RxPG News : South Africa

XDR TB in South Africa traced to lack of drug susceptibility testing

Mon, 22 Oct 2007 03:59:37 PST

( from http://www.rxpgnews.com ) In South Africa, the 2001 implementation of the World Health Organization�s anti-tuberculosis program may have inadvertently helped to create a new strain of extensively drug-resistant tuberculosis (XDR TB). In a new study published in the December 1 issue of Clinical Infectious Diseases, currently available online, researchers tracked the developing drug resistance of one particular strain of Mycobacterium tuberculosis over 12 years. They found that at the time of the 2001 adoption of the DOT+ strategy for multi-drug resistant strains, the strain was already resistant to one or more of the drugs mandated by that strategy, thus allowing the strain to survive and develop resistance to additional drugs.

�The spread of a highly transmissible strain of drug-resistant tuberculosis has been facilitated by applying standard treatment regimens for susceptible and multi-drug resistant tuberculosis in the absence of drug resistance surveillance,� said one of the authors, A. Willem Sturm, MD, of the University of KwaZulu-Natal�s Nelson R. Mandela School of Medicine in South Africa. �Public health programs for the treatment and control of infectious diseases need to be supported by drug resistance surveillance programs.�

Like all bacteria, M. tuberculosis can evolve and develop resistance to the drugs that have historically killed them. The strategy that has been used to limit the development of drug-resistant TB is to treat the patient with multiple drugs so that if one drug is ineffective, then the others will ensure the elimination of the bacteria.

Drug-resistant M. tuberculosis develops when tuberculosis patients cannot or do not comply with the medication regimen. A second line of drugs has been used to treat those infected with drug-resistant TB. This second-line medication regimen was adopted in South Africa in 2001 to treat drug-resistant TB.

Unfortunately, at least one strain of M. tuberculosis in South Africa had already developed resistance to one or more of these second-line drugs by the time they were introduced. Drug susceptibility tests would have warned doctors that the standard second-line regimen was unlikely to help the patient but was likely to lead to additional drug-resistance, but these tests were not performed or were not available. Indeed, the reduced efficacy of the regimen allowed the strain to survive and, over time, develop resistances to other drugs.

The authors recorded the development of resistance to seven drugs in just over a decade in one strain of M. tuberculosis. There are very few treatment options for patients infected with XDR TB. For the most part, patients are given drugs that had been used to treat tuberculosis but which were abandoned when today�s first-line drugs became available. The older drugs were abandoned because they were less effective or more toxic.

The authors call for an increased use of drug resistance surveillance programs to help forestall the development of drug-resistance in M. tuberculosis.

Training Local Health Workers Improves TB Control In South Africa

Thu, 06 Oct 2005 21:47:38 PST

( from http://www.rxpgnews.com ) Tuberculosis is a growing problem in lower and middle income countries, including South Africa. The World Health Organization estimates that about two thirds of people with tuberculosis are never diagnosed and so cannot benefit from treatment, leaving the epidemic unchecked despite global treatment programmes.

Lack of trained staff is thought to be the most important constraint on the control of tuberculosis, but training is of doubtful effectiveness.

Eight specially trained nurses delivered educational outreach training to clinical staff in 20 primary care clinics in the Free State province, South Africa. Staff in another 20 clinics received no training. Detection and treatment of respiratory illness in almost 2,000 patients was monitored over a five-month period.

Detection and treatment of tuberculosis and asthma were higher in the outreach clinics, suggesting that educational outreach training improves the quality of tuberculosis and asthma care without interrupting services, and without the need for extra staff.

The Free State and other provinces are adapting educational outreach for HIV/AIDS and implementing it widely, say the authors. They suggest that in other lower and middle income countries, where non-physicians provide primary care, equipping middle managers as outreach trainers is feasible within existing constraints on staff and could improve quality of care.

The National Polio Eradication Awareness Week

Fri, 08 Apr 2005 03:45:38 PST

( from http://www.rxpgnews.com ) The Department of Health in South Africa will be observing the National Polio Eradication Week from Monday 4 April to Sunday 10 April 2005 as part of the Health Month campaign that is focusing specifically on maternal and child health care in the country.

The campaign seeks to complement on the World Health Organisation 2005 World Health Day campaign slogan "Make Every Mother and Child Count" that emphasises global efforts towards the significant reduction of maternal death and child mortality.

This is in line with the Millennium Development Goals agreed on by the international community in 2000 to reduce maternal deaths by three-quarters and reduce child mortality by two-thirds by the year 2015.

During this week the Department of Health would seek to create awareness geared towards sensitising mothers, parents and communities in taking initiatives in employing available preventative measures to combat vaccine preventable child diseases such as polio and measles.

In South Africa it is recommended that children under the age of five be immunised against the most common childhood diseases. Immunisation should be administered at birth, 6 weeks, 10 weeks, 14 weeks, 9 months, 18 months and 5years of age. Childhood immunisations are given to prevent Polio, Tuberculosis, Diphtheria, Pertussis, Tetanus, Haemophilus Influenzae type B, Hepatitis B and Measles.

Dangerous childhood diseases such as measles and polio, with potential fatal complications - especially in small children - can be prevented most effectively. Parents are thus urged to ensure that their children receive their routine immunisations on time. If unsure about their children's immunisation status they can report to their nearest public health facility for screening and advice.

It has been years since a case of polio was detected in South Africa. The last case was reported in 1989. Similarly the last ten years have also been a relative quiet period in as far as measles outbreaks were concerned.

However last year the country started experiencing an upsurge of measles cases. Cases were reported in Gauteng, Mpumalanga, KwaZulu Natal, and the Western Cape and more recently in the Eastern Cape. This upsurge can be attributed to importation from neighbouring countries with poor immunisation coverage.

Therefore, as long as there are still sporadic cases of vaccine preventable diseases anywhere in the world, these diseases can easily be imported and spread within countries if all children have not been fully vaccinated.

Thus it is the responsibility and obligation of countries to ensure that standards recommended by the World Health Organisation (WHO) to reduce childhood vaccine related disease are attained. The set routine immunisation coverage target for fully immunised children under one year is 90%. Currently the overall routine immunisation coverage for South Africa stands at 82% but some of districts are still lagging behind with less than 60% immunisation coverage.

It is therefore critical that we endeavour to strengthen our disease surveillance mechanisms in order to ensure that potential importations are identified rapidly so that appropriate responses can be initiated.

Early signs to look out for in the case of polio include sudden onset of a floppy paralysis in one or more limbs. Symptoms for measles include a red rash, high fever, runny nose, red and watery eyes and coughing. Immunisation for childhood vaccine preventable disease are available free of charge at public health clinics.