Drug-Resistant TB in South Africa Draws Attention From U.N.
By LAWRENCE K. ALTMAN Published: September 6, 2006
WASHINGTON, Sept. 5 — The World Health Organization will hold an urgent meeting this week to seek ways to deal with deadly strains of tuberculosis that are virtually untreatable with standard drugs.
The meeting, in Johannesburg on Thursday and Friday, comes in response to recent reports from a number of the world’s regions about a small but growing number of cases of the deadly strains, known as extreme drug-resistant tuberculosis, or XDR-TB.
“XDR-TB poses a grave public health threat, especially in populations with high rates of H.I.V.” and few health care facilities, the health organization, a United Nations agency, said Tuesday.
The meeting will include officials from African countries and the United States Centers for Disease Control and Prevention.
Although the resistant strains have been identified in all regions of the world, especially Asia and the former Soviet Union, the immediate goal is to help South Africa control an outbreak that killed 52 of 53 patients in a rural province in recent months. The deaths occurred swiftly, on average within 25 days, and included patients who were taking antiretroviral drugs for H.I.V., the virus that causes AIDS.
The meeting also aims at determining whether scientists can identify some drug already on the market, or a new combination of such drugs, that would still be effective against the resistant strains of tuberculosis.
The origins of the South African outbreak are unknown, but misuse of antituberculosis drugs is the most likely explanation, said Paul P. Nunn, a World Health Organization tuberculosis expert who is expected to be at the meeting. “Whatever the practice is, it must be changed,” Dr. Nunn said in an interview.
Dr. Mario C. Raviglione, who directs the health organization’s tuberculosis program, said in an interview that “nobody at the moment can be considered an expert” about the problem.
So other aims of the meeting include adopting what experts believe are “best practice” recommendations, as well as:
¶Strengthening standard measures like the use of masks, gowns and other means of protecting health workers from the drug-resistant strains and preventing their further spread.
¶Improving steps to ensure prompt diagnosis and treatment of tuberculosis cases and monitoring the incidence of new drug-resistant infections.
¶Developing and upgrading laboratories in poor countries to do tuberculosis testing.
¶Seeking details about two unreported outbreaks in the last 10 years that W.H.O. officials have heard about informally.
The situation is “extremely scary,” Dr. Raviglione said. But he added that officials wanted to prevent health care providers from stopping work in affected areas.
The lack of effective drugs brings doctors back to the era before antibiotics, when the limited treatment measures included chest surgery. For patients whose tuberculosis was confined to one lung, surgeons could remove a portion or whole lung, but without assurance of cure.
If the strain keeps spreading, it could exceed by “hundreds of times” the outbreak of drug-resistant tuberculosis in New York City in the 1990’s, Dr. Raviglione said. That outbreak was brought under control by adopting strong measures, including observation of infected patients to make sure they took their drugs properly.
作者:admin@医学,生命科学 2011-09-08 17:13