South Africa: XDR TB

[hawkeye]

Re: South Africa: XDR TB

Drug resistant TB hits Botswana
16 January, 2008

GABORONE - The Ministry of Health is appealing to all individuals with chronic coughs and those who have been exposed to patients with active TB to visit the nearest health facilities for check up.

This comes after 100 people were recently diagnosed with multi-drug resistant TB, while a further two were diagnosed with a more serious case where both first and second line drugs have no use.

Treatment options for such complicated TB are seriously limited, and some cases may be virtually untreatable. It is therefore vital that TB control is managed properly, Permanent Secretary in the Ministry of Health, Mrs Batatu Tafa, says in a statement.

Health workers who develop symptoms of TB while managing infected patients are also urged to go for check up, while people living with HIV/AIDS should screen for TB at the nearest health facility for early diagnosis and treatment.

Mrs Tafa advices patients on anti-TB treatment to strictly adhere to the treatment regimens since erratic anti-TB treatment may lead to severe cases.

TB is usually treated with a course of four standard first-lines anti-TB drugs. If these drugs are misused or mismanaged, multi-drug resistant TB can develop.

This type of TB takes longer to treat with second line drugs which are more expensive and have more side effects, Mrs Tafa warns. BOPA

 

[Shiloh]

Re: South Africa: XDR TB

Source:
http://www.nytimes.com/2008/03/25/w...em&ex=1206504000&en=9793c0d894629eca&ei=5087

(Page 1)
By CELIA W. DUGGER
Published: March 25, 2008

PORT ELIZABETH, South Africa ? The Jose Pearson TB Hospital here is like a prison for the sick. It is encircled by three fences topped with coils of razor wire to keep patients infected with lethal strains of tuberculosis from escaping.

But at Christmastime and again around Easter, dozens of them cut holes in the fences, slipped through electrified wires or pushed through the gates in a desperate bid to spend the holidays with their families. Patients have been tracked down and forced to return; the hospital has quadrupled the number of guards. Many patients fear they will get out of here only in a coffin.

?We?re being held here like prisoners, but we didn?t commit a crime,? Siyasanga Lukas, 20, who has been here since 2006, said before escaping last week. ?I?ve seen people die and die and die. The only discharge you get from this place is to the mortuary.?

Struggling to contain a dangerous epidemic of extensively drug-resistant tuberculosis, known as XDR-TB, the South African government?s policy is to hospitalize those unlucky enough to have the disease until they are no longer infectious. Hospitals in two of the three provinces with the most cases ? here in the Eastern Cape, as well as in the Western Cape ? have sought court orders to compel the return of runaways.

The public health threat is grave. The disease spreads through the air when patients cough and sneeze. It is resistant to the most effective drugs. And in South Africa, where these resistant strains of tuberculosis have reached every province and prey on those whose immune systems are weakened by AIDS, it will kill many, if not most, of those who contract it.

As extensively drug-resistant TB rapidly emerges as a global threat to public health ? one found in 45 countries ? South Africa is grappling with a sticky ethical problem: how to balance the liberty of individual patients against the need to protect society.

It is a quandary that has recurred over the past century, not least in New York City, where uncooperative TB patients were confined to North Brother Island in the East River in the early 1900s and to Rikers Island in the 1950s.

In the early 1990s, when New York faced its own outbreak of drug-resistant TB, the city treated people as outpatients and locked them up in hospitals only as a last resort.

Most other countries are now treating drug-resistant TB on a voluntary basis, public health experts say. But health officials here contend that the best way to protect society is to isolate patients in TB hospitals. Infected people cannot be relied on to avoid public places, they say. And treating people in their homes has serious risks: Patients from rural areas often live in windowless shacks where families sleep jammed in a single room ? ideal conditions for spreading the disease.

?XDR is like biological warfare,? said Dr. Bongani Lujabe, the chief medical officer at Jose Pearson hospital. ?If you let it loose, you decimate a population, especially in poor communities with a high prevalence of H.I.V./AIDS.?

But other public health experts say overcrowded, poorly ventilated hospitals have themselves been a driving force in spreading the disease in South Africa. The public would be safer if patients were treated at home, they say, with regular monitoring by health workers and contagion-control measures for the family. Locking up the sick until death will also discourage those with undiagnosed cases from coming forward, most likely driving the epidemic underground.

?It?s much better to know where the patients are and treat them where they?re happy,? said Dr. Tony Moll, chief medical officer at the Church of Scotland Hospital in Tugela Ferry. It is running a pilot project to care for patients at home.

Some 563 people were confirmed with extensively drug-resistant TB last year in South Africa and started on treatment, compared with only 20 cases in the United States from 2000 through 2006. A third of those patients in South Africa died in 2007; more than 300 remained in hospitals.

Further complicating matters, South Africa?s provinces have taken different approaches to deciding how long to hospitalize people with XDR-TB. In KwaZulu-Natal, the other province with the most cases, the main hospital is discharging patients after six months of treatment, even if they remain infectious, to make room for new patients who have a better chance of being cured. The province is rapidly adding beds, part of a national expansion of hospital capacity for XDR-TB.

?We know we?re putting out patients who are a risk to the public, but we don?t have an alternative,? said Dr. Iqbal Master, chief medical officer of the King George V Hospital in Durban.

 

[Shiloh]

Re: South Africa: XDR TB

TB Patients Chafe Under Lockdown in South Africa

Published: March 25, 2008

(Page 2 of 2)

Two days of interviews with patients cloistered here at the Jose Pearson hospital offered a rare glimpse of what all sides agree are the wrenching human costs of the patients? confinement, as well as their rebellious feelings about being cut off from their loved ones.

Zelda Hansen, 37, the wife of a welder and mother of sons ages 4, 12 and 14, has lived at the hospital for more than a year. She was among the 31 extensively drug-resistant patients who escaped from the 350-bed hospital before Christmas, along with 57 patients with less severe strains of drug resistance. Her eldest son had started to seem like a stranger to her, she said, while her youngest, her ?flower pot,? was growing up without her guidance.

Once home, she said: ?I just sat and watched them. And I was very happy.?

Soon the media trumpeted news of the infectious runaways. A provincial health department spokesman vowed they would be ?hunted down.? On Dec. 23, a Sunday morning, Mrs. Hansen said, police officers wearing infection-control masks came to her door. A crowd of neighbors gathered for the spectacle.

Mrs. Hansen refused to go. She begged for a few more days ? just through Christmas.

Her middle son, Trevino, 12, fearing she had done something wrong, offered his barefoot mother his sneakers, called tekkies here.

? ?Here, Mommy, take my tekkies, go with the police,? ? she said he had pleaded with her. ? ?Please, Mommy, go.? ?

Back at the hospital, on the outskirts of Port Elizabeth, Mrs. Hansen descended into despair. ?I felt like going to the trees and just hanging myself, I was so humiliated,? she said.

When news of South Africa?s outbreak of extensively drug-resistant TB was announced in Toronto in 2006 at an international AIDS meeting, it sent shudders through the ranks of infectious-disease specialists. These virulent strains had rapidly killed 52 of 53 patients.

Drug resistance emerges in large part because health care systems too often have failed to ensure that patients successfully complete treatments with first- and second-line drugs, according to international health officials.

The medicines for ordinary TB here cost about $36 and take six to eight months to cure the patient. The drugs for XDR-TB cost about $7,000, and treatment lasts two years. At the start, patients endure four to six months of painful daily injections in the buttocks or thigh, a morning ritual at Jose Pearson that leaves faces scrunched up in agony. A 10-year-old boy whose mother recently died here of the disease rubbed cream into his backside to relieve the ache. He now lives on the XDR-TB ward as its solitary child, with no family around.

?I do think about my mother,? he said. ?But I don?t cry because I?ll never get her back again.?

Dr. Lindiwe Mvusi, who manages the government?s tuberculosis program, said the hospitals shouldn?t be seen as prisons, and that requests in special circumstances to go home should be considered individually.

The Jose Pearson hospital had suspended all weekend passes to patients for months, and only recently reinstated them for the handful of XDR-TB patients showing signs of becoming noninfectious.

The provinces began diagnosing and treating XDR-TB on a large scale more than a year ago, but the question of where to care for South Africans who remain infected after two years or more of treatment is unsettled.

?We expect they will die at some stage, but what do we do with them in the meantime?? asked Dr. Mvusi. ?Do we send them home or keep them in a sanitarium for life??

At Jose Pearson, patients who have different degrees of drug resistance ? with XDR-TB being more deadly than multidrug-resistant TB ? live in different quarters, but they mix on the grounds. Infectious disease experts say that some of the multidrug-resistant patients are likely to catch the more severe XDR strains of tuberculosis directly from their fellow patients.

Peter Jantjes, the chief professional nurse in Jose Pearson?s XDR-TB unit, said that multidrug-resistant patients were turning into XDR-TB patients at an ?intense rate.?

Vuyokazi Gqawe, 30, a saloonkeeper, was admitted to the hospital more than two years ago with the lesser form of drug-resistant TB, then was found to have the far more dangerous kind in June. ?They don?t have the answers,? she said.

Mrs. Gqawe was pregnant when she was admitted and gave birth here, but she sent her newborn to live with family. She has since seen her daughter, now 2, only in photographs, except when she once waved to her through the hospital gate. ?She didn?t even know who I was,? Ms. Gqawe said.

The hospital itself is a caldron of discontent. The staff members and the patients share a pervasive sense of dread.

?It?s going to burst,? warned Louise Bruiners, the sole social worker for the more than 300 patients. ?Something really bad is going to happen.?

Angry patients bully and threaten the staff and have even brandished knives at security guards to get out of the hospital, hospital managers said. Crowds of patients have blockaded the entry gate, demanding weekend passes to go home.

On a recent Saturday, as workmen tried to erect a second buffer gate at the entrance, patients pulled it down, jumped up and down on it and repeatedly heaved a chunk of concrete on it.

The hospital?s management has been trying to make Jose Pearson more tolerable. It has brought in a pool table, flat-panel televisions, soccer balls and sewing machines. Hospital managers hope to bring patients? families for more regular visits.

?It?s good, the things they?re doing, and we thank them for it,? said Mrs. Hansen, the patient who briefly escaped, ?but nothing can replace your freedom.?
Source: http://www.nytimes.com/2008/03/25/w...&ei=5087&em&en=9793c0d894629eca&ex=1206504000

 

[Shiloh]

Re: South Africa: XDR TB

Source: http://www.plusnews.org/Report.aspx?ReportId=77447

SOUTH AFRICA: Prison-like hospitals for drug-resistant TB patients

JOHANNESBURG, 25 March 2008 (PlusNews) - Another hospital breakout in South Africa by drug-resistant tuberculosis (TB) patients desperate to spend the holidays with their families has some public health experts questioning whether forced isolation is either the most effective or humane way to treat such patients.

On Thursday, 25 patients with multi drug-resistant (MDR) TB and eight with extensively drug-resistant(XDR) TB pushed their way past guards at Jose Pearson TB Hospital in Port Elizabeth, in the Eastern Cape. By Monday, 21 of them had returned, most of them voluntarily, four as a result of court orders.

MDR-TB is resistant to the two most powerful anti-TB drugs, while XDR-TB is resistant to these and at least two others. Whereas non-drug resistant TB is treated on an out-patient basis with a six-month course of drugs, South Africa's policy is to treat drug-resistant TB patients as in-patients until they are no longer infectious. XDR-TB patients, who are the most difficult to treat and pose the greatest public health risk, are required to spend up to two years in hospital, isolated from their families and facing the very real possibility that they will die before being released.

The average mortality rate for XDR-TB patients is just over 50 percent, but is closer to 85 percent for patients co-infected with HIV, according to South Africa's Medical Research Council.

Patients have described the isolation wards where they are quarantined as prison-like. While a number of the hospitals have installed pool tables, televisions and gym equipment to help patients combat boredom and depression, they have also boosted security by hiring more guards and building higher fences.

Despite such measures, patients regularly escape and have to be tracked down by health authorities fearful that the air-borne disease could be spread to families and communities.

South Africa is battling a dual epidemic of TB and HIV/AIDS. In 2006, it had both the highest TB prevalence rate in the world and the highest number of TB-related deaths, according to the Global TB report, released by the World Health Organisation this month. People living with HIV are 50 times more likely to develop an active TB infection, but in 2006, only one third of TB patients in South Africa were tested for HIV.

Ensuring that TB patients complete their six-month course of drugs is vital to containing the spread of drug-resistant TB. South Africa has a cure rate of just 58 percent, the third worst in the world after Uganda and Russia according to the WHO report, which suggests that many patients are defaulting on treatment.

Arnaud Trebucq, who provides technical assistance to the TB division of the International Union Against Tuberculosis and Lung Disease, an organisation formed to help lower-income countries combat TB and lung disease, suggestd that improving South Africa's TB cure rates would do much more to reduce the spread of MDR and XDR-TB than isolating patients who are already infected.

Drug-resistant TB patients pose the greatest threat to their families and communities during the often lengthy period before they are diagnosed, pointed out Trebucq. "If the patient reacts to the drugs, he?ll be infectious for a very short time; so, controlling infection by isolating patients - it?s not obvious that it will do a lot," he told IRIN/PlusNews.

The main reason to keep MDR and XDR-TB patients hospitalised, he added, was to better supervise complex and toxic drug regimens. "Usually, you give a lot of different drugs; if you keep them in the hospital, you have a better insurance they take all the drugs under directly-observed treatment," he said. "But you have to discuss with the patient how long they can stay so it?s an agreement."

The WHO recommends forced confinement of TB patients only as a last resort. "There is definitely a case for isolating MDR and XDR patients within health facilities, especially when they?re infectious," commented Dr Paul Nunn, head of the WHO's XDR-TB unit. "It's less clear cut when it comes to isolating them by force."

Apart from the human rights issues surrounding forced isolation, a number of recent studies have suggested that hospitals themselves can be breeding grounds for drug-resistant TB. Research conducted at at the Church of Scotland Hospital in Tugela Ferry, KwaZulu-Natal Province, where an outbreak of XDR-TB claimed 50 lives in 2006, found that most cases of drug-resistant TB were attributable to airborne infections, often contracted within the hospital, not the failure of patients to complete TB treatment.

Even at a TB hospital like Port Elizabeth's Jose Pearson, where XDR-TB patients stay on a different ward from MDR-TB patients, a report in the New York Times this week quoted a nurse saying that MDR patients there were contracting XDR-TB strains at an "intense rate".

Professor Greg Hussey, director of the Institute of Infectious Disease and Molecular Medicine at the University of Cape Town, agreed that hospitals can be "dangerous environments", especially for patients with HIV-compromised immune systems. "It would protect the patient, in a sense, if they were treated in a home-setting," he said.

Hussey is among those who believe the scale of drug-resistant TB infection in South Africa demands an alternative approach. Hospitals are already over-stretched, he told IRIN/PlusNews, and lack the resources to cater for bored patients hospitalised for long periods.

"We make assumptions on the basis of what we think is best for patients, but if you?re talking about issues around compliance, you need to have a patient who trusts what you?re doing for them and you need to make the environment conducive to them taking the medication."

Hussey suggested that homes and communities may be the best environments for patients who are often reasonably well and don't have symtoms that would normally require hospitalisation.

ks

 

[Gert van der Hoek]

Re: South Africa: XDR TB

TB patients escape hospital

A special team has been sent out to look for 19 tuberculosis patients who escaped from the Jose Pearson TB hospital in Port Elizabeth, the Eastern Cape Health Department said on Sunday.

"The patients escaped yesterday [Saturday] after a security guard who has since been suspended, allegedly allowed one patient to go shopping... we are worried that they may put others at risk," said spokesman Sizwe Kupela.

The 19 demanded that they be let out of the hospital, and then managed to overpower security guards and fled.

He said the team would wear protective gear when looking for the patients, to avoid infection.

"We have sent people in to investigate what happened at the hospital... anyone who may have assisted in their escape will be dealt with.

"We are in contact with the relatives of those patients who escaped.

"Families of three of the patients have already confirmed that they have returned home and will bring them back to the hospital."

He said that a search was still on for the 16 others.

"We appeal to these patients to return to the hospital as they need to take their proper medication and look after themselves."

Kupela said he was not sure why the patients wanted to leave the hospital, and the search would continue. - Sapa

http://www.capetimes.co.za/?fSectionId=&fArticleId=nw20080615131933212C796641#

 

[Gert van der Hoek]

Re: South Africa: XDR TB

10 escaped TB patients found, but nine are still on the loose

June 17, 2008


PORT ELIZABETH: Ten out of 19 patients who escaped from the Jose Pearson TB hospital in Port Elizabeth have been found and are back on treatment, but nine others are still missing, the Eastern Cape Health Department said yesterday.

"Police and a special task team were sent out to find the patients who escaped on Saturday; we are glad they have been found, as they may have put others at risk," said spokesperson Sizwe Kupela.

He said the families of three patients who escaped brought them back to the hospital, and police and the special task team found seven others on Sunday.

The 19 patients escaped after a security guard, who has since been suspended, allowed one patient to go shopping.

Others then demanded that they also be let out of the hospital, and overpowered security guards. Kupela said the task team and police were still searching for the remaining nine patients.

"We have also sent people in to investigate what happened at the hospital ? anyone who may have assisted in their escape will be dealt with."

http://www.capetimes.co.za/index.php?fArticleId=4457911

 

[Shiloh]

Re: South Africa: XDR TB

Source: http://ap.google.com/article/ALeqM5hslq8FTDbi24VaepyU8hQ6MoUTWgD91IIC300

South African TB patients rampage

By CLARE NULLIS ? 1 hour ago

CAPE TOWN, South Africa (AP) ? Authorities increased security Friday at a tuberculosis hospital where patients with drug-resistant forms of the disease went on a rampage to protest prison-like conditions.

Twenty-two patients were arrested Wednesday, accused of public violence and assault after they pelted staff with stones and vandalized equipment. But the local police station and prison refused to admit them because of fears of the highly infectious disease. Instead, they were returned to the hospital.

"When the patients were arrested, they threatened staff members, saying that they would retaliate when they returned to the hospital," local health authority spokesman Sizwe Kupelo said. "This will not be tolerated."

The Jose Pearson hospital, near the coastal city of Port Elizabeth, treats about 300 patients. Many have multidrug-resistant TB and the even more dangerous extensively drug-resistant TB, which is very difficult and expensive to treat. Those with drug-resistant strains are supposed to stay in the hospital for six months to two years, living in isolated wards surrounded by barbed wire and security guards.

South African authorities have reluctantly resorted to enforced confinement of patients with drug-resistant TB because of fears that it might otherwise spread through the community. TB is an airborne bacteria and can be spread easily through coughing or sneezing.

[/B]The country is gripped by a tuberculosis crisis, which is feeding off the AIDS epidemic and striking the weakened immune system of victims. Nearly 60 percent of South African TB patients have AIDS.[/B] The emergence of drug-resistant TB strains ? often the result of not sticking to the standard six-month course of treatment ? has worsened patients' chances of survival.

There were 2,901 cases of multidrug-resistant TB in South Africa last year, and 561 cases of extensively drug-resistant TB. But the reported figures are believed to be only an indication of the real situation, because many patients die before they can be diagnosed.

This year, the government is spending an additional 400 million rands (US$50 million euro32 million) on beds for people with drug-resistant TB. But anger, frustration and depression are high at hospitals like Jose Pearson, and there are constant staff shortages because nurses are afraid of contracting the disease.

Twenty-two patients cut through the hospital's wire fencing and escaped just before Christmas to spend time with their families. Most eventually returned after authorities searched house to house, but the same pattern was repeated at Easter.

The Eastern Cape provincial health department equipped the hospital with new televisions, DVDs and games to try to relieve the boredom.

The local Herald newspaper said tension at the hospital exploded Wednesday after patients refused to let a nurse give them their daily injection. A local government official arrived to try to defuse the row and when security guards opened a gate to allow the nurse to leave, patients stormed them.

The guards, armed with pepper spray and batons, formed a human chain behind the car and blocked the patients who wielded iron rods and golf clubs. Some patients hurled rocks and a large concrete brick through the window of the security booth and smashed video monitors. A large contingent of police arrived, donned protective masks and latex gloves, and arrested the patients, the newspaper reported.

 

[Shiloh]

Re: South Africa: XDR TB

Source: http://www.plusnews.org/Report.aspx?ReportId=79084

SOUTH AFRICA: TB plan has a gap between talk and action

DURBAN, 3 July 2008 (PlusNews) - Health Minister Manto Tshabalala-Msimang opened South Africa's first national tuberculosis (TB) conference this week with some welcome good news: her department is to acquire technology that will reduce the time it takes to diagnose drug-resistant TB from as long as four months to less than a week.

South Africa is struggling with a rising incidence of multidrug-resistant (MDR) TB, a form of the disease that does not respond to standard treatment with first-line drugs. The difficulty of diagnosing MDR-TB using the current method of growing cultures in a specially equipped laboratory has meant that many patients infect countless others or die before their results are known.

Although 7,369 cases of MDR-TB were diagnosed in 2007, according to health department figures, it is likely that many more cases went undetected.

The new diagnostic test, which uses a molecular method known as "line probe assays", was developed by the World Health Organisation (WHO) and the Foundation for Innovative New Diagnostics and tested in a South African field trial conducted by the Medical Research Council and the National Health Laboratory Services.

According to a WHO statement, the trial produced results encouraging enough for the DNA-based tests to be rolled out in 16 countries with a high TB burden, but delivery of the new equipment and training staff in how to use it would take place over the next four years. Lesotho is so far the only country equipped to do the tests.

Tshabalala's speech skimmed over the grim figures behind South Africa's TB burden, among the highest in the world, and focused on the small gains made in the last two years: a one percent drop in national TB infections between 2006 and 2007, and an increase in the national cure rate from 55 percent in 2005 to 63 percent in 2006- still way below the 85 percent cure rate recommended by the WHO if goals for reducing the global TB burden are to be met.

"We are moving in the right direction," Tshabalala insisted, "and with the support of our stakeholders ... we shall be able to reach our targets."

Not everyone at the conference shared the minister's optimism. "There seems to be some sort of rosy lens that the ministry is trying to put on TB," said Paula Akugizibwe, a TB/HIV training and advocacy officer with the AIDS and Rights Alliance of Southern Africa (ARASA), a regional partnership of non-governmental organisations, based in Windhoek, Namibia.

"It's important to highlight achievements, but we can't let that obscure the pressing challenges," she commented.

The emergence of MDR-TB is widely recognised as the result of failures in the country's TB control efforts. Drug resistance is usually the result of TB patients not completing their six-month course of first-line treatment. TB is curable, yet it is South Africa's leading natural cause of death and one of the main factors behind the country's declining life expectancy.

Lesley Odendal of the AIDS lobby group, Treatment Action Campaign (TAC), presented a critical analysis of the government's 2007 to 2011 strategic plan for TB, in which she identified insufficient budget allocations, a failure to adequately address critical issues like drug supply and infection control, and a lack of detail on how to implement the goal of integrating TB and HIV programmes as some of the plan's weaknesses.

"There's a lack of accountability structures, decisiveness and sense of urgency," she told delegates.

National Treasurer of the TAC and Executive Director of the AIDS Law Project, Mark Heywood, went further: "We have a gap between rhetoric and lack of action," he said.

He described the strategic plan as "an enormous step forward", but worried that it would be no more than a wish-list if the government did not back it up with political leadership and resources.

"The plan will fail," he said, unless the government takes a number of steps, including identifying and implementing emergency measures, coordinating a massive information campaign, and developing a human-resource plan for TB.

ks/kn/he

 

[Shiloh]

Re: South Africa: XDR TB

Source: http://www.theherald.co.za/herald/news/n14_09072008.htm

Quicker tests now for XDR TB ? but East Cape must be patient

Nomahlubi Sonjica HERALD REPORTER

NEW tests for diagnosing extreme drug-resistant (XDR) tuberculosis have reduced the testing time of four to six months down to a week, but testing facilities will only be available in the Eastern Cape next year, say health officials.

The new testing method is already available from laboratories in KwaZulu Natal, the Western Cape, Kimberley and Gauteng.

National health department TB programme head Dr Lindiwe Mvusi said the department still had to identify a site in the Eastern Cape where the lab would be set up next year.

?We are working on a plan for other provinces to have the new testing method,? she said.

Mvusi said the Eastern Cape health department would, in the meantime, send specimen samples of potential XDR cases to other provinces to be diagnosed. She acknowledged that this would mean that there would still be delays in the results.

Mvusi said the new testing method was a lot quicker than the previous tests and a lot cheaper as well.

?The new method takes seven days. The sooner the person is diagnosed, the sooner they can be treated.?

Mvusi said the new testing method included a microscopic test, which took only two days.

The new method would save the department between eight per cent and 10% on what was currently being spent in diagnosing XDR TB.

Eastern Cape health spokesman Sizwe Kupelo said the new testing method would be a huge boost for the Eastern Cape. The method would also assist in cases where a person had both HIV/Aids and TB.
Previous

 

[Shiloh]

Re: South Africa: XDR TB

Source: http://www.thetimes.co.za/PrintEdition/News/Article.aspx?id=823747

Alarm at rising rate of deadly TB in SA
Bobby Jordan Published:Aug 17, 2008

One sixth of world?s cases are found locally ? and we may be exporting it

New medical research suggests South Africa is faced with several new strains of dangerous drug-resistant tuberculosis for which there is no known cure.

The latest findings suggest that, despite a massive TB control programme, the government is losing the battle against the killer disease, known as XDR-TB (extensively drug-resistant).

The number of XDR-TB patients now poses an international health threat and has prompted intervention from the World Health Organisation.

The new strains ? identified in a study of 699 drug-resistant patients ? is the latest troubling insight into a disease that either does not respond to drugs at all, or only reacts very slowly.

One sixth of the world?s XDR-TB cases are now in SA, new figures show, and there are growing concerns that the country may be exporting the epidemic, thereby disrupting disease-control efforts elsewhere.

?The importance of this finding is that the population structure of XDR-TB is not confined to a single genotype; in other words, XDR-TB is emerging independently in different regions of South Africa,? said one of the study?s authors, Professor Rob Warren from Stellenbosch University?s health sciences faculty.

The scale of South Africa?s XDR-TB problem has prompted major international concern.

?South Africa clearly has an extremely serious problem,? said the head of the global Stop TB programme, Dr Paul Nunn.

In addition to the latest research report, the Sunday Times this week established that:

# The WHO has set up a permanent office in Pretoria to assist the government with XDR-TB control;

# There is a 30% to 40% increase in the annual XDR-TB case load in SA ? currently just under 1000 official cases, although it may be as high as 2000;

# XDR-TB has been reported in 39 SA hospitals;

# A detailed study of a recent XDR-TB outbreak in Tugela Ferry in KwaZulu-Natal ? 53 cases, 53 dead ? showed that, on average, patients died within 16 days of diagnosis;

# Despite the huge crisis, the TB control programme has no access to thoracic (lung) surgeons in SA?s state hospitals (surgery is one of the last-resort treatment options);

# An estimated 80% of South Africans now carry latent normal TB; and

# The latest research into new strains of XDR-TB ? a collaboration between various universities and the National Health Laboratory Service ? was based on patients from several provinces, of whom 41 (6%) were found to be resistant to the country?s two main second-line TB drugs. Most of the XDR-TB strains were different from the strain identified at Tugela Ferry that killed 53 people.

The problem is largely the result of an overburdened health service, which means TB patients are either not getting drugs or not completing their drug treatment, causing drug resistance. The national HIV epidemic has also fuelled the problem by lowering people?s immunity to TB.

 

[Gert van der Hoek]

Re: South Africa: XDR TB

Six TB patients break loose from PE hospital

September 04 2008

About six tuberculosis patients are on the run after they overpowered security guards and escaped from the Jose Pearson hospital in Port Elizabeth, the Eastern Cape health department said on Thursday.

Spokesperson Sizwe Kupelo said several patients escaped on Wednesday after overpowering 10 guards but many had returned to the hospital.

"So far six patients are still on the run. We are trying to contact their relatives to find out their whereabouts to track them down.

"On Thursday several other patients at the hospital went on a hunger strike."

The patients' demands were unreasonable as they wanted to be allowed to go out and do shopping.

Kupelo said the health department was not running a prison facility but a health facility.

"What is happening is beyond the control of the doctors and nurses as there is a criminal element involved."

The Jose Pearson hospital has about 300 TB patients.

"These people are being kept at the facility as patients and not as prisoners."

Similar protests by TB patients took place at the Fort Grey hospital in East London on Wednesday.

In July this year 19 TB patients escaped from Jose Pearson TB hospital for the first time. Kupelo said the 19 demanded that they be let out of the hospital, then managed to overpower security guards and fled.

They escaped after a security guard, who has since been suspended, allegedly allowed one patient to go shopping.

Others then demanded that they also be let out of the hospital, and overpowered security guards. A special team was sent out to look for them.

Sixteen of the patients returned to the hospital and security was beefed up.

Entertainment features were also added to the hospital to prevent further incidents.

Kupelo said the health department installed televisions screen with creative channels, provided pool tables and other entertainment facilities.

The health department is appealing to the patients to return to the hospital as they were too sick to be out in public.

"They have to understand that they are been kept at the hospital because their condition dictates that. They have to take their medication.

http://www.iol.co.za/index.php?set_id=1&click_id=125&art_id=nw20080904135808819C539597

 

[Gert van der Hoek]

Re: South Africa: XDR TB

SOUTH AFRICA: Strike sends XDR-TB patients home

Source: United Nations Office for the Coordination of Humanitarian Affairs - Integrated Regional Information Networks - PlusNews

Date: 03 Sep 2010

DURBAN, 3 September 2010 (PLUSNEWS) - Striking public health workers in South Africa have virtually shut down King George V Hospital, a referral facility in the port city of Durban, KwaZulu-Natal Province, which specializes in caring for and isolating patients with multidrug-resistant (MDR) and extremely drug-resistant (XDR)-TB.

A senior doctor, who spoke on condition of anonymity, said only 32 adult patients and five children were left in the 192-bed hospital; the others had been sent home during the first few days of the strike, which started on 18 August.

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