Experts devise strategy to fight new TB strain

The new strain was already present on every continent, but a recent outbreak in South Africa was particularly worrying, experts told the meeting, which was hosted by the South African Medical Research Council, with support from the World Health Organization and the US Centers for Disease Control and Prevention. The outbreak in South Africa was of an extraordinarily virulent form and occurs in a region with extremely high HIV co-infection. 

WHO said that multidrug resistant strains of the disease are already widespread worldwide-mainly, it says, because of healthcare workers' improper treatment regimens and failure to ensure that patients complete the whole course of treatment. Essentially, drug resistance arises in areas with poor TB control programmes, WHO said. 

Paul Nunn, of WHO's Stop TB campaign, said that there is now tremendous international concern over the spectre of untreatable TB
and the extraordinarily high mortality rate demonstrated in the recent outbreak in KwaZulu/Natal. 

Sputum samples from 536 people with TB in the town of Tugela Ferry were collected between January 2005 and March 2006. A total of 221 (41%) participants had multidrug resistant TB, of whom 53 had the extensively drug resistant strain. Fifty two of these 53 patients died, within an average of
25 days. 

Dr Nunn said the immediate priority was to establish the extent of infection. We know about the problems in KwaZulu/Natal because the area has comparatively good health facilities. We don't know how serious the disease is in other parts of Africa where there is almost no surveillance. 

Karin Weyer, of the South African Medical Research Council, said, Among the actions required are urgent and rapid surveys in high risk countries to assess the full extent of XDR-TB [extensively drug resistant TB] globally. 


Seven point action plan on extensively drug resistant tuberculosis

* Conduct rapid surveys of the strain
* Enhance laboratory capacity
* Improve technical capacity of clinical and public health managers to effectively respond to outbreaks
* Implement infection control precautions
* Increase research support for development of anti-TB drugs
* Increase research support for development of rapid diagnostic tests
* Promote universal access to antiretrovirals under joint TB and HIV activities 

Related Links:

- XDR-TB*a global threat, The Lancet 2006 368:964 DOI:10.1016/S0140-6736(06)69391-4
http://www.thelancet.com/journals/lancet/article/PIIS0140673606693914/fulltext 
Following an emergency consultation in Johannesburg on Sept 7 and 8, global health agencies have developed a seven-point plan to combat extensively (or extremely) drug-resistant tuberculosis (XDR-TB). Representatives from several southern African countries have agreed to implement the plan within 3 months.

- Killer TB: Government was warned by Chris McGreal, Mail & Guardian 
http://www.mg.co.za/articlePage.aspx?area=/insight/insight__national/&articleid=284090 
We were very excited when the antiretroviral [ARV] drugs came at last, said Tony Moll, chief medical officer at the Church of Scotland hospital near Tugela Ferry, KwaZulu-Natal.

- XDR TB a sign of failure, by Khopotso Bodibe, Health-E
http://www.health-e.org.za/news/article_audio.php?uid=20031506 
The emergence of the super drug resistant strain of tuberculosis, XDR-TB, in KwaZulu-Natal is not an unexpected occurrence. Its a product of a TB programme that does not effectively address the TB problem, say experts. 

- XDR TB found in 28 hospitals in South Africa by Keith Alcorn,AIDSMAP 
http://www.aidsmap.com/en/news/42C32A43-FECA-46A4-8021-67BCE7EF58B7.asp 
A strain of tuberculosis (TB) resistant to virtually drugs available to treat it has been detected in 28 hospitals since its presence in South Africa was first revealed last month in one district hospital in Kwazulu-Natal, international health experts heard yesterday at an emergency meeting in Johannesburg.

- Editorial Extensively drug resistant tuberculosis A serious wake-up call for global health - BMJ 2006333:559-560 (16 September), doi:10.1136/bmj.38971.587222.AB  
http://bmj.bmjjournals.com/cgi/content/full/333/7568/559  
Tuberculosis outbreaks in the developed world are newsworthy.1 However, in the developing world, where deaths from tuberculosis are common, it takes something exceptional for an outbreak to attract much attention. In response to a recent report at the 16th international AIDS conference2 and to increasing South African media reports, the World Health Organization last week expressed concern about extensively drug resistant tuberculosis (also referred to as XDR tuberculosis).3 

- WHO information on Drug- and multidrug-resistant tuberculosis (MDR-TB)
http://www.who.int/tb/dots/dotsplus/en/index.html  

- Local company to provide drug for resistant TB by Department of Health 
http://www.doh.gov.za/docs/pr/pr0911-f.html 
The Department of Health is making progress in ascertaining supply of additional drugs Capreomycin and Para Amino Salicylic Acid - to deal with Extreme Drug Resistant Tuberculosis with a local company agreeing to provide one of the drugs.The drug is in the process of being registered. We are also looking internationally for other options.