A team of medical ethics and public health experts say tough isolation measures, involuntary if need be, are justified to contain a deadly, contagious, drug-resistant strain of TB in South Africa and to prevent "a potentially explosive international health crisis."
In a policy paper in the international health journal PLoS Medicine, Dr Jerome Singh of the Centre for the AIDS Programme of Research in Durban, South Africa (who is also an Adjunct Professor at the Joint Centre for Bioethics, University of Toronto) and colleagues say that "the forced isolation and confinement of extensively drug resistant tuberculosis (XDR-TB) and multiple drug resistant tuberculosis (MDR-TB) infected individuals may be a proportionate response in defined situations given the extreme risk posed."
On September 01, 2006, the World Health Organisation announced that a deadly new strain of XDR-TB had been detected in Tugela Ferry, a rural town in the South African province of KwaZulu-Natal, the epicentre of South Africa's HIV/AIDS epidemic. Of the 544 patients studied in the area in 2005, 221 had MDR-TB (Mycobacterium tuberculosis resistant to at least rifampicin and isoniazid). Of these 221 cases, 53 were identified as XDR-TB (i.e. MDR-TB plus resistance to at least three of the six classes of second line drug treatments). Of the 53, 44 were tested for HIV and all were HIV infected.
This strain of XDR-TB in Kwazulu-Natal proved to be particularly deadly: 52 of the 53 patients died (within a median of 16 days of the initial collection of sputum for diagnostic purposes).
But the authors say that there have been a number of obstacles in the way of dealing effectively with the crisis. "The South African government's initial lethargic reaction to the crisis," they say, "and uncertainty amongst South African health professionals concerning the ethical, social and human rights implications of effectively tackling this outbreak highlights the need to address these issues as a matter of urgency lest doubt and inaction spawns a full-blown XDR-TB epidemic in South Africa and beyond."
Citation: Singh JA, Upshur R, Padayatchi N (2007) XDR-TB in South Africa: No time for denial or complacency. PLoS Med 4(1): e50. (http://dx.doi.org/10.1371/journal.pmed.0040050)
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