Africa Wrestles With Extreme TB

[Guest guest]

Africa Wrestles With Extreme TB By Koenig

ScienceNOW Daily News 5 September 2006

PRETORIA, SOUTH AFRICA--Alarmed by a new outbreak of extensively drug

resistant (XDR) tuberculosis, health officials from a dozen nations

in southern Africa will gather in Johannesburg later this week to try

to agree on a plan to deal with the threat in a region already

reeling from HIV/AIDS infections.

" This is a very serious regional issue, and we need to develop a

strategy to counter the threat, " says Karin Weyer, director of the

South African Medical Research Council's TB policy research unit. She

and her counterparts from other southern African nations will be

joined at the 2-day meeting by drug-resistance experts from the World

Health Organization (WHO), the U.S. Centers for Disease Control and

Prevention, and other health organizations with a focus on TB and

HIV/AIDS.

Weyer estimates that there may be close to a half-million cases of TB

in South Africa, with perhaps 3% multidrug resistant. " We are very

concerned that XDR strains may be going undetected, " she says, noting

that the most recent TB estimates are based on a 2002 nationwide

survey. Funds are not available for annual surveys, she adds.

The most recently reported outbreak of XDR tuberculosis--which

swiftly killed 52 of the 53 infected patients--took place last year

in the South African town of Tugela Ferry in KwaZulu-Natal Province

(Science, 25 August, p. 1030). Tony Moll, AIDS treatment director at

the Church of Scotland Hospital in Tugela Ferry, will describe at the

meeting this week that 1540 patients had been treated at the hospital

between January 2005 and March 2006. About a third had TB; 221 of

those were infected with multi-antibiotic-resistant TB. Of the 53

cases of XDR-TB, at least 44 were also infected by HIV/AIDS. XDR-TB

renders persons infected with HIV virtually untreatable using current

TB medications. Moll hopes to widen the survey to a dozen hospitals

in KwaZulu-Natal Province: " If hospitals throughout the country

started looking closely for XDR-TB, I believe they will find it. "

van Helden, co-director of South Africa's Center of Excellence

in Biomedical Tuberculosis Research, also fears that the incidence of

XDR tuberculosis may be underestimated. He faults the current TB drug-

treatment regimen for exacerbating the problem and says his center is

developing new molecular tests to accelerate TB drug-resistance

testing. " We need a full spectrum of tests for all antibiotics at the

outset, " he told ScienceNOW.

Worldwide, health officials reported about 350 other cases of XDR

tuberculosis between 2000 and 2004, but the outbreaks were not as

closely linked as the South African cases to parallel HIV/AIDS

infections. Last year, TB killed a half-million people in Africa;

WHO's Africa office declared a " TB emergency " and called for " urgent

extraordinary actions " to try to contain the epidemic.

http://sciencenow.sciencemag.org/cgi/content/full/2006/905/2