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CDC HIV/AIDS/Viral Hepatitis/STD/TB Prevention News Update
SOUTH AFRICA: South Africa Risks Spreading Totally Drug-Resistant TB: Study
By Kate Kelland
January 21, 2014
Reuters (01.16.2014)

Reuters reported that a four-year study of 107 South African TB patients documented that hospitals across South Africa “systematically” discharged patients with extremely drug-resistant TB (XDR TB) into the community, even after TB treatment failed, posing a major public health threat. Keertem Dheda, who led the University of Cape Town department of medicine study, theorized that hospitals sent infectious TB patients back into the community because of “lack of space in designated tuberculosis hospitals” and a scarcity of long-term and palliative care facilities. The study monitored 107 XDR TB-infected patients from 2008 to 2012 and found that 42 percent did not respond to treatment and continued to test positive for active TB. Approximately one-third of the group had a high risk of transmitting the bacteria. The patients survived for an average of 20 months in the community, which was ample time to spread XDR TB to others. The study also tested 56 patients to determine whether their TB infections were susceptible to 10 first-and second-line anti-TB drugs. Even with intensive treatment with an average of eight anti-TB drugs, only 12 patients had “favorable outcomes” after five years, and 74 percent of the patients died. Two-thirds of the patients were resistant to eight of the anti-TB drugs, and one patient was resistant to every anti-TB drug (totally drug resistant). Albert Einstein College of Medicine spokesperson Max O’Donnell stated that the study served as an “urgent alarm” of the bleak, out-of-control, multidrug-resistant TB (MDR TB) and XDR TB situation. The World Health Organization estimated that 450,000 people in Eastern Europe, Asia, and South Africa had MDR TB, and approximately half of these would not respond to existing treatments. The full report, “Long-Term Outcomes of Patients with Extensively Drug-Resistant Tuberculosis in South Africa: A Cohort Study,” was published online in the journal, The Lancet (2014; doi:10.1016/S0140-6736(13)62675-6).