Extent of XDR-TB in South Africa unknown
By, Mail & Guardian Online, May 3, 2007
The extent of multidrug-resistant (MDR-TB) and extensively drug-resistant (XDR-TB) strains of TB in South Africa was not currently known, the World Health Organisation (WHO) said on Wednesday.
"We know there are quite a lot of MDR and XDR-TB, although we don't know the extent," said Dr Fabio Scano, a tuberculosis expert from the WHO.
Scano is in South Africa as part of a two-year collaboration with the government to provide technical support and advice in the fight against the disease.
"There are a lot of interventions under way but we have yet to see the results ... the fight against TB is a marathon, not a sprint," he said.
Since TB was "magnified by" HIV, it was the biggest public health challenge both nationally and internationally, he said.
According to the Health Department's latest figures, 237 of 350 XDR-TB patients identified in South Africa so far -- 68% -- have died. A total of 112 are on treatment and one patient has defaulted on treatment.
KwaZulu-Natal has the country's largest share of cases, with 221 out of 247 patients -- 89% -- having died. The survivors are all on treatment.
Special advisor to the Health Minister, Professor Ronnie Green-Thompson, said the high number of XDR-TB cases identified in the province could be due to it being well-equipped for TB testing.
"I don't think that KwaZulu-Natal is unique," he added.
Scano said an epidemiological investigation was under way in that province and the rest of the country to better understand the extent of the disease.
While the government would provide the resources to fight the disease, its magnitude meant South Africa would have to look elsewhere for funding.
It had already approached the Global Fund to Fight Aids, TB and Malaria. The WHO had said it was "very willing" to help, said the Health Department's deputy director general, Nthari Matsau.
There was much ignorance in other Southern African Development Community (SADC) countries about the extent of the disease.
"The other countries don't know whether they have it or not. South Africa so far is the only country [in the SADC region] that has the capacity and the capability to test for XDR-TB," said Matsau.
Scano said the government was increasing the cure rate for TB. He called for a "sustained support and fight" and said suspected TB cases needed access to HIV testing.
Deputy Health Minister Nozizwe Madlala-Routledge said the department would work closely with the Home Affairs Department to try to identify patients entering the country, but acknowledged it was difficult.
"We can't just grab everybody coming into the country and put them through tests."
She said measures to control the disease would include putting ultraviolet lights in waiting rooms at hospitals to kill the bacteria that caused TB.
Radebe said locking up XDR-TB patients who refused to take steps to avoid infecting others was not yet an option.
"We feel we have not yet reached a point where we can consider those extraordinary measures."
The Associated Press reported on Tuesday that a 27-year-old XDR-TB patient was being held in a jail in the United States because he failed to take precautions to avoid infecting others. He also did not heed instructions to wear a mask in public.
Matsau said the department recognised the importance of separating patients, but said having TB was not a criminal act.
"There are much more acceptable and humane ways," she added.
In March the Health Department got an interim High Court order compelling 13 MDR-TB patients back to their beds after they forced their way out of Pretoria West Hospital. They went to the Sizwe Tropical Disease Hospital in Edenvale, east of Johannesburg, insisting they be treated as outpatients. They had received treatment there previously.
Matsau said patients might try to run away becasue treatment took a long time. Drug addicts, delinquents or breadwinners not wanting to lose money were also more likely to run away.
"An average person generally detests being controlled in that kind of situation," said Matsau.
MDR-TB could develop if standard TB drug treatment was misused or not adhered to. More expensive and harmful second-line drugs would then be required. If this course of treatment was mismanaged, XDR-TB could result, making treatment options and chances of a cure far narrower.
According to medicalnewstoday.com website, countries with good TB control programmes could cure between 50 to 60% of XDR-TB cases.
Successful treatment however depended on the extent of drug resistance, the severity of the disease and whether a patient's immune system had been compromised. - Sapa
Source: http://www.mg.co.za/articlePage.aspx?articleid=303829&area=/breaking_news/breaking_news__national/
The extent of multidrug-resistant (MDR-TB) and extensively drug-resistant (XDR-TB) strains of TB in South Africa was not currently known, the World Health Organisation (WHO) said on Wednesday.
"We know there are quite a lot of MDR and XDR-TB, although we don't know the extent," said Dr Fabio Scano, a tuberculosis expert from the WHO.
Scano is in South Africa as part of a two-year collaboration with the government to provide technical support and advice in the fight against the disease.
"There are a lot of interventions under way but we have yet to see the results ... the fight against TB is a marathon, not a sprint," he said.
Since TB was "magnified by" HIV, it was the biggest public health challenge both nationally and internationally, he said.
According to the Health Department's latest figures, 237 of 350 XDR-TB patients identified in South Africa so far -- 68% -- have died. A total of 112 are on treatment and one patient has defaulted on treatment.
KwaZulu-Natal has the country's largest share of cases, with 221 out of 247 patients -- 89% -- having died. The survivors are all on treatment.
Special advisor to the Health Minister, Professor Ronnie Green-Thompson, said the high number of XDR-TB cases identified in the province could be due to it being well-equipped for TB testing.
"I don't think that KwaZulu-Natal is unique," he added.
Scano said an epidemiological investigation was under way in that province and the rest of the country to better understand the extent of the disease.
While the government would provide the resources to fight the disease, its magnitude meant South Africa would have to look elsewhere for funding.
It had already approached the Global Fund to Fight Aids, TB and Malaria. The WHO had said it was "very willing" to help, said the Health Department's deputy director general, Nthari Matsau.
There was much ignorance in other Southern African Development Community (SADC) countries about the extent of the disease.
"The other countries don't know whether they have it or not. South Africa so far is the only country [in the SADC region] that has the capacity and the capability to test for XDR-TB," said Matsau.
Scano said the government was increasing the cure rate for TB. He called for a "sustained support and fight" and said suspected TB cases needed access to HIV testing.
Deputy Health Minister Nozizwe Madlala-Routledge said the department would work closely with the Home Affairs Department to try to identify patients entering the country, but acknowledged it was difficult.
"We can't just grab everybody coming into the country and put them through tests."
She said measures to control the disease would include putting ultraviolet lights in waiting rooms at hospitals to kill the bacteria that caused TB.
Radebe said locking up XDR-TB patients who refused to take steps to avoid infecting others was not yet an option.
"We feel we have not yet reached a point where we can consider those extraordinary measures."
The Associated Press reported on Tuesday that a 27-year-old XDR-TB patient was being held in a jail in the United States because he failed to take precautions to avoid infecting others. He also did not heed instructions to wear a mask in public.
Matsau said the department recognised the importance of separating patients, but said having TB was not a criminal act.
"There are much more acceptable and humane ways," she added.
In March the Health Department got an interim High Court order compelling 13 MDR-TB patients back to their beds after they forced their way out of Pretoria West Hospital. They went to the Sizwe Tropical Disease Hospital in Edenvale, east of Johannesburg, insisting they be treated as outpatients. They had received treatment there previously.
Matsau said patients might try to run away becasue treatment took a long time. Drug addicts, delinquents or breadwinners not wanting to lose money were also more likely to run away.
"An average person generally detests being controlled in that kind of situation," said Matsau.
MDR-TB could develop if standard TB drug treatment was misused or not adhered to. More expensive and harmful second-line drugs would then be required. If this course of treatment was mismanaged, XDR-TB could result, making treatment options and chances of a cure far narrower.
According to medicalnewstoday.com website, countries with good TB control programmes could cure between 50 to 60% of XDR-TB cases.
Successful treatment however depended on the extent of drug resistance, the severity of the disease and whether a patient's immune system had been compromised. - Sapa
Source: http://www.mg.co.za/articlePage.aspx?articleid=303829&area=/breaking_news/breaking_news__national/
posted by AIDS-Care-Watch at 11:07 am
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