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General Health : Infectious Disease Last Updated: Apr 20, 2011 - 9:38:09 AM

WHO issues warning over drug-resistant tuberculosis strains
By Kathy Jones
Sep 6, 2006 - 4:04:00 PM

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6 Sep, ( - The emergence of extreme drug resistant tuberculosis (XDR-TB) in South Africa has greatly alarmed the World Health Organization (WHO). These news strains of tuberculosis virtually untreatable with existing drugs. The WHO is calling for increased preventive measures to stop the spread of these deadly TB strains.

Extensive Drug Resistant TB (XDR-TB) is resistant to the first line of drugs, namely isoniazid and rifampicin. But the problem here is that even the second line of tuberculosis drugs fail to contain these strains.

XDR-TB poses a grave public health threat, especially in populations with high rates of HIV and where there are few health care resources, the WHO said in a statement.

In March a joint survey by WHO and the US Centers for Disease Control and Prevention (CDC) found that XDR-TB has spread across the world. In the Morbidity and Mortality Weekly report, CDC reported that 15 percent of samples in South Korea had extreme drug resistance, 19 percent in Latvia, as well as 14 percent in the East European/West Asia region.

The recent episode in KwaZulu-Natal province in South Africa where 52 of the 53 people infected by drug resistant TB died has set alarm bells ringing.

All patients in this outbreak died within 25 days on average, including those benefiting from antiretroviral drugs.

The resistant strains have been identified in all regions of the world in recent months, most often in Asia and countries of the former Soviet Union.

Paul P. Nunn, a W.H.O. tuberculosis expert, who is to be a part of the meeting in South Africa said that improper implementation of treatment strategies, may have led to the emergence of this "virtually untreatable" form of tuberculosis.

"This is very worrying, especially when mixed with HIV. We need to make sure we do the basics properly, in other words, ensuring, and where necessary, supervising that the patient takes ever pill for the course of the treatment," he added. "If you do that, then the rate of development of resistance drops dramatically, even in the context of HIV."

Dr Nunn said that although the XDR-TB strains were widespread, it was not clear how transmissible it was or whether it was limited to isolated pockets.

On the South African outbreak, Dr Nunn said the situation was complicated by the presence of HIV. Karin Weyer, director of the South African Medical Research Council's TB policy research unit shared this view and called the current outbreak a serious issue.

"With XDR-TB we have very few options left -- all we can even try are very old, very ineffective drugs. For many people, there is no option," she added.

Meanwhile the KwaZulu-Natal health department is trying to import drugs to contain the outbreak of XDR-TB. "The UKZN (University of KwaZulu-Natal) and the department of health have taken steps to limit the spread of this XDR-TB," said department spokesperson Nhlanhla Nkosi in a statement.

Independent Online reports that of the 11 drugs to treat TB, South Africa has access to nine. Among these seven drugs have already failed to combat TB. "Because one needs a minimum of three drugs to treat tuberculosis, this form of tuberculosis has become almost untreatable," Nkosi said.

TB is caused by the bacterium Mycobacterium tuberculosis and in its infective stage spreads through droplet infection in air. The presence of HIV complicates this disease. "A person with Aids has a much higher chance of getting this infection as compared to healthy individuals. KwaZulu-Natal has the largest Aids problem in South Africa. Therefore, it also the largest number of patients with tuberculosis," said Nkosi.

The CDC says that drug resistance is common in people who
* have spent time with someone with drug-resistant active TB disease
* do not take their medicine regularly
* do not take all of their medicine as told by their doctor or nurse
* develop active TB disease again, after having taken TB medicine in the past
* come from areas where drug-resistant TB is common

Dr Nunn says it is vital that new drugs be developed to fight this scary disease. Currently, researchers are working on TB vaccines, he added.

Editor's Note: Cited below are common questions on drug resistant TB from WHO.

Drug- and multidrug-resistant tuberculosis (MDR-TB) - Frequently asked questions

How does drug-susceptible TB become drug-resistant TB?

Drug resistance arises due to the improper use of antibiotics in chemotherapy of drug-susceptible TB patients. This improper use is a result of a number of actions, including administration of improper treatment regimens by health care workers and failure to ensure that patients complete the whole course of treatment. Essentially, drug-resistance arises in areas with poor TB control programmes.

What is multidrug-resistant tuberculosis (MDR-TB)?

MDR-TB is a specific form of drug-resistant TB due to a bacillus resistant to at least isoniazid and rifampicin, the two most powerful anti-TB drugs.

What is the difference between the management of drug-resistant TB and drug-susceptible TB?

In areas of minimal or no MDR-TB, DOTS achieves cure rates of up to 95%; rates high enough to dramatically reduce the TB burden while preventing the emergence of drug-resistant TB. However, an effective strategy, the management of drug-resistant TB is still in pilot stage. While drug-susceptible TB can be cured within six months, forms of drug-resistant TB (such as MDR-TB) require extensive chemotherapy (with drugs which have more side effects) for up to two years.

How do we measure drug-resistant TB globally?

In 1994, WHO, the International Union Against TB and Lung Disease, and other partners began the Global Project on Drug Resistance Surveillance in order to standardize the sampling and laboratory methodologies used to measure drug resistant tuberculosis. Today, areas representing almost one-third of global TB cases have been surveyed.

Are TB and drug-resistant TB real threats to everyone?

Presently, TB is the second greatest contributor among infectious diseases to adult mortality causing approximately two million deaths a year worldwide. WHO estimates that one-third of the world's population is infected with Mycobacterium tuberculosis. The WHO/IUATLD Global Project on Drug Resistance Surveillance has found MDR-TB (prevalence > 4% among new TB cases) in Eastern Europe, Latin America, Africa, and Asia.

Given the increasing trend toward globalisation, trans-national migration, and tourism, all countries are potential targets for outbreaks of MDR-TB.

How is WHO addressing the problem of drug resistance?

In 1998 WHO and several partners around the world conceived DOTS-Plus, a strategy currently under continuous development and testing for the management of MDR-TB. In 1999, WHO established the Working Group on DOTS-Plus for MDR-TB. The aims of the working group are to approve, conduct, and oversee pilot projects based on the Guidelines for Establishing DOTS-Plus Pilot Projects for the Management of MDR-TB prepared by the Scientific Panel of the Working Group. In addition, the Working Group aims to improve access to second-line anti-TB drugs for DOTS-Plus pilot projects via mechanisms such as the Green Light Committee.

© 2004-2008 by unless otherwise specified

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