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 ‘€œbig’€ 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.

 

 ‘€œIt 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.

‘€œThis 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 ‘€œmend 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.

 

‘€œMDR 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. ‘€œIn 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.

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