PRETORIA, SOUTH AFRICA--Alarmed by a new outbreak of extensively drug resistant (XDR) tuberculosis, health officials from a dozen nations in southern Africa will gather in Johannesburg later this week to try to agree on a plan to deal with the threat in a region already reeling from HIV/AIDS infections.
"This is a very serious regional issue, and we need to develop a strategy to counter the threat," says Karin Weyer, director of the South African Medical Research Council's TB policy research unit. She and her counterparts from other southern African nations will be joined at the 2-day meeting by drug-resistance experts from the World Health Organization (WHO), the U.S. Centers for Disease Control and Prevention, and other health organizations with a focus on TB and HIV/AIDS.
Weyer estimates that there may be close to a half-million cases of TB in South Africa, with perhaps 3% multidrug resistant. "We are very concerned that XDR strains may be going undetected," she says, noting that the most recent TB estimates are based on a 2002 nationwide survey. Funds are not available for annual surveys, she adds.
The most recently reported outbreak of XDR tuberculosis--which swiftly killed 52 of the 53 infected patients--took place last year in the South African town of Tugela Ferry in KwaZulu-Natal Province (Science, 25 August, p. 1030). Tony Moll, AIDS treatment director at the Church of Scotland Hospital in Tugela Ferry, will describe at the meeting this week that 1540 patients had been treated at the hospital between January 2005 and March 2006. About a third had TB; 221 of those were infected with multi-antibiotic-resistant TB. Of the 53 cases of XDR-TB, at least 44 were also infected by HIV/AIDS. XDR-TB renders persons infected with HIV virtually untreatable using current TB medications. Moll hopes to widen the survey to a dozen hospitals in KwaZulu-Natal Province: "If hospitals throughout the country started looking closely for XDR-TB, I believe they will find it."
Paul van Helden, co-director of South Africa's Center of Excellence in Biomedical Tuberculosis Research, also fears that the incidence of XDR tuberculosis may be underestimated. He faults the current TB drug-treatment regimen for exacerbating the problem and says his center is developing new molecular tests to accelerate TB drug-resistance testing. "We need a full spectrum of tests for all antibiotics at the outset," he told ScienceNOW.
Worldwide, health officials reported about 350 other cases of XDR tuberculosis between 2000 and 2004, but the outbreaks were not as closely linked as the South African cases to parallel HIV/AIDS infections. Last year, TB killed a half-million people in Africa; WHO's Africa office declared a "TB emergency" and called for "urgent extraordinary actions" to try to contain the epidemic.