Tweet
Extreme TB outbreak just 'tip of the iceberg'
Extreme TB outbreak just 'tip of the iceberg'
http://www.iol.co.za/index.php?set_id=14&click_id=125&art_id=vn20060910 094616232C393327
http://www.iol.co.za/index.php?set_id=14&click_id=125&art_id=vn20060910 094616232C393327
<table style="width: 405px; height: 44px; background-color: rgb(255, 255, 255);" cellpadding="0" cellspacing="0"><tbody><tr><td style="width: 360px;" class="caption">September 10 2006 at 11:27AM </td> </tr> <tr><td colspan="2" style="height: 1px; background-color: rgb(204, 204, 204);">
</td></tr> </tbody></table> <table border="0" cellpadding="23" cellspacing="0"> <tbody><tr> <td class="svarticletext"> By Liz Clarke & Charlene Smith
The extremely virulent form of tuberculosis that killed 52 out of 53 people at a hospital in KwaZulu-Natal, is just the "tip of the iceberg" in southern Africa, scientists have warned.
What makes this strain of TB so lethal is that unlike normal TB, XDR TB can infect even the healthiest of people. But healthy people are more likely to be able to fight off the disease, while those who have compromised immune systems, will die within a month.
The discovery of the strain at just one small hospital in Tugela Ferry forms a sixth of the world's known XDR TB cases. The lethal strain is untreatable and kills the victim in less than a month.
</td></tr> </tbody></table> <table border="0" cellpadding="23" cellspacing="0"> <tbody><tr> <td class="svarticletext"> By Liz Clarke & Charlene Smith
The extremely virulent form of tuberculosis that killed 52 out of 53 people at a hospital in KwaZulu-Natal, is just the "tip of the iceberg" in southern Africa, scientists have warned.
What makes this strain of TB so lethal is that unlike normal TB, XDR TB can infect even the healthiest of people. But healthy people are more likely to be able to fight off the disease, while those who have compromised immune systems, will die within a month.
The discovery of the strain at just one small hospital in Tugela Ferry forms a sixth of the world's known XDR TB cases. The lethal strain is untreatable and kills the victim in less than a month.
TB eradication programmes are failing
Dr Tony Moll of the Church of Scotland hospital at Tugela Ferry was the first to alert the world to the emerging human tragedy when it was found that HIV positive people who had appeared initially to "do well" on antiretroviral treatment, were dying of a virulent form of TB - and "frighteningly fast".
"We have seen HIV move in and create havoc in our community. We tremble in our boots at XDR TB," Moll said.
"Worldwide there are 347 cases of XDR TB, we picked up 53 cases in our small hospital alone, 51 percent had no prior TB, 28 percent had prior treatment, 14 percent were newly infected with drug resistant strains. We have lost two health care workers to XDR TB," he said.
"52 of the 53 died within 16 days of sputum collection, many died before sputum results came out. We have two to five new patients with XDR TB each month."
South Africa will launch a survey of 10 affected hospitals in KwaZulu-Natal within two weeks, but scientists say national surveys are needed. Tuberculosis is airborne and stays in the air for four hours after an infected person leaves the room.
Experts flew in for an emergency international conference in Johannesburg this week. They came from World Health Organisation offices in Europe, the Centres for Disease Control in the US and all of the Southern African Development Community countries, except Zimbabwe.
However, there was not a single representative of South Africa's National Department of Health present, reportedly under orders from Minister of Health Manto Tshabalala Msimang. Sources in her department claim she is furious that news of the extent of South Africa's XDR TB problem has leaked.
Officials from her department have also phoned doctors at the 28 hospitals in KwaZulu-Natal which have or have had XDR TB-infected patients, and warned them not to speak to the media or to allow them onto their premises or to take photographs - or risk losing their jobs.
And the place where you are most likely to get lethal strains of TB? In a South African hospital because of inadequate infection control. This has led to lethal diseases in state hospitals, including klebsiella and XDR-TB, leading to the deaths of patients.
Dr Karin Weyer who heads the Medical Research Council's TB programme says "South Africa is the epicentre of HIV and TB. HIV has the capacity to fast-track MDR into an uncontrollable epidemic. If this epidemic gets out of control the impact on a regional and global basis could be severe."
She says that, "research shows patients treated for TB in a hospital are at the highest risk of MDR TB. We have interviewed health staff and they admit to not always following TB treatment policies."
South Africa's TB eradication programmes which are supposed to be a government priority are failing. Medical Research Council research presented at the conference shows 22 percent of those who report for treatment die, 21 percent default, 23 percent are cured and only 22 percent complete treatment.
Dr Willem Sturm of the University of KwaZulu-Natal said they were petitioning the Medicines Control Council to urgently reregister "capreomycin. Its use was discontinued some years ago because of liver toxicity in some patients, but now we have extensive resistance to existing drugs." The last time a new TB drug developed, worldwide, was in 1963.
He said that in 1995 when the KZN strain of XDR TB was discovered it had been resistant to three drugs: isoniazide, rifmapicin and streptomycin. Then "the genotype began progressing from a single print into a genotype family" and it now rejects all drugs available in South Africa.
"XDR TB is not restricted to the 28 KZN hospitals. I suspect it is crossing the borders with Mozambique, Lesotho, the Western Cape, the Free State and Mpumalanga. We need to become better with directly observed treatment (DOT) throughout South Africa and with infection control in hospitals."
Prof Umesh Lalloo of the University of KwaZulu-Natal's Nelson Mandela School of Medicine in Durban, leader of the MDR TB research at Tugela Ferry, warned that all those in contact with the extreme form of TB were at risk of developing it, including health care personnel.
"That is the calamity," said Lalloo.
"We are the most resourced country, in respect of TB, on the continent, yet we have one of the worst cure rates for TB."
The extent of this virtually untreatable strain is not known as mass screening is expensive and difficult to monitor. Many patients are dying without being diagnosed.
As one scientist pointed out: "With this research we are looking through a keyhole. We don't know what is in the rest of the room."
TB bacteria are airborne and stay in the air four hours after a TB-infected person leaves the room.
About 75 percent of South Africans are TB-infected, but will become ill only if their immune system collapses.
Symptoms of TB include a persistent cough, fever, weight loss and tiredness.
Ordinary TB takes six months to treat and the treatment costs R250.
Multidrug-resistant TB takes 18 months to treat and costs R250 000. For the first four months, daily injections are needed.
XDR TB resists all drugs. It is lethal. Life expectancy is 16 days to a month after infection.
</td></tr></tbody></table>"We have seen HIV move in and create havoc in our community. We tremble in our boots at XDR TB," Moll said.
"Worldwide there are 347 cases of XDR TB, we picked up 53 cases in our small hospital alone, 51 percent had no prior TB, 28 percent had prior treatment, 14 percent were newly infected with drug resistant strains. We have lost two health care workers to XDR TB," he said.
"52 of the 53 died within 16 days of sputum collection, many died before sputum results came out. We have two to five new patients with XDR TB each month."
South Africa will launch a survey of 10 affected hospitals in KwaZulu-Natal within two weeks, but scientists say national surveys are needed. Tuberculosis is airborne and stays in the air for four hours after an infected person leaves the room.
Experts flew in for an emergency international conference in Johannesburg this week. They came from World Health Organisation offices in Europe, the Centres for Disease Control in the US and all of the Southern African Development Community countries, except Zimbabwe.
However, there was not a single representative of South Africa's National Department of Health present, reportedly under orders from Minister of Health Manto Tshabalala Msimang. Sources in her department claim she is furious that news of the extent of South Africa's XDR TB problem has leaked.
Officials from her department have also phoned doctors at the 28 hospitals in KwaZulu-Natal which have or have had XDR TB-infected patients, and warned them not to speak to the media or to allow them onto their premises or to take photographs - or risk losing their jobs.
And the place where you are most likely to get lethal strains of TB? In a South African hospital because of inadequate infection control. This has led to lethal diseases in state hospitals, including klebsiella and XDR-TB, leading to the deaths of patients.
Dr Karin Weyer who heads the Medical Research Council's TB programme says "South Africa is the epicentre of HIV and TB. HIV has the capacity to fast-track MDR into an uncontrollable epidemic. If this epidemic gets out of control the impact on a regional and global basis could be severe."
She says that, "research shows patients treated for TB in a hospital are at the highest risk of MDR TB. We have interviewed health staff and they admit to not always following TB treatment policies."
South Africa's TB eradication programmes which are supposed to be a government priority are failing. Medical Research Council research presented at the conference shows 22 percent of those who report for treatment die, 21 percent default, 23 percent are cured and only 22 percent complete treatment.
Dr Willem Sturm of the University of KwaZulu-Natal said they were petitioning the Medicines Control Council to urgently reregister "capreomycin. Its use was discontinued some years ago because of liver toxicity in some patients, but now we have extensive resistance to existing drugs." The last time a new TB drug developed, worldwide, was in 1963.
He said that in 1995 when the KZN strain of XDR TB was discovered it had been resistant to three drugs: isoniazide, rifmapicin and streptomycin. Then "the genotype began progressing from a single print into a genotype family" and it now rejects all drugs available in South Africa.
"XDR TB is not restricted to the 28 KZN hospitals. I suspect it is crossing the borders with Mozambique, Lesotho, the Western Cape, the Free State and Mpumalanga. We need to become better with directly observed treatment (DOT) throughout South Africa and with infection control in hospitals."
Prof Umesh Lalloo of the University of KwaZulu-Natal's Nelson Mandela School of Medicine in Durban, leader of the MDR TB research at Tugela Ferry, warned that all those in contact with the extreme form of TB were at risk of developing it, including health care personnel.
"That is the calamity," said Lalloo.
"We are the most resourced country, in respect of TB, on the continent, yet we have one of the worst cure rates for TB."
The extent of this virtually untreatable strain is not known as mass screening is expensive and difficult to monitor. Many patients are dying without being diagnosed.
As one scientist pointed out: "With this research we are looking through a keyhole. We don't know what is in the rest of the room."
TB bacteria are airborne and stay in the air four hours after a TB-infected person leaves the room.
About 75 percent of South Africans are TB-infected, but will become ill only if their immune system collapses.
Symptoms of TB include a persistent cough, fever, weight loss and tiredness.
Ordinary TB takes six months to treat and the treatment costs R250.
Multidrug-resistant TB takes 18 months to treat and costs R250 000. For the first four months, daily injections are needed.
XDR TB resists all drugs. It is lethal. Life expectancy is 16 days to a month after infection.
Comment