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SOUTH AFRICA: Global effort to fight deadly TB strain

Photo: Stop TB Partnership
Tuberculosis in a new guise is causing global concern
Johannesburg, 28 September 2006 (IRIN) - The World Health Organisation (WHO) will convene a "global task force" in Geneva in October to thrash out a battle plan against extremely drug resistant tuberculosis (XDR-TB), a deadly, drug-resistant disease that has already killed 60 people in South Africa and is threatening to spread across the region.

Experts fear that South Africa's high rates of HIV/AIDS - about one in nine of the country's 45 million people are HIV positive, making them acutely susceptible to tuberculosis - could fast-track XDR-TB into a global epidemic. HIV infection rates are similarly high in the neighbouring countries of Botswana, Lesotho, Mozambique, Swaziland, and Zimbabwe, which have yet to report any XDR-TB cases.

The particularly virulent strain, resistant to drugs used to treat both tuberculosis and multi-drug resistant tuberculosis (MDR-TB), has already surfaced in two South African provinces and is suspected in a third, with Gauteng province, the country's economic hub, recently reporting a batch of new cases.

"Following rigorous testing of multi-drug resistance TB patients, the Gauteng Health Department has confirmed six cases of XDR-TB in the province," the department said in a statement.

"Three of these patients are already receiving medical care at (Johannesburg's) Sizwe Tropical Disease Hospital. The department is in the process of tracing the other three patients," it said.

South Africa's health minister, attacked by critics for her slow and confusing response to the HIV/AIDS crisis, which includes promoting nutrition as an effective HIV treatment, has been faster to respond to the threat posed by XDR-TB.

Minister minister Manto Tshabalala-Msimang has called for an "urgent meeting" with the WHO and has promised to deliver more drugs to fight the disease.

"I have been in touch with the WHO as well as ministers of health in the region. I have requested an urgent meeting with experts from the WHO so that we can get assistance to develop a national as well as a regional strategy to deal with XDR-TB," Tshabalala-Msimang said in a statement.

"I held a consultative meeting with TB researchers, clinicians as well as laboratory scientists and we agreed that they will keep me briefed on a continuous basis with regard to the extent of the problem and what can and is being done to contain the problem," she said.

Health ministers from the Southern African Development Community (SADC) put XDR-TB at the top of their agenda at a meeting in Maputo, Mozambique last week.

In a statement, the ministers said they agreed to strengthen tuberculosis programmes in their respective countries, to enhance surveillance systems and to develop a "preparedness plan" to deal with the XDR-TB challenge in the region.

SPREADS LIKE COMMON COLD

Tuberculosis, especially the XDR-TB strain, poses an acute threat in Africa and other less-developed regions because the disease is easy to contract, but problematic and expensive to treat.

An airborne disease that killed millions in Europe in the 19th and early 20th centuries, TB spreads much like the common cold through the coughs and sneezes of infected people.

The first symptoms of the illness include weight loss, fever and night sweats. In the advanced stages victims cough up blood. If untreated, TB can kill a patient by gradually boring holes through the lungs.

The numbers the disease infects today makes for sober reading. Globally, about 8 to 10 million people contract TB each year and about 1.7 million of those die, according to the WHO. While most strains of drug-resistant TB are treatable, fighting them requires prolonged and expensive doses of medication. The required time to treat TB can vary from six months through to two years, putting huge pressure on the health infrastructure of developing countries.

Experts say XDR-TB has been detected in other countries, including the United States, the Republic of Korea and the former Soviet republic of Latvia, but that the situation in South Africa is particularly worrying because of the extremely high mortality rates.

Of the 60 reported deaths in South Africa all have been in KwaZulu-Natal province, where doctors first detected XDR-TB last year. Of the 60 deaths, 44 were HIV positive, meaning the disease is also killing patients with relatively healthy immune systems. Doctors are also carrying out tests on two deceased miners in the Free State province to determine whether they died from XDR-TB.

Health officials in South Africa have stressed to tuberculosis sufferers the importance of completing a full course of treatment. Doctors have even raised the threat of legal action against patients who refuse treatment after a woman suffering from XDR-TB walked out of a Johannesburg hospital and returned home, possibly infecting many more people.

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