‘Infection control is urgently needed to prevent global spread of extremely-drug-resistant tuberculosis among healthcare workers’… top US lung-health conference was warned…
May 29 2009 -- Healthcare workers in South Africa are at a significantly increased risk of developing drug-resistant tuberculosis, XDR-TB – and moreover, the rapid progression of this nearly uncurable, deadly lung-disease also threatens to destabilize global TB-control in its rapid march throughout the sub-Saharan region of Africa.
This warning was issued by top researchers from Calgary, Boston and Cape Town’s medical universities, while presenting a series of reports on their latest findings at the prestigious 105th American Thoracic Society International Conference in San Diego on May 17.
The researchers warned after presenting their detailed studies of the exact way in which health-care workers became infected with XDR-TB in South Africa, that ‘infection control was urgently needed to prevent the spread of extremely-drug-resistant tuberculosis among healthcare workers worldwide’. see
Black Americans also at greater risk of acute respiratory diseases like TB:
- And in another important study, researchers from the Emory University school at Atlanta also issued a warning that black Americans were at 50% higher risks of acute respiratory diseases such as Tuberculosis than were white Americans. This important finding, which points to genetic predisposition in addition to poor living environments, closely matches similar study results in South Africa, where the black population historically showed proportionally higher rates of acute respiratory diseases than do whites, even when comparisons were made between white and black destitute families in the identical living poor conditions. Dr Sarah Erickson of Emory university said in her presentation that more research funding must be made available to investigate why black Americans are more prone to acute respiratory diseases than are whites. For the abstract of the American study see Most of the XDR-TB cases identified in the USA still are among foreign-born migrants into the country. For the prevalence of drug-resistant TB in the United States, see
Dramatic march of XDR-TB worldwide:
But it’s the dramatic progress of XDR-TB which worries the international health-care community so much, mainly because there’s almost no effective cure for this strain at all. TB had been beaten back for years, but now is making a new come-back worldwide. And the only way to stop its progress at the moment, is to prevent it from spreading more: there’s no effective vaccine against it, either.
“The progression of XDR-TB is threatening to destabilize global tuberculosis control,’ warned Cape-Town based researcher Dr Keertan Dheda, associate professor of medicine at the University of Cape Town. He was speaking at the ATS International Conference, which is devoted to the presentation and discussion of new research findings and the latest clinical developments in respiratory, critical care and sleep medicine.
- During the conference, more than 13,500 attendees heard over 5,300 original research presentations related to the prevention, diagnosis and treatment of respiratory diseases such as lung cancer, chronic obstructive pulmonary disease (COPD), asthma, allergies, sleep-related disorders, cystic fibrosis, tuberculosis and many more. Click here for other reports
Swine flu kills far fewer people than does XDR-TB
The research documents submitted about the rapidly-spreading XDR-TB epidemic in South Africa drew a large number of delegates and a high level of interest from the news media too - although not as high as the sessions on the Swine Flu epidemic, which thus far has infected about 11,034 people and killed 9 people worldwide thus far this year.
Hundreds of thousands of deaths from XDR-TB in southern Africa
- The XDR-TB epidemic in South Africa has already killed many hundreds of thousands of patients since it was first detected in KwaZulu-Natal province in 2006 – and is still spreading like wildfire throughout the continent south of the Sahara. It’s difficult to diagnose, but patients with poor immune systems usually die from it within just weeks of admission to hospitals.
The researchers warned that their latest studies ‘underscored the urgent need for stringent TB screening policies among healthcare workers in these areas.” Dheda and collaborators Julie Jarand, MD email@example.com tel 403 943 5425 from the University of Calgary and Max O’Donnell, MD from Boston University said their retrospective studies focused on healthcare workers who have contracted XDR-TB in a non-outbreak setting.
- Dr. Dheda said that “the purpose of this study was to describe a series of healthcare workers in South Africa with extensively drug-resistant tuberculosis and to determine whether XDR-TB was prevalent among them,” Dr. Dheda noted.
Dr Dheda’s study was based on a chart review of 317 patients in South Africa with passively detected XDR-TB, including 11 healthcare workers. Of those 11, eight were working in district hospitals, 10 had been treated for TB at least once previously and eight were negative for HIV. At the time these workers were diagnosed with XDR-TB, there were no standard infection control measures in place at the facilities where they were employed.
- Drs. O’Donnell and Dheda also presented their findings from similar studies at Kwa-Zulu Natal and four treatment centers in South Africa, respectively.
Young, mostly female, non-smoking, non-HIV health care workers:
Among 317 'passively detected' XDR-TB cases in South Africa, eleven health care workers were identified who contracted it in a 'non-outbreak' setting. The patients were young, average age 36 years, predominantly female (91%), non-smokers (100%), mostly nurses working in district hospitals. Eight of these eleven patients also were HIV-negative.
Ten of these patients had been treated for TB on at least one previous occasion.
XDR-TB is important health risk globally for health workers…
It was concluded by this research that XDR-TB is 'an important risk for health care workers globally, particularly for those who work and/or travel to high burden areas, regardless of HIV-status'. The researchers said that 'urgent infection control and rapid diagnostic testing for all health care workers suspected of TB needs to be undertaken to minimize the risk of drug-resistant TB'. Dr. Dheda noted that although tuberculosis is a ‘well-recognized occupational risk’ for healthcare workers in both low- and high-income countries, the prevalence and natural history of XDR-TB in these particular workers was unknown.
Health workers’ shortage at crisis levels in Sub-Saharan Africa:
“The emergence and progression of XDR-TB is threatening to destabilize global tuberculosis control,” he said. “The negative impact of XDR-TB is further exacerbated by (… ) a shortage of health workers which has reached crisis levels in most of sub-Saharan Africa.”
“XDR-TB is an important risk for healthcare workers globally, particularly for those who work or travel to high-burden areas, regardless of HIV status,” Dr. Dheda added. “Implementation of infection control measures and rapid diagnostic testing for all healthcare workers suspected of TB needs to be undertaken urgently to minimize the risk of drug-resistant TB.”
However it must also be noted that in South Africa, many of the health-care staffing shortages are due to the fact that the South African government has banned and even fired the vast majority of white health care staff, and often are unable to replace them with trained black workers, thus leaving many thousands of health care sector jobs open. They have even been forced to take on ‘suitably-coloured’ doctors from Cuba and Morocco to fill these vacancies.
At least 6% of people diagnosed with tuberculosis in Khayelitsha township near Cape Town, South Africa last year alredy had a drug-resistant strain of the disease. This was reported by Medicines Sans Frontieres in a report on its pilot programme in the township. http://www.digitaljournal.com/article/269719
other sources and links:
- Drug-resistant tuberculosis is a 'time bomb' warns WHO
Young whites emigrate, young blacks die of XDR-TB/AIDS in South Africa:
Doctors strike at South African public hospitals:
Racist hiring quotas cripple South African hospitals:
6 % of TB cases are drug-resistant in Cape Town: (2008)
Images by Adriana Stuijt