Deadly TB Strain Threatens South Africa

South Africa is being urged to enforce isolation of patients infected with a new deadly strain of tuberculosis (TB) to avoid a pandemic in the country where human deficiency virus (HIV) is widespread.

Experts from the Centre for the Aids Programme of Research (Caprisa; Durban, South Africa; www.caprisa.org), and the University of Toronto's Joint Centre for Bioethics (Canada) say that the point where the rights of the individual must give way to the interests of public health has been reached and that the country must act now to stop a pandemic that could spread to the rest of the world. The experts made this recommendation in an article published in the January 2007 edition of the journal Public Library of Science (PLoS) Medicine.

On September 1, 2006, the World Health Organization (WHO, Geneva, Switzerland) announced that a deadly new strain of extensively drug-resistant tuberculosis (XDR-TB) had been detected in Tugela Ferry, a rural town in the South African province of KwaZulu-Natal, the epicentre of South Africa's HIV/AIDS epidemic. Of the 544 patients studied in the area in 2005, 221 had multi-drug-resistant tuberculosis (MDR-TB), that is, Mycobacterium tuberculosis that is resistant to at least rifampicin and isoniazid. Of these, 53 were identified as XDR-TB, which is MDR-TB plus resistance to at least three of the six classes of second-line agents.

The median survival term after diagnosis for the 53 XDR-TB patients was 16 days, showing a fatality rate and speed of development for TB that is unprecedented anywhere in the world. Six of the patients who died were health workers, and the dead also included those on antiretroviral treatment. The WHO has called for XDR-TB to be given the same global priority as avian flu, and has asked the governments in the sub-Saharan part of Africa to unite their HIV and TB fighting strategies.

"All reasonable attempts must be made to accommodate the interests of infected patients in a sensitive and humane manner, although, if necessary, the government must adopt a more robust approach towards uncooperative patients with MDR-TB and XDR-TB, which might necessitate favoring the interests of the wider public over that of the patient,” concluded lead author Jerome Singh, a lawyer at CAPRISA, and colleagues.



Related Links:
Centre for the Aids Programme of Research
University of Toronto's Joint Centre for Bioethics