Intended for healthcare professionals

News Roundup [abridged Versions Appear In The Paper Journal]

South Africa acts to curb spread of lethal strain of TB

BMJ 2006; 333 doi: (Published 19 October 2006) Cite this as: BMJ 2006;333:825
  1. Pat Sidley
  1. Johannesburg

    The South African government has invited experts from the World Health Organization to meet next week in a bid to formulate a plan to combat the rise in multidrug resistant and extensively multidrug resistant tuberculosis. The move comes amid allegations that the government has failed to act promptly.

    South Africa's Medical Research Council, its National Health Department, and WHO say that none of the drugs currently available in South Africa for first or second line treatment of tuberculosis is effective against the extensively resistant variant.

    The government's response follows an emergency meeting held last month in Johannesburg that was attended by representatives from the Medical Research Council, WHO, and the US Centers for Disease Control but not health department officials.

    About 500 000 South Africans have tuberculosis, most of whom are also infected with HIV. Around 6000 people have the multidrug resistant variant.

    The extensively resistant variant first came to public attention when it was diagnosed in some 50 people in a rural hospital in KwaZulu-Natal. They were all HIV positive and died rapidly. All but one had died when a paper dealing with the phenomenon was presented at this year's international AIDS conference in Toronto. Most provinces around South Africa have now reported cases of the deadly variant.

    It has since become clear that the problem has been around for longer than health department officials have suggested, although as the BMJ went to press South African government officials had not responded to requests for a comment on the apparent delay.

    Tony Moll, principal medical officer at the Church of Scotland Hospital in Tugela Ferry in KwaZulu-Natal province, has been quoted in the national and international press as having said that he reported the outbreak to the health department some 18 months ago (Guardian,, 13 Sep, “Rocked by Aids, Zulu kingdom now faces even worse foe”). But only now has action been taken.

    An expert in tuberculosis, Mary Edginton, from the Wits Medical School at Chris Hani Baragwanath Hospital in Johannesburg, then told a discussion group at the University of the Witwatersrand Medical School two weeks ago that laboratories in South Africa had had cases of the extensively resistant variant for at least four years, but no action had been taken.

    Not enough drugs at some clinics, including at the hospital where she works, had contributed to the growth of this variant, Professor Edginton said. But other factors had also played their part.

    Laboratory confirmation of the variant took around three months, during which time patients would have been discharged back into their communities, she said. Also, the directly observed treatment system (DOTS) had not worked in South Africa, and patients often did not complete their courses of treatment.

    Although regulations allow for people to be quarantined on grounds of public health, local authorities taking this option face potential legal challenge, because of the human rights requirements contained in the South African constitution.

    But legal and tuberculosis experts have said that quarantine measures should be used when absolutely necessary. Several patients have been quarantined in a hospital at a goldmine in the Free State and in other areas.

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