E-DRUG: XDR-TB strain in South Africa
-------------------------------------
[Below a few frightening newsstories from South Africa about the
new XDR-TB strain which killed nearly all infected people,
especially the HIV+ ones. All anti-TB drugs are ineffective,
except cycloserine, ethionamide and PAS. To quote CDC: "The
emergence of XDR-TB in the world poses a threat everywhere in
the world." Thanks to Andy/DRUGINFO; copied as fair use. WB]
http://www.mg.co.za/articlePage.aspx?articleid=283446&area=/breaking_news/breaking_news__national/
New TB strain in SA: 'No time to wait'
Louise Flanagan | Johannesburg, South Africa
07 September 2006 03:52
The extreme drug-resistant tuberculosis (XDR-TB) in KwaZulu-
Natal must be dealt with urgently, international health experts
said in Johannesburg on Thursday.
"There is no time to wait before we embark on decisive action,"
said the World Health Organisation's Dr Ernesto Jaramillo,
explaining that an epidemic could have a deadly impact.
"It's imperative that we don't allow this to go unmitigated,"
said Dr Ken Castro, of the United States's Centres for Disease
Control and Prevention. "The emergence of XDR-TB in the world
poses a threat everywhere in the world."
They were part of a group of more than 100 medical experts and
policymakers from around the world meeting to discuss the XDR-
TB, which emerged in KwaZulu-Natal recently. Fifty-three cases
of XDR-TB were identified in the province, and 52 of the
patients died within 25 days.
The experts are putting together a seven-point plan to combat
the spread of XDR-TB. Top priority is establishing the extent of
infection.
"Among the actions required are urgent and rapid surveys in
high-risk countries to assess the full extent of XDR-TB
globally, matched by increased laboratory capability to carry
out vital culture and drug resistance testing," said the South
African Medical Research Council (SAMRC).
Rapid diagnostic tests are crucial, as current tests to confirm
the XDR-TB diagnosis take too long due to the speed of fatality
of the disease.
New drugs
The plan calls for new drugs to fight the disease.
The surviving KwaZulu-Natal patient "is the only one that is at
the moment alive and we now have nothing to offer", said Dr
Willem Sturm, the dean of the faculty of medicine at the Nelson
Mandela medical school in Durban.
He said KwaZulu-Natal urgently needs two existing anti-TB drugs,
which South Africa does not have, in the hope that they will be
effective against XDR-TB.
Cases of XDR-TB were found mainly at Tugela Ferry in KwaZulu-
Natal, but also at another 28 places in the province, said
Sturm.
The plan also calls for infection-control precautions, research
support and universal access to antiretrovirals under joint
TB/HIV programmes.
Jaramillo said it is imperative for programmes backing HIV
infection and TB to be linked, as there is a "deadly synergy"
between the two. "Both have to receive the same priority,
otherwise no impact would be obtained."
He said XDR-TB exists elsewhere in the world, but South Africa
is the first place where its emergence with HIV infection has
been identified as a "major threat".
"HIV has the potential to fast-track XDR-TB into an
uncontrollable epidemic," said Dr Karin Weyer, TB research
director for the SAMRC.
Some of the KwaZulu-Natal victims were on antiretrovirals, but
succumbed rapidly to XDR-TB, which the experts said was an
ominous sign.
Emergency TB kills 1,7-million people a year, and a year ago
African ministers declared TB an emergency. The SAMRC said
combating XDR-TB must now be added to the TB emergency plans,
together with promoting access to antiretrovirals under joint
TB/HIV activities.
XDR-TB is resistant to the two most potent anti-TB drugs, as
well as at least three of the six classes of reserve second-line
drugs.
Globally, there have been just 347 identified cases of XDR-TB,
mainly in the former Soviet Union and Asia.
In KwaZulu-Natal, a recent survey found that of 554 patients,
221 had multi-drug-resistant TB (MDR-TB). Of these, 53 had XDR-
TB. Of the XDR-TB patients, all 44 of those tested for HIV were
HIV-positive.
MDR-TB arises when patients do not complete their medication
from an earlier bout of TB. However, not all the XDR-TB patients
had previously been treated for TB. -- Sapa --- Hi all
News of the XDR-TB strain in KZN has hit the local and
international media. here's BDay's coverage, as "fair use".
Apart from the issues of registration of new (and old) TB drugs,
this problem raises significant ethical questions. Should known
XDR-TB cases be isolated? How could this be accomplished? Should
hospitalization and isolation be mandatory? How should health
workers be protected in such units?
regards Andy