'True outbreak' of TB super bug at Tugela Ferry

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'True outbreak' of TB super bug at Tugela Ferry

Faul | Tugela Ferry, South Africa

07 September 2006 08:12

A particularly drug-resistant tuberculosis discovered in eastern

South Africa is likely to have spread beyond the rural area where 52

of the 53 people first diagnosed with the new strain have died, the

doctor who discovered the super bug said.

The extent of the new outbreak is unknown because tests are expensive

and specialised. Dr Tony Moll identified the strain in tests carried

out at King V hospital in Durban, about 250km south-east of

Tugela Ferry, where Moll works at a government hospital.

" Most hospitals don't have such facilities and support, " Moll said in

an interview this week.

Extreme drug resistant TB has been identified among highly mobile

miners and probably can be found all over the country, Moll said.

" In some of the mines, they have identified [extremely drug-resistant

TB] and, because our population is so mobile, if you looked in other

provinces, no doubt you will find " the new strain, he said.

The World Health Organisation warned about the new strain Moll

discovered at a news conference in London on Friday, and said people

could be dying in places that don't have the capacity to find and

diagnose patients. WHO classified the strain as extremely drug-

resistant, saying drugs from two of the six medicines used as

a last line of defence against TB proved ineffective against the new

strain.

Drug resistance is a common problem in TB treatment, but the new

strain appears particularly virulent. Worldwide, about 2% of drug-

resistant TB cases are classified as extremely drug-resistant.

Moll found only a few cases in thousands of people tested, but said

the strain was " very highly troubling and alarming because of the

very high fatality rate " .

TB has been on the rise because HIV/Aids has lowered so many South

Africans' ability to fight off it and other infections. All 53

patients who had extreme drug-resistant TB tested positive for HIV or

were suspected positive, Moll said.

The government estimates more than 5,5-million of the 44-million

South Africans are HIV-positive, second only to India. On average,

more than 900 people die of the disease a day in South Africa.

A high illiteracy rate and poor adherence to the grueling six-month

regimen of medication that can cure TB has in turn fueled a crisis

with multidrug-resistant TB in South Africa. About 330 000 South

Africans have TB at any given time and about 6 000 have the multiple

drug-resistant variant.

Moll said that his Church of Scotland Hospital, founded by ish

missionaries and now government-run, has 1 300 people on

antiretrovirals but that there probably are 10 000 or 12 000 in the

community going untreated for many reasons, including the stigma

attached to HIV/Aids.

He is the only doctor prescribing antiretrovirals to adults in an

area covering 1 700 square kilometres.

Moll said he became suspicious when HIV/Aids patients responded well

to antiretrovirals but died rapidly. Further tests showed the TB

strain was drug-resistant. Sixty percent of the patients had never

had TB before, so had no history of failing to complete the

medication course, which usually leads to resistance. The patients

came from all over the district.

" What actually happened here at Tugela Ferry is what we call a true

outbreak ... one single bug that was fingerprinted and that was

transmitted, " he said. " These people caught TB for the first time and

were infected by a super bug that was already resistant to this whole

spectrum of medication ... making them practically untreatable. "

He said it appeared to attack newly compromised HIV victims. Some

patients had been previously hospitalised, and could have caught the

bug in the hospital, he said. At least two were hospital health

workers.

Officials from the 14-country Southern African Development Community

along with the World Health Organisation and the United States

Centres for Disease Control start a two-day conference in South

Africa from Thursday to discuss how to confront the threat posed by

drug-resistant TB.

Conference organisers said such cases were increasing in Botswana,

Mozambique and South Africa. And they warned that the extreme drug-

resistant strain was becoming " a major threat to successful HIV

treatment and care in sub-Saharan Africa. "

South Africa's Health Department said Tuesday it was monitoring " the

magnitude of the problem " of extreme drug resistant TB in KwaZulu-

Natal, and making plans to extend surveillance to other provinces.

" The solution to this problem is to prevent the development of such

resistant strains by ensuring that people are treated properly right

from the beginning and that they complete the treatment, " the Health

Department said.

Last week, the government banned Health Ministry officials from

talking to the media about HIV/Aids. It seemed that ban might have

been expanded to include TB this week. An Associated Press interview

with doctors treating extreme drug-resistant TB at King V

Hospital in Durban was canceled at the last minute by health

officials.

US-based Aids activists, including a Yale University doctor who co-

authored Moll's study, said they were prevented on Wednesday from

making a long-planned video at the Tugela Ferry hospital, and urged

South African officials to stop obstructing them. - Sapa-AP

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