XDR-TB may be bigger risk than Aids
By, Louise Flanagan, Pretoria News, January 11, 2008
Extensively drug-resistant tuberculosis (XDR-TB) could become a more serious public health risk than HIV and Aids because of government inaction.
That's the warning from a team of health researchers who assessed the risk of the usually fatal illness. They concluded that health authorities were not doing enough to combat it.
"The government's initial lethargic reaction to the crisis and uncertainty among health professionals concerning the ... implications of effectively tackling this outbreak highlight the urgent need to address these issues, lest inaction spawn a full-blown XDR-TB epidemic," said Jerome Amir Singh, Ross Upshur and Nesri Padayatchi in their paper, titled XDR-TB in South Africa: No time for denial or complacency.
The research is published in the January issue of PLoS Medicine.
XDR-TB is a strain of multi-drug-resistant TB (MDR-TB) that is infectious, extremely difficult and expensive to treat. It has a high death rate.
The researchers' warnings were underlined by recent problems in the Eastern Cape when dozens of patients with XDR-TB and MDR-TB broke out of two hospitals where they had been living in enforced isolation for months so they could go home for Christmas.
Authorities spent weeks searching for them. Some are still missing.
XDR-TB was first identified in South Africa in rural KwaZulu-Natal, but has since been found in all provinces; MDR-TB emerged before that and in January 2006 the Medical Research Council estimated that there were 6 000 cases a year.
The researchers warned that XDR-TB was now considered endemic to KwaZulu-Natal with at least 30 new cases reported there each month and 300 cases nationally.
"Diagnosed cases of XDR-TB likely represent a small proportion of the extent of the problem."
In November the health department confirmed 481 cases of XDR-TB and 216 of those patients had died.
"XDR-TB is a serious global health threat.
"It has the potential to derail the global efforts to contain HIV/Aids, as broadly disseminated XDR-TB will prove to be a much more serious public health threat owing to its mode of transmission."
The researchers said the emergence of MDR- and XDR-TB was an indication of the poor implementation of the TB control programme.
This was fuelled by lack of infection control in hospitals and clinics.
They said South Africa should reduce overcrowding in hospitals, expand disease surveillance "and rethink its counselling, treatment and tracing strategies".
The government's social policy was making it difficult for some to get treatment, so grant policies should be reviewed, they said.
TB thrives in the crowded social conditions of the poor, who are often dependent on social grants. They also get free hospital treatment.
"Current government policy stipulates that those who are hospitalised at state expense lose their social welfare benefits for the duration of their hospitalisation.
"Faced with the prospect of being deprived of their gainful employment and/or having their welfare benefits suspended for the duration of hospitalisation - which in the case of MDR-TB or XDR-TB could last 18 to 24 months - many opt not to stay in hospitals."
Instead they mix with non-infected people, use public transport and continue working, posing a significant health risk to others.
Source: http://www.pretorianews.co.za/index.php?fSectionId=672&fArticleId=vn20080111033336532C636940
Extensively drug-resistant tuberculosis (XDR-TB) could become a more serious public health risk than HIV and Aids because of government inaction.
That's the warning from a team of health researchers who assessed the risk of the usually fatal illness. They concluded that health authorities were not doing enough to combat it.
"The government's initial lethargic reaction to the crisis and uncertainty among health professionals concerning the ... implications of effectively tackling this outbreak highlight the urgent need to address these issues, lest inaction spawn a full-blown XDR-TB epidemic," said Jerome Amir Singh, Ross Upshur and Nesri Padayatchi in their paper, titled XDR-TB in South Africa: No time for denial or complacency.
The research is published in the January issue of PLoS Medicine.
XDR-TB is a strain of multi-drug-resistant TB (MDR-TB) that is infectious, extremely difficult and expensive to treat. It has a high death rate.
The researchers' warnings were underlined by recent problems in the Eastern Cape when dozens of patients with XDR-TB and MDR-TB broke out of two hospitals where they had been living in enforced isolation for months so they could go home for Christmas.
Authorities spent weeks searching for them. Some are still missing.
XDR-TB was first identified in South Africa in rural KwaZulu-Natal, but has since been found in all provinces; MDR-TB emerged before that and in January 2006 the Medical Research Council estimated that there were 6 000 cases a year.
The researchers warned that XDR-TB was now considered endemic to KwaZulu-Natal with at least 30 new cases reported there each month and 300 cases nationally.
"Diagnosed cases of XDR-TB likely represent a small proportion of the extent of the problem."
In November the health department confirmed 481 cases of XDR-TB and 216 of those patients had died.
"XDR-TB is a serious global health threat.
"It has the potential to derail the global efforts to contain HIV/Aids, as broadly disseminated XDR-TB will prove to be a much more serious public health threat owing to its mode of transmission."
The researchers said the emergence of MDR- and XDR-TB was an indication of the poor implementation of the TB control programme.
This was fuelled by lack of infection control in hospitals and clinics.
They said South Africa should reduce overcrowding in hospitals, expand disease surveillance "and rethink its counselling, treatment and tracing strategies".
The government's social policy was making it difficult for some to get treatment, so grant policies should be reviewed, they said.
TB thrives in the crowded social conditions of the poor, who are often dependent on social grants. They also get free hospital treatment.
"Current government policy stipulates that those who are hospitalised at state expense lose their social welfare benefits for the duration of their hospitalisation.
"Faced with the prospect of being deprived of their gainful employment and/or having their welfare benefits suspended for the duration of hospitalisation - which in the case of MDR-TB or XDR-TB could last 18 to 24 months - many opt not to stay in hospitals."
Instead they mix with non-infected people, use public transport and continue working, posing a significant health risk to others.
Source: http://www.pretorianews.co.za/index.php?fSectionId=672&fArticleId=vn20080111033336532C636940
posted by AIDS-Care-Watch at 9:13 am
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