Drug-Resistant TB in South Africa Draws Attention From UN

In Johannesburg, officials from the World Health Organization, African countries and CDC will meet Thursday and Friday to develop a "best practices" strategy for controlling extremely drug-resistant TB (XDR-TB). The meeting follows the report of an XDR-TB outbreak that killed 52 of 53 patients, within an average 25 days, in a rural hospital in a South African province.

"XDR-TB poses a grave public health threat, especially in populations with high rates of HIV" and few health facilities, said WHO. Some of the patients who recently died were AIDS patients on antiretroviral drugs.

The meeting aims to identify either some existing treatment or a new combination of drugs to which XDR-TB is susceptible. The misuse of TB drugs is the likeliest explanation for the creation of XDR-TB, said Paul P. Nunn, a WHO TB expert expected to attend the meeting. "Whatever the practice is, it must be changed."

• Strengthening standard protective measures to ensure health care workers do not acquire XDR-TB.

• Improving the prompt diagnosis and treatment of TB and monitoring of XDR-TB incidence.

• Developing or improving laboratories in poor countries for TB testing.

• Seeking details about two previously unreported XDR-TB outbreaks that WHO officials have informally heard occurred in the last decade.

Without effective drug therapy, treatment options include chest surgery but cannot guarantee a cure.

Officials want to ensure health workers do not abandon XDR-TB affected areas, said Dr. Mario C. Raviglione, WHO's TB program director. If the XDR-TB strain continues to spread, it could surpass by "hundreds of times" New York City's resistant TB outbreak during the 1990s, he said.

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