Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date.
South African Press Association - September 7, 2006
Louise Flanagan
"There is no time to wait before we embark on decisive action," said the World Health Organisation's Dr Ernesto Jaramillo, explaining that an epidemic could have a deadly impact.
"It's imperative that we don't allow this to go unmitigated," said Dr Ken Castro, of the United States's Centres for Disease Control and Prevention. "The emergence of XDR-TB in the world poses a threat everywhere in the world."
They were part of a group of more than 100 medical experts and policymakers from around the world meeting to discuss the XDR-TB, which emerged in KwaZulu-Natal recently. Fifty-three cases of XDR-TB were identified in the province, and 52 of the patients died within 25 days.
The experts are putting together a seven-point plan to combat the spread of XDR-TB. Top priority is establishing the extent of infection.
"Among the actions required are urgent and rapid surveys in high-risk countries to assess the full extent of XDR-TB globally, matched by increased laboratory capability to carry out vital culture and drug resistance testing," said the South African Medical Research Council (SAMRC).
Rapid diagnostic tests are crucial, as current tests to confirm the XDR-TB diagnosis take too long due to the speed of fatality of the disease.
New drugs The plan calls for new drugs to fight the disease.
The surviving KwaZulu-Natal patient "is the only one that is at the moment alive and we now have nothing to offer", said Dr Willem Sturm, the dean of the faculty of medicine at the Nelson Mandela medical school in Durban.
He said KwaZulu-Natal urgently needs two existing anti-TB drugs, which South Africa does not have, in the hope that they will be effective against XDR-TB.
Cases of XDR-TB were found mainly at Tugela Ferry in KwaZulu-Natal, but also at another 28 places in the province, said Sturm.
The plan also calls for infection-control precautions, research support and universal access to antiretrovirals under joint TB/HIV programmes.
Jaramillo said it is imperative for programmes backing HIV infection and TB to be linked, as there is a "deadly synergy" between the two. "Both have to receive the same priority, otherwise no impact would be obtained."
He said XDR-TB exists elsewhere in the world, but South Africa is the first place where its emergence with HIV infection has been identified as a "major threat".
"HIV has the potential to fast-track XDR-TB into an uncontrollable epidemic," said Dr Karin Weyer, TB research director for the SAMRC.
Some of the KwaZulu-Natal victims were on antiretrovirals, but succumbed rapidly to XDR-TB, which the experts said was an ominous sign.
Emergency TB kills 1,7-million people a year, and a year ago African ministers declared TB an emergency. The SAMRC said combating XDR-TB must now be added to the TB emergency plans, together with promoting access to antiretrovirals under joint TB/HIV activities.
XDR-TB is resistant to the two most potent anti-TB drugs, as well as at least three of the six classes of reserve second-line drugs.
Globally, there have been just 347 identified cases of XDR-TB, mainly in the former Soviet Union and Asia.
In KwaZulu-Natal, a recent survey found that of 554 patients, 221 had multi-drug-resistant TB (MDR-TB). Of these, 53 had XDR-TB. Of the XDR-TB patients, all 44 of those tested for HIV were HIV-positive.
MDR-TB arises when patients do not complete their medication from an earlier bout of TB. However, not all the XDR-TB patients had previously been treated for TB.
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