AP Interview: Fatal TB Likely Widespread
Pastor Dale Morgan
AP Interview: Fatal TB Likely Widespread*
By MICHELLE FAUL
The Associated Press
Thursday, September 8, 2006; 1:34 PM
TUGELA FERRY, South Africa -- A deadly new strain of extremely
drug-resistant tuberculosis discovered in South Africa is likely to have
spread beyond the rural area where 52 of the 53 people diagnosed with it
have died, the doctor who discovered the super bug said.
The extent of the outbreak in the Kwazulu-Natal region of eastern South
Africa is unknown because tests are expensive and specialized, said Dr.
Tony Moll.
Moll identified the strain in tests carried out at King George V
Hospital in Durban, the provincial capital about 150 miles southeast of
Tugela Ferry, where he works at a government hospital.
"Most hospitals don't have such facilities and support," Moll told The
Associated Press in an interview this week.
Extremely drug-resistant TB has been identified among highly mobile
miners and probably can be found all over the country, Moll said.
"In some of the mines, they have identified (extremely drug-resistant
TB) and, because our population is so mobile, if you looked in other
provinces, no doubt you will find" the new strain, he said.
The World Health Organization issued a warning at a news conference in
London on Friday, and said people could be dying in places that don't
have the capacity to find and diagnose patients.
WHO classified the strain as extremely drug-resistant, saying drugs from
two of the six medicines used as a last line of defense against TB
proved ineffective against the new strain.
Drug resistance is a common problem in TB treatment, but the new strain
appears particularly virulent. Worldwide, about 2 percent of
drug-resistant TB cases are classified as extremely drug-resistant.
Moll found only a few cases in thousands of people tested, but said the
strain was "very highly troubling and alarming because of the very high
fatality rate."
TB has been on the rise because AIDS has lowered so many South Africans'
ability to fight it and other infections. All 53 patients who had
extremely drug-resistant TB tested positive for HIV or were suspected
positive, Moll said.
The government estimates more than 5.5 million of the 44 million South
Africans are HIV-positive, second only to India. On average, more than
900 people die of the disease each day in South Africa.
A high illiteracy rate and poor adherence to the grueling six-month
regimen of medication that can cure TB has in turn fueled a crisis with
drug-resistant TB in South Africa.
Moll said his Church of Scotland Hospital, founded by Scottish
missionaries and now government-run, has 1,300 people on antiretrovirals
but that there probably are 10,000 or 12,000 in the community going
untreated for many reasons, including the stigma attached to AIDS.
Moll said he could treat as many people as ask, with the only constraint
being a shortage of personnel. He is the only doctor prescribing
antiretrovirals to adults in an area covering 650 square miles and
regularly works at least 12 hours a day.
The doctor, who has worked at the hospital for 20 years, said he became
suspicious when AIDS patients responded well to antiretrovirals but died
rapidly.
Further tests showed the TB strain was drug-resistant. Sixty percent of
the patients had never had TB before, so had no history of failing to
complete the course of medication, which usually leads to resistance.
The patients came from all over the district.
"What actually happened here at Tugela Ferry is what we call a true
outbreak ... one single bug that was fingerprinted and that was
transmitted," he said. "These people caught TB for the first time and
were infected by a super bug that was already resistant to this whole
spectrum of medication ... making them practically untreatable."
He said it appeared to attack newly compromised HIV victims. Some
patients had been previously hospitalized, and could have caught the bug
in the hospital, he said. At least two were hospital health workers.
Officials from the World Health Organization, the South African
Development Community and the U.S. Centers for Disease Control and
Prevention will meet in South Africa this week to discuss how to
confront the threat posed by drug-resistant TB.
Conference organizers said such cases were increasing in Botswana,
Mozambique and South Africa. And they warned that the extremely
drug-resistant strain was becoming "a major threat to successful HIV
treatment and care in sub-Saharan Africa."
South Africa's Health Department said Tuesday it was monitoring "the
magnitude of the problem" of extremely drug-resistant TB in
KwaZulu-Natal, and making plans to extend surveillance to other provinces.
"The solution to this problem is to prevent the development of such
resistant strains by ensuring that people are treated properly right
from the beginning and that they complete the treatment," the Health
Department said.
There was concern the South African government, which has come under
sharp criticism for its response to the AIDS crisis, considered the TB
issue sensitive.
Last week, the government banned Health Ministry officials from talking
to the media about AIDS. It seemed that ban might have been expanded to
include TB this week. An AP interview with doctors treating extremely
drug-resistant TB at King George V Hospital was canceled at the last
minute by health officials.
U.S.-based AIDS activists, including a Yale University doctor who
co-authored Moll's study, said they were prevented Wednesday from making
a long-planned video at the Tugela Ferry hospital.
Zackie Achmat, a South African AIDS activist, on Wednesday accused South
African officials of being in "psychological denial" about the AIDS and
TB epidemics "at the cost of people's lives."
International scientists, AIDS activists and South African opposition
parties have accused Health Minister Dr. Manto Tshabalala-Msimang and
President Thabo Mbeki of ignorance and poor judgment in addressing the
AIDS epidemic.