South Africa Urged To Isolate Patients With New Deadly TB Strain To Avoid Pandemic

A panel of HIV and bioethics experts are urging South Africa to enforce isolation of patients infected with a new deadly strain of TB to avoid a pandemic in the country where HIV is widespread. They say that the point where the rights of the individual must give way to the interests of public health has been reached and the country must act now to stop a pandemic that could spread to the rest of the world.

The experts have made this policy recommendation in an article published in the online journal Public Library of Science (PLoS) Medicine.

The lead author of the report is Jerome Singh, a lawyer at the Centre for the Aids Programme of Research in Durban in South Africa. Mr Singh and his colleagues, Ross Upshur and Nesri Padayatchi between them represent the Aids Programme and the University of Toronto's Joint Centre for Bioethics.

It is thought that the new deadly TB strain may have developed because patients were treated with insufficient medication or because they missed some of their treatments.

Mr Singh and his colleagues consider the threat to be global because South Africa has a fast growing throughput of tourists and is home to millions of migrant workers from surrounding countries. It has a thriving ship and road transport system connecting with many other African nations.

Combined with the high rate of HIV infection in the region, the threat of spread of the new deadly TB strain is high, the authors say. This is emphasized by the fact that XDR-TB is now considered to be endemic in the province of KwaZulu-Natal where the strain was first detected. 39 hospitals in the province and other parts of South Africa have now admitted patients with XDR-TB. The authors say that at least 30 new cases of the deadly strain are being reported in the province every month.

The World Health Organization (WHO) has called for XDR-TB to be given the same global priority as avian flu. It has asked the governments in the sub-Saharan part of Africa to unite their HIV and TB fighting strategies.

Health Officials in South Africa are grappling with the conflict between the rights of the individual and the public health importance of this new situation. They have consulted with the WHO but have not yet released any information on their decision.

The WHO reported in September last year that the town Tugela Ferry, in KwaZulu-Natal was harbouring a new and deadly strain of extensively drug-resistant tuberculosis, XDR-TB. Tugela Ferry is also said to be the "epicentre of South Africa's HIV/AIDS epidemic".

Of the 544 patients observed in the region in 2005, 221 had developed the multi-drug-resistant form of tuberculosis, MDR-TB, and from these 53 of them had the extensively drug-resistant strain, XDR-TB. Also, 44 of the 53 XDR-TB patients were infected with HIV. 52 of the 53 patients died.

The median survival term after diagnosis for the 52 XDR-TB patients who died was 16 days, showing a fatality rate and speed of development for TB that is unprecedented anywhere in the world. Six of the patients who died, were health workers, and the dead also included those on antiretroviral treatment.

MDR-TB stands for multi-drug-resistant tuberculosis, i.e. Mycobacterium tuberculosis that has developed resistance to the antibiotic rifampicin and prodrug isoniazid, and most likely other drugs as well.

XDR-TB is a more resistant version of MDR-TB with additional resistance to at least three of the six classes of second-line anti-TB drugs. A second-line drug is a drug that is either less effective than a first-line drug such as rifampicin, or it could have toxic side-effects.

"XDR-TB in South Africa: No Time for Denial or Complacency."
Jerome Amir Singh, Ross Upshur, Nesri Padayatchi.
PLoS Med 4(1): e50 doi:10.1371/journal.pmed.0040050

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Written by: Catharine Paddock
Writer: Medical News Today