Free State province
20 September 2006
What is XDR-TB?
Background
Multi-drug Resistant Tuberculosis (MDR-TB) describes strains of tuberculosis
that are resistant to at least the two main first-line TB drugs - Isoniazid and
Rifampicin. XDR-TB is MDR-TB that is also resistant to three or more of the six
classes of second-line drugs.
Resistance to anti-TB drugs in populations is a phenomenon that occurs
primarily due to poorly managed TB care. Problems are mainly due to patient
non-adherence.
What is the current evidence of XDR-TB?
Recent findings from a survey conducted by World Health Organisation (WHO)
and the Centre for Disease Control (CDC) on data from 2000 - 2004 found that
XDR-TB has been identified in all regions of the world but is most frequent in
the countries of the former Soviet Union and in Asia. It was recently
identified in the Republic of South Africa, namely in KwaZulu-Natal and
Gauteng.
Management of XDR
Recommendations outlined in the WHO guidelines for the programmatic
management of drug resistant tuberculosis includes:
* strengthen basic TB care to prevent the emergence of drug-resistance
* ensure prompt diagnosis and treatment of drug resistant cases to cure
existing cases and prevent further transmission
* increase collaboration between HIV and TB control programmes to provide
necessary prevention and care to co-infected patients
* close collaboration with laboratory infrastructures to enable better
detection and management of resistant cases.
Situation in the Free State
According to laboratory tests, six patients were diagnosed with XDR-TB.
Further investigation has revealed that two patients died, one in December 2005
and one died four weeks ago. Both after a period of long illness � one was
previously an MDR patient and the others details are unknown at this stage.
Another patient absconded from the mines and they are trying to trace the
patient. Two patients who are both MDR patients, have responded very well to
treatment, despite the lab diagnosis of XDR-TB, and one patient is an MDR
patient who has been ill for at least six months.
Proposed approach in the Free State
* This is not an epidemic. From the basic clinical information we have, the
XDR-TB strain seems not to be the dangerous strain
* As a precautionary measure patients will be moved from the Welkom area to an
isolation unit at Pelonomi hospital, in Bloemfontein. The Department is making
the necessary infrastructural arrangements at the isolation unit, to
accommodate the patients, within the next week
* The Department is working on a long term strategy, on how to make the
necessary infrastructure arrangements to accommodate future patients.
The department will continue to engage all relevant stakeholders, in
ensuring that the disease is managed and controlled in the Free State.
Enquiries:
Gela Naudé
Cell: 082 381 9483
Issued by: Department of Health, Free State Provincial Government
20 September 2006
