Playing catch up with XDR-TB
A special two-day TB crisis meeting is being held between health officials and the WHO in Pretoria at present, and last week the WHO set up a special task force to assist countries facing threats of XDR and multi-drug resistant (MDR) TB.
South African Director General for Health Thami Mseleku told the meeting yesterday (Tuesday) that without special efforts to test MDR patients for resistance to other drugs, government will be unaware of the presence of XDR-TB among TB patients.
He urged pharmaceutical and diagnostic companies to correct the gap with respect to new TB drugs and new diagnostic tests MDR and XDR TB are man-made problems, caused by super-resistant strains of TB developing from decades of patients not completing their TB medication.
Doctors’ mis-prescribing of TB drugs was another major reason for the XDR-TB outbreak, according to Dr Karin Weyer, Director for TB Research at South Africa’s Medical Research Council (MRC).
Weyer said that many doctors had used second line TB drugs (reserved for patients with MDR TB who are not responding to the first line drugs) for other ailments such as pneumonia without checking whether patients had undiagnosed TB.
South Africa’s TB cure rate is a matter of grave concern.
The latest information from health districts countrywide reveal cure rates as low as 12 percent in the Nkangala district in Mpumalanga, 18% in KwaZulu-Natal’s Uthungula district and 20% in the Northern Cape’s Frances Baard district.
Eastern Cape and Mpumalanga have the worst TB cure rates in the country (32%), followed closely by KwaZulu Natal (34%). Despite having one of the highest TB rates, the Western Cape recorded an average cure rate of 70 percent. In Gauteng the cure rate was 62 percent.
Hospitals have been identified as high-risk sites for the spread of MDR and XDR TB. At most public hospitals, TB patients are placed in medical wards alongside those with weak immune systems ‘ such as people with HIV, cancer patients on chemotherapy and badly managed diabetics.
The TB bacteria are easily transmitted, mostly by sneezes and coughs. One ‘big’ sneeze can release up to a million TB organisms.
XDR-TB was fast tracked to the top of the international agenda after results from a KwaZulu-Natal study was presented at the Toronto AIDS conference in August.
The study showed that 41% of 536 TB patients at Tugela Ferry had multi-drug resistant (MDR) TB and 53 had the XDR strain. All but one of the XDR TB patients died within a month.
‘It takes a long time to develop resistance, but we have seen that this strain is transmitted very quickly – in countries around the world and in our region,’ said Weyer.
She warned that there was only one drug, Capreomycin, that could be added to the current drug arsenal and that it would have to be managed very strictly to avoid resistance.
Patients who are prescribed Capreomycin as part of their regimen would have to be hospitalized as the medicine needs to be injected into the patient.
‘This come with a whole set of dilemmas as you need to isolate these patients from your HIV+ patients and they cannot be treated by HIV positive nurses,’ Weyer added.
Weyer said that proper infection controls were vital to prevent the spread of MDR and XDR TB.
The face masks currently being used by health workers in public hospitals offer little protection as they have large pores and no seals around the edges.
What is needed are respirators with tiny pores and an airtight seal around the edge.
Weyer said it was no good trying to ‘mend the leaking pipes, we must close the tap’. She said that even though South Africa reported 100 percent coverage of its flagship DOTS (directly observed short course strategy) programme, implementation was dismal.
‘MDR and XDR TB is a reflection of our (failing) DOTS system and you can also see it in our 50 percent cure rate, which also reflects the inappropriate treatment being prescribed,’ Weyer added.
Weyer said her greatest concern was the risk XDR-TB posed to HIV positive individuals. ‘In some settings, you find that 80 percent of TB patients are also HIV positive,’ she said.
The health department failed to respond to questions sent to it over a week ago.
Author
Republish this article
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Unless otherwise noted, you can republish our articles for free under a Creative Commons license. Here’s what you need to know:
-
You have to credit Health-e News. In the byline, we prefer “Author Name, Publication.” At the top of the text of your story, include a line that reads: “This story was originally published by Health-e News.” You must link the word “Health-e News” to the original URL of the story.
-
You must include all of the links from our story, including our newsletter sign up link.
-
If you use canonical metadata, please use the Health-e News URL. For more information about canonical metadata, click here.
-
You can’t edit our material, except to reflect relative changes in time, location and editorial style. (For example, “yesterday” can be changed to “last week”)
-
You have no rights to sell, license, syndicate, or otherwise represent yourself as the authorized owner of our material to any third parties. This means that you cannot actively publish or submit our work for syndication to third party platforms or apps like Apple News or Google News. Health-e News understands that publishers cannot fully control when certain third parties automatically summarise or crawl content from publishers’ own sites.
-
You can’t republish our material wholesale, or automatically; you need to select stories to be republished individually.
-
If you share republished stories on social media, we’d appreciate being tagged in your posts. You can find us on Twitter @HealthENews, Instagram @healthenews, and Facebook Health-e News Service.
You can grab HTML code for our stories easily. Click on the Creative Commons logo on our stories. You’ll find it with the other share buttons.
If you have any other questions, contact info@health-e.org.za.
Playing catch up with XDR-TB
by Anso Thom, Health-e News
October 17, 2006
Related
Gauteng patient: Five weeks of hell and then death
Patient CZ’s horror story represents a myriad of breakdowns within the Gauteng health system ‘ ranging from stockouts of critical drugs, long delays in investigative and diagnostic procedures and stockouts of basics such as clean linen.
MCC says no to TB drug access
South Africa’s Medicines Control Council (MCC) has confirmed that it will continue to deny compassionate access to a TB drug that for many drug resistant patients is their last hope.