Gert van der Hoek
In Memoriam - Editor, Senior Moderator
Extensively drug resistant tuberculosis like bird flu 'running in molasses'
Helen Branswell, Canadian Press
Published: Wednesday, May 23, 2007
TORONTO (CP) - Extensively drug resistant tuberculosis - a strain of the TB bug that is effectively immune to the power of most antibiotics - is a looming crisis that is underappreciated by much of the world, experts at a major infectious diseases conference suggested Tuesday.
"What is known amongst the technocrats is somehow not getting out to the general public," admitted Dr. Peter Small, senior program officer for tuberculosis with the Bill and Melinda Gates Foundation.
"The fact is that tuberculosis is killing someone every 15 seconds. And an increasing percentage of those cases are resistant to the drugs we have for treating them."
This is a huge issue which is not being addressed and is not generally appreciated."
Small and others were speaking at the general meeting of the American Society for Microbiology, a major gathering of microbiologists and infectious diseases experts from across North America.
While 37 countries - including Canada - have reported cases of XDR-TB, as it is called, experts admit they have no clear idea of how many cases exist worldwide.
The problem? Some of the parts of the world where TB rates are highest have little capacity to test whether the bacteria that infect individual cases are resistant to antibiotics.
Dr. Ruth Berkelman, director of the Center for Public Health Preparedness and Research at Emory University in Atlanta, said building up global capacity to rapidly test TB isolates for antibiotic resistance is an urgent priority in the response to XDR-TB.
"It's no longer a question of whether we can afford to have laboratories in those countries. We can't afford not to have good laboratories in those countries," Berkelman said.
Another urgent priority brought to the fore by XDT-TB is the need to strengthen infection control, said Dr. Karin Weyer, of the tuberculosis research and policy unit of South Africa's Medical Research Council. Patients with extensively resistant strains are both a risk to other patients in hospitals and to hospital staff.
Weyer admitted that in the context of XDR-TB, respiratory masks and personal protective equipment for health-care workers - unaffordable luxuries in many parts of the world - are now "essential."
The World Health Organization estimates that 27,000 people develop XDR-TB each year, and 16,000 people die from the disease, which has a case fatality rate of over 50 per cent.
When extensively drug resistant TB goes hand in hand with HIV infection - as it does with alarming frequency in parts of sub-Saharan Africa - it is believed as few as one in 10 survives.
While XDR-TB case numbers are still a small fraction of the 8.8 million new TB infections that are estimated to take place globally every year, the fear is that resistant strains could spread.
"The global concern is . . . we will face untreatable TB," Weyer said
"It's like TB in the '20s," Berkelman said of that possibility, though she admitted with increased population density, global travel and HIV-AIDS, the problem of untreatable TB would actually be more complex in the 21st century.
It is often suggested that in the world of pathogens - both bacterial and viral - developing resistance to drugs comes at a cost. Bugs that evolve to become resistant to the medications used to try to kill them are often less able to transmit from person to person.
But research presented at this conference suggested that with XDR-TB, the lessening of transmissibility may be short-lived. The resistant bacteria appear to be able to overcome the limitations to transmissibility, Small said.
It's believed the bulk of infections to date have occurred in parts of Asia and the Russian Federation as well as some countries of southern Africa. But cases have been recorded in all regions of the world and the risk is global, experts say.
"There's no question that we live in an increasingly globalized world where people can be in one continent and then into another very, very quickly," Small said.
"And with that comes the risk of global transmission of infectious diseases. Tuberculosis is particularly problematic because it is airborne, meaning that your risk for acquiring this is simply breathing."
"It's really important that we both focus our attention on improving the tuberculosis control situation in the high burden countries and maintain a high degree of vigilance here to make sure that that's not happening," he said.
http://www.canada.com/nationalpost/news/story.html?id=dae95bd3-caf6-4ebf-980e-960ad036f3a9&k=78895
Helen Branswell, Canadian Press
Published: Wednesday, May 23, 2007
TORONTO (CP) - Extensively drug resistant tuberculosis - a strain of the TB bug that is effectively immune to the power of most antibiotics - is a looming crisis that is underappreciated by much of the world, experts at a major infectious diseases conference suggested Tuesday.
"What is known amongst the technocrats is somehow not getting out to the general public," admitted Dr. Peter Small, senior program officer for tuberculosis with the Bill and Melinda Gates Foundation.
"The fact is that tuberculosis is killing someone every 15 seconds. And an increasing percentage of those cases are resistant to the drugs we have for treating them."
This is a huge issue which is not being addressed and is not generally appreciated."
Small and others were speaking at the general meeting of the American Society for Microbiology, a major gathering of microbiologists and infectious diseases experts from across North America.
While 37 countries - including Canada - have reported cases of XDR-TB, as it is called, experts admit they have no clear idea of how many cases exist worldwide.
The problem? Some of the parts of the world where TB rates are highest have little capacity to test whether the bacteria that infect individual cases are resistant to antibiotics.
Dr. Ruth Berkelman, director of the Center for Public Health Preparedness and Research at Emory University in Atlanta, said building up global capacity to rapidly test TB isolates for antibiotic resistance is an urgent priority in the response to XDR-TB.
"It's no longer a question of whether we can afford to have laboratories in those countries. We can't afford not to have good laboratories in those countries," Berkelman said.
Another urgent priority brought to the fore by XDT-TB is the need to strengthen infection control, said Dr. Karin Weyer, of the tuberculosis research and policy unit of South Africa's Medical Research Council. Patients with extensively resistant strains are both a risk to other patients in hospitals and to hospital staff.
Weyer admitted that in the context of XDR-TB, respiratory masks and personal protective equipment for health-care workers - unaffordable luxuries in many parts of the world - are now "essential."
The World Health Organization estimates that 27,000 people develop XDR-TB each year, and 16,000 people die from the disease, which has a case fatality rate of over 50 per cent.
When extensively drug resistant TB goes hand in hand with HIV infection - as it does with alarming frequency in parts of sub-Saharan Africa - it is believed as few as one in 10 survives.
While XDR-TB case numbers are still a small fraction of the 8.8 million new TB infections that are estimated to take place globally every year, the fear is that resistant strains could spread.
"The global concern is . . . we will face untreatable TB," Weyer said
"It's like TB in the '20s," Berkelman said of that possibility, though she admitted with increased population density, global travel and HIV-AIDS, the problem of untreatable TB would actually be more complex in the 21st century.
It is often suggested that in the world of pathogens - both bacterial and viral - developing resistance to drugs comes at a cost. Bugs that evolve to become resistant to the medications used to try to kill them are often less able to transmit from person to person.
But research presented at this conference suggested that with XDR-TB, the lessening of transmissibility may be short-lived. The resistant bacteria appear to be able to overcome the limitations to transmissibility, Small said.
It's believed the bulk of infections to date have occurred in parts of Asia and the Russian Federation as well as some countries of southern Africa. But cases have been recorded in all regions of the world and the risk is global, experts say.
"There's no question that we live in an increasingly globalized world where people can be in one continent and then into another very, very quickly," Small said.
"And with that comes the risk of global transmission of infectious diseases. Tuberculosis is particularly problematic because it is airborne, meaning that your risk for acquiring this is simply breathing."
"It's really important that we both focus our attention on improving the tuberculosis control situation in the high burden countries and maintain a high degree of vigilance here to make sure that that's not happening," he said.
http://www.canada.com/nationalpost/news/story.html?id=dae95bd3-caf6-4ebf-980e-960ad036f3a9&k=78895