MULTI-DRUG-RESISTANT TUBERCULOSIS STRIKES MINERS IN SA

[ruthbeme]

<TABLE cellSpacing=0 cellPadding=0 width=570 align=left border=0><TBODY><TR><TD width=5></TD><TD><HR></TD></TR><TR><TD width=5></TD><TD width=5></TD><TD class=html_title_author_a height=10>25 September 2006</TD></TR><TR><TD colSpan=3 height=14></TD></TR><TR><TD width=5></TD><TD width=5></TD><TD><TABLE width="98%" align=left border=0><TBODY><TR><TD class=html_content align=left>South Africa?s Chamber of Mines has been informed by some mining companies that a few cases of multi-drug-resistant tuberculosis have been isolated in Free State mine hospitals.

The existence of multi-drug-resistant TB is not a new phenomenon in South Africa or in the mining industry. However, the existence of the extensively drug-resistant strain of virulent tuberculosis in some parts of South Africa is of concern because of its high mortality rate. To date there are no confirmed cases of the particularly virulent strain in mining.

Health professionals in the mining industry are co-operating closely with the Department of Health, the National Institute of Communicable Diseases and international health groupings to respond effectively to this health challenge.

Tuberculosis is fuelled by the low resistance in persons suffering from AIDS. Most mining companies provide antiretroviral treatment to mineworkers and provide top-class medical treatment to all their employees.

Dr Frans Barker, acting CE of the Chamber, says he is confident that co-operation between the various stakeholders will ensure that the necessary support and treatment are provided.
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[ruthbeme]

Re: MULTI-DRUG-RESISTANT TUBERCULOSIS STRIKES MINERS IN SA

<TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR><TD class=headline>TB preventive drug to be administered to 38 000 miners <HR color=#990033 SIZE=1></TD></TR><TR><TD class=content>Extremely drug-resistant tuberculosis (XDR-TB) is emerging as a new threat to the local mining industry.

South Africa?s mineworkers in general, and those in the gold-mining sector, in particular, are vulnerable to contracting XDR-TB owing to the prevalence of HIV/Aids and the occupational lung disease, silicosis, which weakens the immune system.

The first suspected cases of the deadly strain of the disease were reported last week in South Africa?s mining industry when two of South Africa?s largest gold-mining companies ? Harmony and Gold Fields ? had isolated six Free State mineworkers who were showing signs of the disease. However, it was subsequently found that these cases were likely to be multidrug-resistant or highly resistant TB, but not XDR-TB. The Chamber of Mines pointed out in a statement that there had been no confirmed cases of XDR-TB in the mining industry.

A recent outbreak of XDR-TB ? which is a deadly strain of multi-drug-resistant TB ? has killed more than 60 people in Tugela Ferry, in Kwazulu-Natal.

All of those diagnosed with the strain were HIV-positive, received antiretroviral therapy and died within an average of 16 days of diagnosis. Despite well-implemented control programmes, drug-susceptible or usual TB ranks as the most common cause of illness and death in the South African mining industry, killing more than twice as many mineworkers as occupational accidents in the local mining industry Between 2% and 4% of the workforce will develop the disease every year.

Aurum Institute for Health Research CEO Professor Gavin Churchyard tells Mining Weekly that, while the existence of multi-drug-resistant TB is not a new phenomenon in South Africa, the high mortality rate and absence of a successful treatment regime for those infected with XDR-TB have raised concerns about the potential effects of the disease.

Churchyard says that indivi- duals who are on TB treatment, but take treatment eratically, are at risk of developing drug-resistant TB.

?People who have previously had TB and who get it again are, hence, more likely to have drug resistance.

?However, the evidence from the Tugela Ferry outbreak is that a lot of the XDR-TB was acquired through transmission, rather than by poor adherence to treatment regimes,? he explains.

Tuberculosis (TB) is a disease caused by bacteria called Myco- bacterium tuberculosis, which usually attacks the lungs. TB is spread through the air from one person to another. The bacteria become airborne when a person with active TB disease of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected. Churchyard says that a lot can be done to limit the spread of XDR- TB.

?We need to identify individuals with XDR-TB as soon a possible and provide appropriate treatment. ?Individuals also need to be treated in custom-designed units for multidrug-resistant diseases.

?These individuals should also be offered antiretroviral therapy if appropriate.? Concerning the control of TB in general in South Africa, he adds that the mining industry must ensure that it has strong TB control programmes in place that are able to achieve high cure rates.

An alternative approach to TB
Since the beginning of the year the Aurum Institute has been implement- ing the R98-million Thibela TB (Stop TB) research programme that is investigating an alternative approach to stemming the scourge of drug-susceptible TB in the South African gold-mining industry.

The initiative, which is receiving international support and funding, focuses on communitywide TB preventive therapy that entails administering the drug Isoniazid to 38 000 local gold-miners.

However, Churchyard points out that while Thibela will be effective in reducing overall TB, it will not prevent multidrug-resistant or XDR-TB. ?Nevertheless, with a massive reduction in drug-susceptible TB, which accounts for up to 90% of the incidence of the disease in South Africa, resources can then be focused on dealing with the drug-resistant TB,? he explains.

Thibela TB is premised on computer modelling, which suggests that the treatment of an entire community of mineworkers to prevent TB could have a rapid and significant effect on the prevalence of the disease.

It is believed that the treatment of entire shaft complements of mineworkers to prevent drug-susceptible TB could reduce the incidence of the disease by up to 60%. Churchyard says that, at a cost of only a few cents for a dose of the drug, the programme offers a cost-effective addition to the TB-control initiatives already implemented by the South African gold-mining industry.

The results of the study will be made available four-and-a-half years from its inception to allow for accurate information collection and analyses. </TD></TR><TR><TD></TD></TR></TBODY></TABLE>http://www.miningweekly.co.za/min/ne...ek/?show=94311