XDR-TB poses new global health threat

[Guest guest]

Experts: Resistant TB poses new global health threat

By Gillian Wong, Associated Press

BEIJING — The Beijing Chest Hospital was packed with people on a recent weekday

morning. In the waiting area, Wang Chong, a migrant worker who has been fighting

tuberculosis for several months, was facing a dilemma: Does he continue

treatment that has already cost him more than $5,000 or stop before his savings

are wiped out?

It's not only his health at stake. If Wang stops treatment prematurely, his

tuberculosis is likely to morph into one of the new, hardier strains that resist

the drugs he has been using and that pose a growing threat to global public

health. Countries as diverse as China, Russia and South Africa are vulnerable,

and the new strains have also appeared in the United States.

" TB is now taking on a deadly new form — one that will spread further, " said

Cornelia Hennig, the World Health Organization's TB program coordinator for

China. " We can choose: Either we act now with rational and proven approaches, or

we pay later with a worsening epidemic. "

The WHO is trying to bring renewed vigor to the fight with a three-day meeting

of health ministers from the worst-affected countries in Beijing starting April

1. Also attending are WHO Director-General Margaret Chan and Bill Gates,

co-chair of the Bill & Melinda Gates Foundation, a major contributor to research

on global health problems. Countries are expected to draw up five-year plans to

prevent and control the spread of drug-resistant TB.

TB is caused by germs that spread when a person with active TB coughs, sneezes

or speaks. It's ancient and treatable but now has evolved into stronger forms:

multidrug-resistant TB, which does not respond to two top drugs, and extensively

drug-resistant TB, which is virtually untreatable. TB is usually treated in six

months with a $20 cocktail of four antibiotics, but its drug-resistant form

takes up to two years to fight.

One of the culprits: health care systems that lose track of patients who do not

complete their courses of treatment, allowing the TB bacteria to develop

resistance to normally potent medicines.

This is also a problem in India, where rural health care is often poor and there

is little control over the sale of anti-TB drugs; Russia, which faces a shortage

of qualified medical staff and drugs; and South Africa, where the disease

thrives amid an AIDS epidemic that has weakened the immune systems of people

with HIV.

An estimated half a million people in the world are already infected with

drug-resistant TB, nearly a quarter of them in China. Most are still waiting for

help, which only increases the risk.

Less than 5% of people suffering from drug-resistant TB worldwide are properly

treated, said Mark Harrington, executive director of Treatment Action Group, a

U.S.-based health advocacy group.

" So most of the people are going around coughing and spreading

multidrug-resistant TB, " he said. " But most countries have not yet started to

take it seriously. "

Though the problem is mainly confined to developing countries, health experts

warn the risk is widespread as people and their diseases cross the globe. An

intercontinental scare was set off two years ago when an American lawyer with

drug-resistant TB flew to several countries and back to attend a wedding.

In the U.S., even as TB rates fall, drug resistant strains are showing up in

California and other states with large immigrant communities, because many

people come from or travel frequently to countries such as Mexico, India and

China where TB is a greater risk.

International experts recommend that TB treatment centers monitor their patients

rigorously, supplying them with medication and watching them swallow every dose.

In the past decade, China made marked progress in fighting tuberculosis, which

until last year was the most fatal infectious disease. Once a person tests

positive for TB at a hospital, an Internet-based reporting system helps health

officials channel the infected patients to special TB facilities run by the

communicable diseases agency.

The Health Ministry says more than 90% of new infections are cured every year.

But China still has 112,000 people with drug-resistant TB, according to the WHO.

Experts say only a few thousand of them are receiving proper treatment.

An underfunded health care system means many TB facilities can't closely track

every patient, while most of the 130 million highly mobile migrants from rural

China don't qualify for free treatment given to urban residents. Guangdong

province, where most of China's export factories are located and home to many

migrants, has more TB infections than any other province.

China is developing an electronic system to track infected migrants, the WHO's

Hennig said. The government has also promised revamping of health care with a

$124 billion investment over the next three years.

The Health Ministry says it is working on a national survey of drug-resistant TB

patients and plans to roll out treatment to them, but did not say when. It said

treating drug-resistant TB is a hundred times more expensive than normal TB.

Aid agency Doctors Without Borders, also known as Medecins Sans Frontieres, said

it was trying for two years to start a drug-resistant TB program in Inner

Mongolia but gave up because China wanted too much control over the operation's

finances and other issues. The Health Ministry had no immediate comment.

" We are rather frustrated about it ... and the patients continue to go

untreated, " said MSF's operational coordinator in Brussels, Luc van Leemput, who

was involved in the negotiations. " I hope that the Chinese government is going

to get its act together and provide access to treatment for those patients who

need it. "

http://www.usatoday.com/news/health/2009-03-30-tuberculosis_N.htm?csp=34