputum test - failed to diagnose the disease, resulting in misdiagnosed, infected people spreading the disease unknowingly in their communities.

Pietermaritzburg physician Doug Wilson, an expert on smear-negative TB, said about 60 percent of TB cases are smear-negative. "In communities with high HIV prevalence (ie. most of South Africa) smear-negative TB is a major health issue, and probably also a major cause of death," he said.


Source: http://www.iol.co.za/index.php?from=rss_South%20Africa&set_id=1&click_id=13&art_id=vn20070224084546586C432393

S.Africa alters AIDS plan after extreme TB threat

By, Reuters, February 15, 2007

South Africa is overhauling its AIDS strategy in a bid to counter the rise of extreme drug resistant tuberculosis which is proving a serious threat to those suffering HIV/AIDS, a senior official said on Thursday.

Extreme drug resistant tuberculosis, or XDR-TB, has killed at least 183 people in South Africa since September. Most of the victims were already HIV-positive and their immune systems severely weakened by the AIDS virus.

"One of the areas that we are working on is strengthening specifically that aspect that deals with HIV/TB collaboration," said Nomonde Xundu, the health department's chief director for HIV and tuberculosis (TB).

South Africa is suffering one of the world's worst HIV/AIDS crises, with over 5 million of its 45 million population infected with the virus and up to 1,000 people dying of AIDS-related illnesses each day.

XDR-TB, which is easily spread in poor areas where people live in close quarters, threatens to compound the crisis as the new strain is immune to almost all drugs now used to treat TB.

Health planners were looking at ways to deal with co-infection of TB and HIV and improve TB screening ahead of the launch of a new AIDS strategy in March, said Xundu.

Health Minister Manto Tshabalala-Msimang told a news conference that drug-resistant mutations of the virus were emerging because TB patients were failing to complete the required course of drug treatment.

"Our biggest challenge will still remain the same: to ensure that patients complete the prolonged TB treatment," she said.

"Patients understand the need for hospitalization, fortunately for all of us, and none of the XDR patients have declined treatment after appropriate counseling."

The government did not think measures such as the forcible isolation of XDR-TB patients to prevent the spread of an outbreak was currently necessary, she added.

'Tuberculosis may hit back'

By, The Indian Express, February 16, 2007

Apart from AIDS and Hepatitis, tuberculosis may hit South Asia in a much devastating way if not dealt with properly and arrested effectively. Keeping on its priority agenda the health needs of the South Asian nations, the World Health Organization has earmarked funds for services to identify and address the problem.

The director of Christian Medical College and Hospital (CMCH), Dr John Pramod said this while addressing continuing medical education (CME) programme on tuberculosis update held at CMC.

Eminent experts from TRC, Chennai, and the chairman of State Task Force were the key speakers. Hospital spokesperson stated that the WHO has recommended that clinical practitioners keep themselves updated with the latest know how of the field that they are practicing in. This was for the first time that CMC started the CME where the attendance got 3 credit point for the participant.

During this CME the scientific basis of Revised National TB Control Programme (RNTCP), challenges in TB control and extra pulmonary TB- rational approach to management were discussed by chairman special task force Dr Jaikishan, deputy director TRC Chennai Dr Rajeshwrai Ramchandran and Dr Balambal Assist. Director, TRC, Chennai. Around 300 delegates participated in the CME.

Also, CME on tuberculosis was held at Dayanand Medical Collge and Hospital (DMCH). It was jointly organized by District Tuberculosis Society and DMCH. Dr Rajeshwari Ramachandran and Dr Balambal delivered lectures at DMCH, too.

Dr Jagdeep Whig vice-principal DMCH introduced the subject, followed by a welcome note by principal Dr. Daljit Singh.

During the session, the speakers lectured on global epidemic of disease, with emphasis on problem in India. Based on evidence-based strategy of DOTS programmes, delegates found the lectures were informative as comprehensive data was obtained from researches done in TRC Chennai. To combat the growing scourge of MDR TB and HIV TB, the need to adopt RNTCP and its protocols strictly and wholeheartedly was stressed upon. The lectures were followed by an interactive panel session, chaired by Dr Jaikishan, chairman, state task force committee. Various problems related to day-to-day management of the disease were discussed by the faculty members, who clear their doubts regarding RNTCP programme. The speakers emphasized that DOTS (RNTCP) is the best way to treat tuberculosis-pulmonary as well as extra pulmonary.

Stating that India is facing the burden of more than one-third of TB cases worldwide, Dr. Jaikishan said that private practioners were generally first point of contact for a considerable number of patients and hence they should support and encourage effective TB control.

Lethal TB strain now in all provinces

By, SABCnews.com, February 12, 2007

Extreme drug resistant tuberculosis (XDR-TB) can be traced to all provinces, the health department said today. The lethal form of the infectious disease first emerged in the Tugela Ferry region of KwaZulu-Natal two years ago. Sibani Mngadi, the health department spokesperson, said 269 cases of XDR-TB had been recorded nationally.

"The Department of Health is working with local and international stakeholders and experts including the SA Medical Research Council and the World Health Organisation to address the challenge of XDR-TB," he said

The department issued the statement in response to drastic new measures proposed by the Johannesburg-based Public Library of Science -including infection monitoring at airports and border posts and the isolation of patients, even against their will - to prevent the spread of XDR-TB.

Varying statistics
This came amid conflicting reports of how many people had died in the Eastern Cape from the disease. Figures released by the Johannesburg-based National TB Control Unit last week put the death toll from XDR-TB at 183 nationally since it was identified in September last year.
The unit said some 328 cases of XDR-TB had been identified and added that its own figure showed that some 18 people had died from the disease in the Eastern Cape.

The deadly strain of TB was more prevalent in patients who were HIV positive. The rise in HIV infection levels and the neglect of TB control programmes contributed to the emergence of drug-resistant strains of TB. - Sapa


Source: Lethal TB strain now in all provinces

Act now, warning on killer TB: Government urged to adopt extreme measures

By, Ntando Makhubu, Dispatch, February 12, 2007

DRASTIC new measures are being proposed to stop the spread of the virulent strain of TB that has killed at least five people in the Eastern Cape.

The urgent new measures, similar to those used to contain the Sars virus, include infection monitoring at airports and border posts and the isolation of patients – even against their will.

The recommendations – in an authoritative report published by the Johannesburg-based Public Library of Science (PLS) – follow confusing reports of how many people have died in the province from XDR-TB, which stands for Extreme Drug-Resistant TB.

Doctors believe XDR-TB mutated from Multi-Drug Resistant TB (MDR-TB) which had, in turn, mutated from ordinary TB, possibly as a result of patients defaulting on their medication regime.

Statistics released by the Johannesburg-based National TB Control Unit last week put the death toll from XDR-TB at 183 nationally since it was first identified in September last year.

The unit said some 328 cases of XDR-TB had been identified and added that its own figure showed that some 18 people have died from the disease in the Eastern Cape.

But provincial Health spokesperson Sizwe Kupelo yesterday disputed the figure, saying that so far only five deaths have positively been linked to the killer disease, with 28 others affected.

The PLS study points out that “diagnosed cases of XDR-TB likely represent a small proportion of the true extent of the problem ... and official statistics also likely underestimate the true prevalence of XDR-TB”.

Comparing XDR-TB to Sars (Severe Acute Respiratory Syndrome) – the viral respiratory illness that became a global threat in March 2003, after breaking out in China – the report says measures taken by countries against that disease should serve as a guideline for South Africa on how to deal with XDR-TB.

The 23-page study, by Jerome Singh, Ross Upshur and Nesri Padayatchi, researchers at the Durban-based Centre for Aids Programme of Research in South Africa, says if necessary, government needed to adopt a “more robust approach towards unco-operative patients with MDR-TB and XDR-TB”.

Referring to the involuntary detention and isolation of patients with XDR-TB, the report says government may have to favour “the interests of the wider public over that of the patient”, adding that “although such an approach might interfere with the patient’s right to autonomy and will undoubtedly have human rights implications ... ultimately in such crisis, the interests of public health must prevail over the rights of the individual”.

The report also recommends that government follow a multi-pronged approach to fighting the virus with “all organs of state, including the judiciary and various government departments” getting involved.

And “efforts must be stepped up to sponsor and equip poor countries to address these challenges”.

It adds that, “depending on how successfully the South African government controls the outbreak, as in the case of Sars, infection monitoring at hospitals, border posts and airports may become necessary”.

According to the report, XDR-TB could easily derail global efforts to contain HIV/Aids because its mode of transmission could prove a more serious public hazard.

It blamed the emergence of the deadly strain of TB, first identified in KwaZulu-Natal in September last year, on the failure of the health system to control problems at an early stage.

“TB should have been adequately managed when it was completely drug sensitive.”

Spreading much like a common cold through the coughs and sneezes of infected patients, the disease has been described by medical experts as fast-travelling and “unusually aggressive”.

The World Health Organisation said the SA Medical Research Council was undertaking a technical assistance mission to KwaZulu-Natal this month.

l A second-line drug used to treat XDR-TB is reportedly having toxic side-effects, SABC reported last week. – Additional reporting by Lunga Mtshizana


Source: http://www.dispatch.co.za/2007/02/12/Easterncape/aalead.html

TB fight takes a turn for the worse as drugs fail

By, SABC News, February 10, 2007

Health authorities in KwaZulu-Natal are faced with a new tuberculosis (TB) challenge. A second-line drug, used to treat the extremely drug resistant (XDR) TB, is showing to be toxic.

Curing XDR is becoming more difficult and more people are dying.

Iqbal Master, a doctor at the King George Hospital, says: "Some of the patients have experienced side-effects such as vomiting, diarrhoea, weakness and capriomason. Some patients have had electrolytes imbalances, which has proven difficult to treat."

Sandile Buthelezi, a doctor with the KwaZulu-Natal department of health, says: "We want to give doctors a chance to try the treatment for some time, monitor patients … then if we still have a problem … really there's no new drug before 2012."

WHO’s assistance

The outbreak of the deadly TB strain two years ago in Tugela Ferry gripped the world's attention. Despite international intervention, it continues to claim lives and up to 184 people have died in the Umsinga area alone. Most susceptible are those living with HIV. Officials concede they cannot win the fight alone.

The province has spent R32 million on ways to fight the spread of the disease.

Initiatives to curb TB spread

TB, a common and deadly infectious disease caused by mycobacterium, most commonly affects the lungs but can also affect the central nervous system, lymphatic system, circulatory system, genitourinary system, bones, joints, and even the skin.

The rise in HIV infection levels and the neglect of TB control programmes have caused a resurgence of TB. Drug-resistant strains of TB have emerged and are spreading (in 2000-2004, 20% of cases were resistant to standard treatments, and 2% were also resistant to second-line drugs).

The WHO declared TB a global health emergency in 1993, and the Stop TB Partnership proposed a Global Plan to Stop Tuberculosis which aims to save 14 million lives between 2006 and 2015.


Source: http://www.sabcnews.com/south_africa/health/0,2172,143541,00.html

Anti-TB drug shows toxic side-effects

By, Mail&Guardian, February 11, 2007

A second-line drug treating extreme drug-resistant tuberculosis (XDR-TB) is having toxic side-effects on patients in KwaZulu-Natal, the South African Broadcasting Corporation reported on Saturday.

Curing XDR-TB, a deadly strain of the infectious disease that emerged in the Tugela Ferry region of KwaZulu-Natal in 2005, is becoming more difficult and more people are dying, the report said.

"Some of the patients have experienced side-effects such as vomiting, diarrhoea, weakness and capriomason. Some patients have had electrolytes imbalances, which has proven difficult to treat," said Iqbal Master, a doctor at the King George Hospital.

Up to 184 people have died from XDR-TB in the Umsinga area of the province alone, despite intervention from the international community and the World Health Organisation.

The province has spent R32-million on fighting the spread of the disease, the report said.

The deadly strain of TB is more prevalent in patients who are HIV-positive.

The rise in HIV infection levels and the neglect of TB control programmes have contributed to the emergence of drug-resistant strains of TB. -- Sapa


Source: http://www.mg.co.za/articlePage.aspx?articleid=298689&area=/breaking_news/breaking_news__national/

Mozambique: Country Prepared to Prevent Spread of XDR-TB

By, Agencia de Informacao de Mocambique (Maputo), February 9, 2007

The Mozambican authorities are taking measures to prevent the spread of extensively drug resistant tuberculosis (XDR-TB), Health Minister Ivo Garrido announced on Thursday.

The discovery of this new, and highly dangerous, form of TB was announced by the World Health Organization (WHO) last September. This type of the disease was first found in the southern African region in the locality of Tungela Ferry, in the South African province of Kwazulu-Natal.

MDR-TB (Multidrug Resistant TB) was known prior to last September, and the term describes strains of tuberculosis that are resistant to at least the two main first-line TB drugs - isoniazid and rifampicin. But XDR-TB is resistant not only to these drugs, but also to three or more of the six classes of second-line drugs.

WHO warns that "Given the underlying HIV epidemic, drug-resistant TB could have a severe impact on mortality in Africa and requires urgent preventative action".

Speaking to reporters during a meeting of his Ministry's Hospital Council, Garrido said that Mozambique has participated in various meetings on the subject, and is drawing up strategies to prevent contamination, since both Mozambicans and South Africans are constantly travelling between their two countries.

Garrido said that two senior officials of the national tuberculosis programme are currently taking part in a workshop in South Africa to discuss XDR-TB.

Garrido noted that patients with tuberculosis, associated with HIV/AIDS, have shown resistance to all medication.

"In a group of 100 patients under treatment for tuberculosis, between four and five are resistant. This disease can be treated, what happens is that the patient can contaminate other people", he explained.

Treatment of XDR-TB implies returning to some drugs that had been abandoned because were found to be extremely toxic, said Garrido.

According to WHO, XDR-TB has been identified in all regions of the world but is most frequent in the countries of the former Soviet Union and in Asia.

The Kwazulu-Natal outbreak, WHO says, was characterised by "alarmingly high mortality rates". 52 of the 53 patients with this strain of TB died, on average 25 days after diagnosis. 44 of them had been tested for HIV, and all were positive. Anti- retroviral drugs proved no defence against XDR-TB.

Meanwhile reports given to the Hospital Council suggest that HIV/AIDS is now the main cause of mortality in hospitals throughout the country.


Source: http://allafrica.com/stories/200702090751.html

Tuberculosis Back and Deadlier Than Ever in Africa

By, Masimba Biriwasha, Ohmy News - International Global Watch, February 8, 2007

The recent emergence of extensively drug-resistant tuberculosis (XDR-TB) in South Africa is not only the result of poor treatment adherence by TB patients. It stems from years of neglect endured by TB program throughout sub-Saharan Africa.

The current scale of the region's drug resistance challenge is poorly understood, and African TB program are so dilapidated many are at a loss to know how to respond.

"We don't understand the extent of it, and whether it's more widespread than anyone thinks," admits the head of the World Health Organization's (WHO) TB department, Dr. Mario Raviglione. "And if we don't know what has caused it, then we don't know how to stop it," he told the New York Times last week.

It has been widely acknowledged that the new deadly TB strain may have developed because of insufficient medication or because patients missed some of their treatments. This ignores the many factors known to have major impact on treatment adherence. These include social and economic factors, as well as weaknesses in the health care system itself -- all widespread in sub-Saharan Africa.

This means that even "compliant" patients are at a high risk of TB recurrence, as well as developing and transmitting drug resistant strains.

The tendency of recent reports to focus on patient-related factors as the "cause" of drug resistant TB, conveniently overlooks the pervasive systemic factors driving TB and drug resistance in Africa.

HIV infection increases the likelihood of active TB more than 50-fold, for example, an estimated one-third of the 24.5 million people living with HIV (PLHIV) in sub-Saharan Africa also have TB. To make matters worse, current diagnostic tests for TB often fail to detect the disease among PLHIV.

As a result of the high rate of HIV infection in the region -- and an almost complete lack of TB infection control measures in health centers -- the threat of spread of the new deadly TB strain is high. There are fears that should XDR TB spread among the HIV-positive population, it could wreak havoc among millions of people throughout sub-Saharan Africa, reversing gains made in TB control and antiretroviral programs.

The capacity for TB drug resistance testing is, ironically, better in South Africa than anywhere else in the region. If XDR-TB had emerged in Zambia, or Lesotho, or Zimbabwe, for example, we might never have known. And if it has already emerged elsewhere, we still might not know even today because of the relative inability to detect TB drug resistance.

More than anything else, what makes the reported South African cases so alarming is that it could indicate TB drug-resistance underlies the HIV epidemic throughout the region. The factors behind the emergence of drug resistant TB are by no means unique to South Africa, but are prevalent throughout neighboring countries.

Eleven of the 15 countries with the highest TB incidence globally are in the sub-Saharan Africa region. Nevertheless, TB is regarded as far less of a health priority than HIV. In recent years annual spending on HIV programs in the region has skyrocketed, while in the same period anti-TB efforts have received paltry increases in resources.

Responding to the challenge of drug resistance -- and TB in general -- will require re-building the basics of African TB programs in a number of ways: Training and retaining health workers in sufficient numbers; strengthening diagnostic and laboratory facilities; maintaining continuous drug supplies (including second-line drugs for treating drug resistant forms of TB); introducing infection control measures to stop the spread of TB; and raising awareness among affected people and communities.

As a first step to rolling back the years of neglect, understanding the extent of the drug resistance problem and its interaction with HIV is paramount. Detailed population-based studies of TB drug resistance in Africa are urgently required.

Second, difficult questions must also be asked about whether current TB control strategies are sufficient to address TB drug resistance and TB/HIV co-epidemics in the context of Africa.

Not until these two question marks are lifted will investment by the international community ensure an appropriate response.


Source: http://english.ohmynews.com/articleview/article_view.asp?at_code=391210

Tough action needed on deadly TB strain

By, newscientistspace, January 27, 2007

Forcibly detaining people infected with a deadly strain of drug-resistant tuberculosis may be the only way to stop its spread. So say AIDS specialists in South Africa, where cases of extensively drug-resistant TB (XDR-TB) are spiralling out of control.

In KwaZulu-Natal, the province hardest hit by South Africa's HIV epidemic, 30 new cases of XDR-TB are being reported each month. HIV makes people easy prey to the disease, which is resistant to most anti-TB drugs and kills almost everyone it infects within 16 days.

"If XDR-TB is not contained, completely drug-resistant TB is waiting in the wings to take its place," says Jerome Singh at the Centre for AIDS Programme of Research in South Africa, based in Durban, KwaZulu-Natal, who is calling for the government to take firmer action (PLoS Medicine, DOI: 10.1371/journal.pmed.0040050).

Cases of XDR-TB have been reported all over the country but there are currently no infection control ...

Source: http://space.newscientist.com/article.ns?id=mg19325883.100&feedId=health_rss20

First two cases of super TB hit Cape

By, Melanie Peters, Indepentdent Online, February 3, 2007

The Western Cape has identified its first two cases of the killer strain of extremely drug resistant tuberculosis, or XDR-TB, the provincial health department said on Friday.

One case, that of an 11-month-old baby girl, was being treated in Brooklyn Chest TB Hospital, said spokesperson Miranda Anthony.

The other patient, a woman from the Eastern Cape, was being treated at the Carnation ward at Lentegeur Hospital. She was in isolation.

XDR-TB made headlines last year when it was first identified in South Africa at Tugela Ferry in KwaZulu-Natal, with 52 of the first 53 patients dying. The disease is complicated by the presence of HIV/Aids.

Late last year over 300 cases of XDR-TB were confirmed across the country, the national health department said. It recorded 263 cases in KwaZulu-Natal, 10 cases each in the Eastern Cape and the North West, eight in Gauteng, six in the Free State, three in Limpopo and two in the Northern Cape. But none were reported in Mpumalanga and the Western Cape.

XDR-TB is defined by the World Health Organisation as TB which is resistant to the main first-line TB drugs and to three or more of the six second-line drugs.

Anthony said precautions have been taken to protect staff caring for the two patients. The department was following up all people who had been in close contact with them. If they had contracted the disease then treatment would involve drugs to which the person was likely to respond.

She said: "Because XDR-TB is resistant to first and second-line drugs, treatment options are seriously limited. It is vital that TB control is managed properly."

Anthony said someone who already had ordinary TB could avoid getting the MDR or XDR strains by taking all their TB treatment exactly as prescribed.

Source: http://www.int.iol.co.za/index.php?from=rss_South%20Africa&set_id=1&click_id=13&art_id=vn20070203104200938C551228

TB Becoming Difficult To Treat In Vietnam Because Of TB/HIV Coinfection, Health Official Says

Tuberculosis is becoming more difficult to treat in Vietnam because 10% of people living with the disease also are HIV-positive, according to statistics from the National TB Control Program, the Vietnam News reports.

"The HIV/AIDS epidemic is one of the main reasons why we still have so many TB patients, regardless of the large number of new TB cases that are discovered and treated every year," NTCP Director Dinh Ngoc Si said recently at a workshop in the city of Ha Noi.
According to Si, 21,000 people in Vietnam are living with TB/HIV coinfection. In addition, the number of people living with TB/HIV coinfection is increasing in large cities -- including An Giang, Ha Noi, Hai Phong, HCM City and Quang Ninh -- according to the Vietnam News.

An increasing number of people with TB also are developing drug resistance, which could affect the country's treatment success rate, which is currently recorded at 90%, the Vietnam News reports. Vietnam has the 13th highest global TB burden, with roughly 221,000 people living with the disease, according to the NTCP. About 145,000 new TB cases are detected annually, and 70% of people with the disease are between ages 15 and 55, according to the Vietnam News (Vietnam News, 1/29).

Source: http://www.medicalnewstoday.com/medicalnews.php?newsid=62061&nfid=rssfeeds