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
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
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