on the status of extremely drug resistant tuberculosis (XDR-TB) in South Africa
at the Southern African Development Community (SADC) Health Ministers meeting,
Maputo, Mozambique
22 September 2006
The media has recently reported on cases of extremely drug resistant
tuberculosis found in some public hospitals in South Africa. Given the mobility
of people in Southern Africa this issue may raise alarm bells amongst Southern
African Development Community Ministers of Health, especially given the emotive
language used by the media, some of whom have compared XDR-TB to Severe Acute
Respiratory Syndrome (SARS)!
I wish, therefore, to take this opportunity to brief colleagues about the
situation in South Africa as I understand it. Two days ago I convened a meeting
of tuberculosis (TB) researchers, clinicians and laboratory scientists so that
I could hear first hand about the nature and extent of the problem and what
interventions are necessary to deal with the problem.
Let me start with the definition of XDR-TB. It is multidrug resistant
tuberculosis (MDR-TB) plus resistance to three classes of second line drugs.
Experts have informed me that they found 53 cases of XDR-TB in a hospital in
KwaZulu-Natal (one of the nine provinces in South Africa). These cases were
found through a research project - they were not found as a matter of routine
clinical investigations. Subsequently, there have been reports of a small
number of additional cases in KwaZulu-Natal, Gauteng and Free State.
This could mean that there are other cases of XDR-TB in the country and in
the region. This statement is supported by a report by World Health
Organisation (WHO) on the existence of cases of XDR-TB in all regions of the
world where tests on MDR patients have been conducted. Countries mentioned
specifically in the WHO report noted that the United States of America (USA)
has a four percent prevalence rate and Latvia a 19 percent rate.
The message is clear, 'unless we make special efforts to test MDR patients
for resistance to other drugs we will be unaware of the presence of XDR-TB
amongst our TB patients. Testing is important for treatment and control of
XDR-TB.'
At my meeting with experts I asked the researchers and laboratory scientists
to conduct additional tests on MDR-TB patients and to submit reports on every
additional case found to me on a regular basis so that we can have a
continuously accurate picture of the prevalence of XDR-TB.
It is important to note that XDR-TB is no more infectious than TB,
therefore, the same measures need to be taken with regards to infection
control. We need to ensure that as Ministers of Health we do not contribute to
the media hype and sensationalism that we are currently finding, which has led
to panic and may result in reluctance on the part of patients to present
themselves for treatment for TB.
Experts have informed me that once we find XDR-TB amongst our patients we
need to do the following as a matter of urgency:
1. strengthen infection control which includes separation of TB patients and
patients who may have TB, from other patients and which may also include the
isolation of XDR-TB patients in order to prevent further infections
2. test patients with MDR-TB for resistance to second line drugs in order to
identify XDR-TB
3. conduct surveys to establish the true extent of XDR-TB
4. strengthen surveillance by enhancing contact tracing of patients with
MDR-TB as well as enhance laboratory capacity for the diagnosis of XDR-TB
5. ensure availability of para-amino salicylic acid and capreomycin to
augment the other drugs used in the treatment of MDR-TB
6. strengthen patient adherence to treatment.
I am glad to report that what our experts told us is very similar to what
the WHO has proposed as initial steps that need to be taken to respond to
XDR-TB in Southern Africa.
South Africa has initiated a process to address those issues, raised by the
experts, that are not currently part of the national TB control programme and
the TB Crisis Management Plan that I launched in March this year in response to
the World Health Organisation Regional Office for Africa (WHO/AFRO) resolution
on TB taken here in Maputo in 2005.
Whilst we do all these things we must strengthen our national TB control
programmes. Unless we do this we will not be able to reduce the number of
patients with TB and consequently MDR and XDR-TB. We need to recognise that TB
is a disease of poverty and its consequences. We must, therefore, accelerate
our development programmes to eradicate poverty, overcrowding and reduce
unemployment.
We must also note that for the past 30 years no new TB drugs or new
diagnostic tests were developed. The consequence of this is that confronted
with this new challenge we have to rely on drugs that were removed from use in
the primary and secondary management of TB because they were less effective,
had unacceptable levels of toxicity and unpleasant side effects. We must
therefore urge pharmaceutical and diagnostic companies to correct this gap with
respect to new TB drugs and new TB diagnostic tests.
Finally, let me reassure colleagues that South Africa will do everything
possible to address this challenge and will work closely with the WHO and SADC
to ensure that we develop a regional response to this challenge. I am sure that
the experiences of the WHO in assisting other regions of the world to deal with
XDR-TB will be of great value to us as well.
I thank you!
Issued by: Department of Health
22 September 2006
Source: Department of Health (http://www.doh.gov.za/)
