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Tuberculosis takes on a whole new dimension
Tuberculosis takes on a whole new dimension<TABLE style="WIDTH: 405px; HEIGHT: 44px; BACKGROUND-COLOR: #ffffff" cellSpacing=0 cellPadding=0><TBODY><TR><TD class=caption style="WIDTH: 360px"> Jillian Green
October 30 2006 at 08:15AM </TD></TR><TR><TD style="HEIGHT: 1px; BACKGROUND-COLOR: #cccccc" colSpan=2></TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=23 border=0><TBODY><TR><TD class=svarticletext>Tuberculosis has been present in the human population since antiquity - fragments of the spinal column of Egyptian mummies from 2 400BC show definite pathological signs of tubercular decay - but never in the history of the disease has the threat to man been as great as it is now.
A new study published last week cast light on perilous drug-resistant strains of TB that have erupted in South Africa.
The prevalence of these resistant strains is far wider than previously thought, according to the paper, published online by British health journal the Lancet.
Once described as "a romantic, ambiguous affliction", normal TB has become a burden to countries around the world, not least of them SA.
</TD></TR></TBODY></TABLE>
In 2004, TB accounted for 63 529 deaths in SA and this number is set to rise with the advent of Extremely Drug-Resistant Tuberculosis (XDR-TB), a development that could set the effective treatment of TB back 60 years.
Fundamentally, the emergence of drug-resistant TB is a man-made phenomenon that occurs primarily due to poorly managed normal TB - a completely curable affliction.
With patients failing to adhere to their treatment, health practitioners prescribing incorrect drugs, and the poor quality and the erratic supply of TB drugs, a new virtually untreatable strain of TB has emerged - XDR-TB.
As its name suggests, XDR-TB is resistant to at least two of the main first-line TB drugs and additionally to three or more of the six classes of second-line drugs.
More and more cases of multi-drug resistant TB (MDR-TB) and XDR-TB are being found in patients who have never previously been treated for the disease.
An easily transferable, airborne respiratory disease, TB is the main direct cause of death of people infected with HIV. As a result, the emergence of XDR-TB poses a grave public-health risk, particularly in places like SA where HIV-prevalence rates are high and where health resources are stretched.
And this scenario has prompted expert Karin Weyer to warn that HIV has the potential to fast track XDR-TB into an uncontrolled epidemic.
TB is the world's deadliest curable infectious disease. The World Health Organisation (WHO) estimates that 1,7-million people died from TB in 2004.
But with TB cure rates of less than 80% in SA, the emergence of drug-resistant TB is a powder keg on the verge of explosion.
SA already has one of the highest rates of normal TB infection in the world and an average of 6 000 cases of MDR-TB are reported annually. Two-thirds of South Africans carry the TB bacterium and have a 10% lifetime risk of developing TB. If the person is HIV-positive, they have a 10% yearly risk of developing the illness. At any given time, there are at least 330 000 South Africans with active TB.
XDR-TB is different from normal TB in that it is resistant to most - if not all - drugs currently available to treat the bacteria. And unlike normal TB, which can be cured, once people are infected with the highly virulent strain, they will, in all likelihood, succumb to the infection and die.
Already, survey data on an outbreak in Tugela Ferry in KwaZulu Natal has been characterised by alarmingly high mortality rates.
Of the 544 patients studied, 221 had MDR-TB. Of the MDR-TB cases, 53 were identified as XDR-TB. And of those 53 patients, 44 had been tested for HIV and were found to be infected with the virus.
Alarmingly, within 25 days of their diagnosis, 52 of the 53 had died, including those who were benefiting from antiretroviral drugs (ARV).
Since then, XDR-TB has been identified in 28 hospitals in KZN and the death toll from the disease has risen to over 70.
More recently, the highly virulent strain has reared its head in other provinces, including Gauteng, the Free State and the North West.
In Joburg, six people confirmed to be infected with the incurable strain of TB are being treated in isolated units at Edenvale's Sizwe Tropical Diseases Hospital.
The North West health department has recently announced that there have been at least 10 identified cases of XDR-TB in the province between 2002 and September 2006. Of that number, four have already died from the disease while the six others are still undergoing treatment at Tshepong Hospital in Klerksdorp.
Now health workers in that province are keeping a close watch in areas like the Bojanala district and the Bophirima and Kosh regions.
In the mining area of the Free State, health authorities are awaiting tests results of six patients who may have been infected with or developed XDR-TB.
And according to health authorities like the WHO and the US Centres for Disease Control (CDC), these cases may just be the tip of the iceberg.
A global survey released earlier this year showed that XDR-TB is present in every region of the world, including the US and Latvia, which have 4% and 19% prevalence rates respectively.
Worryingly, there are numerous strains of XDR-TB and this makes treating the disease difficult.
Health authorities around the world are hard-pressed to find new drugs to treat the various strains.
But research into these new drugs has only recently been revitalised and despite promising drugs in the pipeline, these will not be available for at least five years.
In the meantime, the South African National Health Department is re-registering two old TB drugs, which are more toxic but less effective, in the hope that they will be successful in treating strains of XDR-TB.
In addition, rapid diagnostic tests are needed to fight XDR-TB. At present, getting a diagnosis takes several months, with many patients dying before the results are available.
So in a bid to stop a catastrophic epidemic, TB experts from SA, the WHO and the CDC have recommended that the country needs to urgently strengthen its TB Control Programme, surveillance systems and its infection-control systems.
Experts came up with a seven-point action plan to halt the spread of the deadly strain, which calls for countries to conduct rapid surveys for XDR-TB (to get an accurate picture of how prevalent the strain is); to enhance laboratory capacity (to improve and speed up diagnosis); to improve the technical capacity of clinical and public-health managers to effectively respond to XDR-TB outbreaks; to implement infection-control precautions; to increase research and support for anti-TB drug development; increase research support for rapid diagnostic-test development; and to promote universal access to ARVs under joint TB-HIV activities.
This week, the national health department, the Medical Research Council, the National Health Laboratory Services, representatives from the mining sector, the pharmaceutical industry and various universities are meeting to come up with an actual TB-management and prevention plan.
In 2004, TB accounted for 63 529 deaths in SA and this number is set to rise with the advent of Extremely Drug-Resistant Tuberculosis (XDR-TB), a development that could set the effective treatment of TB back 60 years.
Fundamentally, the emergence of drug-resistant TB is a man-made phenomenon that occurs primarily due to poorly managed normal TB - a completely curable affliction.
With patients failing to adhere to their treatment, health practitioners prescribing incorrect drugs, and the poor quality and the erratic supply of TB drugs, a new virtually untreatable strain of TB has emerged - XDR-TB.
As its name suggests, XDR-TB is resistant to at least two of the main first-line TB drugs and additionally to three or more of the six classes of second-line drugs.
More and more cases of multi-drug resistant TB (MDR-TB) and XDR-TB are being found in patients who have never previously been treated for the disease.
An easily transferable, airborne respiratory disease, TB is the main direct cause of death of people infected with HIV. As a result, the emergence of XDR-TB poses a grave public-health risk, particularly in places like SA where HIV-prevalence rates are high and where health resources are stretched.
And this scenario has prompted expert Karin Weyer to warn that HIV has the potential to fast track XDR-TB into an uncontrolled epidemic.
TB is the world's deadliest curable infectious disease. The World Health Organisation (WHO) estimates that 1,7-million people died from TB in 2004.
But with TB cure rates of less than 80% in SA, the emergence of drug-resistant TB is a powder keg on the verge of explosion.
SA already has one of the highest rates of normal TB infection in the world and an average of 6 000 cases of MDR-TB are reported annually. Two-thirds of South Africans carry the TB bacterium and have a 10% lifetime risk of developing TB. If the person is HIV-positive, they have a 10% yearly risk of developing the illness. At any given time, there are at least 330 000 South Africans with active TB.
XDR-TB is different from normal TB in that it is resistant to most - if not all - drugs currently available to treat the bacteria. And unlike normal TB, which can be cured, once people are infected with the highly virulent strain, they will, in all likelihood, succumb to the infection and die.
Already, survey data on an outbreak in Tugela Ferry in KwaZulu Natal has been characterised by alarmingly high mortality rates.
Of the 544 patients studied, 221 had MDR-TB. Of the MDR-TB cases, 53 were identified as XDR-TB. And of those 53 patients, 44 had been tested for HIV and were found to be infected with the virus.
Alarmingly, within 25 days of their diagnosis, 52 of the 53 had died, including those who were benefiting from antiretroviral drugs (ARV).
Since then, XDR-TB has been identified in 28 hospitals in KZN and the death toll from the disease has risen to over 70.
More recently, the highly virulent strain has reared its head in other provinces, including Gauteng, the Free State and the North West.
In Joburg, six people confirmed to be infected with the incurable strain of TB are being treated in isolated units at Edenvale's Sizwe Tropical Diseases Hospital.
The North West health department has recently announced that there have been at least 10 identified cases of XDR-TB in the province between 2002 and September 2006. Of that number, four have already died from the disease while the six others are still undergoing treatment at Tshepong Hospital in Klerksdorp.
Now health workers in that province are keeping a close watch in areas like the Bojanala district and the Bophirima and Kosh regions.
In the mining area of the Free State, health authorities are awaiting tests results of six patients who may have been infected with or developed XDR-TB.
And according to health authorities like the WHO and the US Centres for Disease Control (CDC), these cases may just be the tip of the iceberg.
A global survey released earlier this year showed that XDR-TB is present in every region of the world, including the US and Latvia, which have 4% and 19% prevalence rates respectively.
Worryingly, there are numerous strains of XDR-TB and this makes treating the disease difficult.
Health authorities around the world are hard-pressed to find new drugs to treat the various strains.
But research into these new drugs has only recently been revitalised and despite promising drugs in the pipeline, these will not be available for at least five years.
In the meantime, the South African National Health Department is re-registering two old TB drugs, which are more toxic but less effective, in the hope that they will be successful in treating strains of XDR-TB.
In addition, rapid diagnostic tests are needed to fight XDR-TB. At present, getting a diagnosis takes several months, with many patients dying before the results are available.
So in a bid to stop a catastrophic epidemic, TB experts from SA, the WHO and the CDC have recommended that the country needs to urgently strengthen its TB Control Programme, surveillance systems and its infection-control systems.
Experts came up with a seven-point action plan to halt the spread of the deadly strain, which calls for countries to conduct rapid surveys for XDR-TB (to get an accurate picture of how prevalent the strain is); to enhance laboratory capacity (to improve and speed up diagnosis); to improve the technical capacity of clinical and public-health managers to effectively respond to XDR-TB outbreaks; to implement infection-control precautions; to increase research and support for anti-TB drug development; increase research support for rapid diagnostic-test development; and to promote universal access to ARVs under joint TB-HIV activities.
This week, the national health department, the Medical Research Council, the National Health Laboratory Services, representatives from the mining sector, the pharmaceutical industry and various universities are meeting to come up with an actual TB-management and prevention plan.
October 30 2006 at 08:15AM </TD></TR><TR><TD style="HEIGHT: 1px; BACKGROUND-COLOR: #cccccc" colSpan=2></TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=23 border=0><TBODY><TR><TD class=svarticletext>Tuberculosis has been present in the human population since antiquity - fragments of the spinal column of Egyptian mummies from 2 400BC show definite pathological signs of tubercular decay - but never in the history of the disease has the threat to man been as great as it is now.
A new study published last week cast light on perilous drug-resistant strains of TB that have erupted in South Africa.
The prevalence of these resistant strains is far wider than previously thought, according to the paper, published online by British health journal the Lancet.
Once described as "a romantic, ambiguous affliction", normal TB has become a burden to countries around the world, not least of them SA.
</TD></TR></TBODY></TABLE>
In 2004, TB accounted for 63 529 deaths in SA and this number is set to rise with the advent of Extremely Drug-Resistant Tuberculosis (XDR-TB), a development that could set the effective treatment of TB back 60 years.
Fundamentally, the emergence of drug-resistant TB is a man-made phenomenon that occurs primarily due to poorly managed normal TB - a completely curable affliction.
With patients failing to adhere to their treatment, health practitioners prescribing incorrect drugs, and the poor quality and the erratic supply of TB drugs, a new virtually untreatable strain of TB has emerged - XDR-TB.
As its name suggests, XDR-TB is resistant to at least two of the main first-line TB drugs and additionally to three or more of the six classes of second-line drugs.
More and more cases of multi-drug resistant TB (MDR-TB) and XDR-TB are being found in patients who have never previously been treated for the disease.
An easily transferable, airborne respiratory disease, TB is the main direct cause of death of people infected with HIV. As a result, the emergence of XDR-TB poses a grave public-health risk, particularly in places like SA where HIV-prevalence rates are high and where health resources are stretched.
And this scenario has prompted expert Karin Weyer to warn that HIV has the potential to fast track XDR-TB into an uncontrolled epidemic.
TB is the world's deadliest curable infectious disease. The World Health Organisation (WHO) estimates that 1,7-million people died from TB in 2004.
But with TB cure rates of less than 80% in SA, the emergence of drug-resistant TB is a powder keg on the verge of explosion.
SA already has one of the highest rates of normal TB infection in the world and an average of 6 000 cases of MDR-TB are reported annually. Two-thirds of South Africans carry the TB bacterium and have a 10% lifetime risk of developing TB. If the person is HIV-positive, they have a 10% yearly risk of developing the illness. At any given time, there are at least 330 000 South Africans with active TB.
XDR-TB is different from normal TB in that it is resistant to most - if not all - drugs currently available to treat the bacteria. And unlike normal TB, which can be cured, once people are infected with the highly virulent strain, they will, in all likelihood, succumb to the infection and die.
Already, survey data on an outbreak in Tugela Ferry in KwaZulu Natal has been characterised by alarmingly high mortality rates.
Of the 544 patients studied, 221 had MDR-TB. Of the MDR-TB cases, 53 were identified as XDR-TB. And of those 53 patients, 44 had been tested for HIV and were found to be infected with the virus.
Alarmingly, within 25 days of their diagnosis, 52 of the 53 had died, including those who were benefiting from antiretroviral drugs (ARV).
Since then, XDR-TB has been identified in 28 hospitals in KZN and the death toll from the disease has risen to over 70.
More recently, the highly virulent strain has reared its head in other provinces, including Gauteng, the Free State and the North West.
In Joburg, six people confirmed to be infected with the incurable strain of TB are being treated in isolated units at Edenvale's Sizwe Tropical Diseases Hospital.
The North West health department has recently announced that there have been at least 10 identified cases of XDR-TB in the province between 2002 and September 2006. Of that number, four have already died from the disease while the six others are still undergoing treatment at Tshepong Hospital in Klerksdorp.
Now health workers in that province are keeping a close watch in areas like the Bojanala district and the Bophirima and Kosh regions.
In the mining area of the Free State, health authorities are awaiting tests results of six patients who may have been infected with or developed XDR-TB.
And according to health authorities like the WHO and the US Centres for Disease Control (CDC), these cases may just be the tip of the iceberg.
A global survey released earlier this year showed that XDR-TB is present in every region of the world, including the US and Latvia, which have 4% and 19% prevalence rates respectively.
Worryingly, there are numerous strains of XDR-TB and this makes treating the disease difficult.
Health authorities around the world are hard-pressed to find new drugs to treat the various strains.
But research into these new drugs has only recently been revitalised and despite promising drugs in the pipeline, these will not be available for at least five years.
In the meantime, the South African National Health Department is re-registering two old TB drugs, which are more toxic but less effective, in the hope that they will be successful in treating strains of XDR-TB.
In addition, rapid diagnostic tests are needed to fight XDR-TB. At present, getting a diagnosis takes several months, with many patients dying before the results are available.
So in a bid to stop a catastrophic epidemic, TB experts from SA, the WHO and the CDC have recommended that the country needs to urgently strengthen its TB Control Programme, surveillance systems and its infection-control systems.
Experts came up with a seven-point action plan to halt the spread of the deadly strain, which calls for countries to conduct rapid surveys for XDR-TB (to get an accurate picture of how prevalent the strain is); to enhance laboratory capacity (to improve and speed up diagnosis); to improve the technical capacity of clinical and public-health managers to effectively respond to XDR-TB outbreaks; to implement infection-control precautions; to increase research and support for anti-TB drug development; increase research support for rapid diagnostic-test development; and to promote universal access to ARVs under joint TB-HIV activities.
This week, the national health department, the Medical Research Council, the National Health Laboratory Services, representatives from the mining sector, the pharmaceutical industry and various universities are meeting to come up with an actual TB-management and prevention plan.
In 2004, TB accounted for 63 529 deaths in SA and this number is set to rise with the advent of Extremely Drug-Resistant Tuberculosis (XDR-TB), a development that could set the effective treatment of TB back 60 years.
Fundamentally, the emergence of drug-resistant TB is a man-made phenomenon that occurs primarily due to poorly managed normal TB - a completely curable affliction.
With patients failing to adhere to their treatment, health practitioners prescribing incorrect drugs, and the poor quality and the erratic supply of TB drugs, a new virtually untreatable strain of TB has emerged - XDR-TB.
As its name suggests, XDR-TB is resistant to at least two of the main first-line TB drugs and additionally to three or more of the six classes of second-line drugs.
More and more cases of multi-drug resistant TB (MDR-TB) and XDR-TB are being found in patients who have never previously been treated for the disease.
An easily transferable, airborne respiratory disease, TB is the main direct cause of death of people infected with HIV. As a result, the emergence of XDR-TB poses a grave public-health risk, particularly in places like SA where HIV-prevalence rates are high and where health resources are stretched.
And this scenario has prompted expert Karin Weyer to warn that HIV has the potential to fast track XDR-TB into an uncontrolled epidemic.
TB is the world's deadliest curable infectious disease. The World Health Organisation (WHO) estimates that 1,7-million people died from TB in 2004.
But with TB cure rates of less than 80% in SA, the emergence of drug-resistant TB is a powder keg on the verge of explosion.
SA already has one of the highest rates of normal TB infection in the world and an average of 6 000 cases of MDR-TB are reported annually. Two-thirds of South Africans carry the TB bacterium and have a 10% lifetime risk of developing TB. If the person is HIV-positive, they have a 10% yearly risk of developing the illness. At any given time, there are at least 330 000 South Africans with active TB.
XDR-TB is different from normal TB in that it is resistant to most - if not all - drugs currently available to treat the bacteria. And unlike normal TB, which can be cured, once people are infected with the highly virulent strain, they will, in all likelihood, succumb to the infection and die.
Already, survey data on an outbreak in Tugela Ferry in KwaZulu Natal has been characterised by alarmingly high mortality rates.
Of the 544 patients studied, 221 had MDR-TB. Of the MDR-TB cases, 53 were identified as XDR-TB. And of those 53 patients, 44 had been tested for HIV and were found to be infected with the virus.
Alarmingly, within 25 days of their diagnosis, 52 of the 53 had died, including those who were benefiting from antiretroviral drugs (ARV).
Since then, XDR-TB has been identified in 28 hospitals in KZN and the death toll from the disease has risen to over 70.
More recently, the highly virulent strain has reared its head in other provinces, including Gauteng, the Free State and the North West.
In Joburg, six people confirmed to be infected with the incurable strain of TB are being treated in isolated units at Edenvale's Sizwe Tropical Diseases Hospital.
The North West health department has recently announced that there have been at least 10 identified cases of XDR-TB in the province between 2002 and September 2006. Of that number, four have already died from the disease while the six others are still undergoing treatment at Tshepong Hospital in Klerksdorp.
Now health workers in that province are keeping a close watch in areas like the Bojanala district and the Bophirima and Kosh regions.
In the mining area of the Free State, health authorities are awaiting tests results of six patients who may have been infected with or developed XDR-TB.
And according to health authorities like the WHO and the US Centres for Disease Control (CDC), these cases may just be the tip of the iceberg.
A global survey released earlier this year showed that XDR-TB is present in every region of the world, including the US and Latvia, which have 4% and 19% prevalence rates respectively.
Worryingly, there are numerous strains of XDR-TB and this makes treating the disease difficult.
Health authorities around the world are hard-pressed to find new drugs to treat the various strains.
But research into these new drugs has only recently been revitalised and despite promising drugs in the pipeline, these will not be available for at least five years.
In the meantime, the South African National Health Department is re-registering two old TB drugs, which are more toxic but less effective, in the hope that they will be successful in treating strains of XDR-TB.
In addition, rapid diagnostic tests are needed to fight XDR-TB. At present, getting a diagnosis takes several months, with many patients dying before the results are available.
So in a bid to stop a catastrophic epidemic, TB experts from SA, the WHO and the CDC have recommended that the country needs to urgently strengthen its TB Control Programme, surveillance systems and its infection-control systems.
Experts came up with a seven-point action plan to halt the spread of the deadly strain, which calls for countries to conduct rapid surveys for XDR-TB (to get an accurate picture of how prevalent the strain is); to enhance laboratory capacity (to improve and speed up diagnosis); to improve the technical capacity of clinical and public-health managers to effectively respond to XDR-TB outbreaks; to implement infection-control precautions; to increase research and support for anti-TB drug development; increase research support for rapid diagnostic-test development; and to promote universal access to ARVs under joint TB-HIV activities.
This week, the national health department, the Medical Research Council, the National Health Laboratory Services, representatives from the mining sector, the pharmaceutical industry and various universities are meeting to come up with an actual TB-management and prevention plan.