The WHO recently reported that MDR-TB was a growing problem among HIV positive patients. This is hardly surprising given that HIV and AIDS both undermine the immune system and expose patients to hospitals where the bacteria is present. The report showed an appalling mortality from the disease in AIDS patients–90%.
Most noteworthy is the report’s confession that there is not much to go on certain parts of the world, such as in Africa. The disease could be far more widespread and still unknown.
MDR-TB in Australia
As a general rule, the industrialized world has been shielded from TB since the height of Industrialization. However, MDR-TB has been reported infrequently in a number of first-world nations. One such nation is Australia. In Papau New Guinea alone there are a mere 15 reported cases of MDR-TB–and they are a fourth of the total cases. As far as epidemics go, this is fairly lackluster.
Which doesn’t explain the Australian response. The country is building a large laboratory and clinic to deal with the problem. The reason is expectation; the authorities expect the epidemic to grow in magnitude. After all, prevention is the only medicine still effective against XDR-TB.
Tuberculosis Continues to Spread
Tuberculosis is spreading according to the WHO. Ironic for a disease that was once thought all but vanquished. The WHO has reported that while in 1995 two nations–Estonia and Latvia–were considered hot spots. (With intervention, they were able to slow the spread and are set to shirk the unsavory title.) Now many more nations have joined them.
Now Moldava, Russia, the Ukraine, and Uzbekastan have all joined the list. And with cases appearing in countries that have ties to them–and let’s be honest, we all have ties–it is clear that the disease is spreading across the globe. I pose a question, then. Knowing what this disease did before the various drugs and knowing what a global pandemic of a slow burn disease (ie, HIV) looks like, can we justify the same kind of inaction?
A New Study on the Lethality of MDR-TB
The American Journal of Respiratory Illness and Treatment announced new finding about the dangers of MDR and XDR-TB. In short, those with MDR-TB had three time the likelihood of dying when compared to those with a treatable form, and the odds were even worse for those who had XDR-TB. This is unsurprising as medicine has long been a cornerstone of treatment. It does raise the question of how we will continue to treat TB as medicine is outdated.
Misuse of Drugs in India
A recent study of TB drugs in India showed that most doctors did not know the proticol for prescribing TB medication. Doctors should first prescribe the medicine with the least side-effects–first do no harm. Of course, if there is evidence the patient has MDR-TB, the form of the drug believed most likely to work is assigned. The problem is that doctors routinely prescribe second line drugs to patients who do not have MDR-TB. This can fuel resistance in the second line drugs, blurring the line between the two and encouraging the formation of XDR-TB.
India Launches Numerous Counter-TB Measures
India has a major TB epidemic. The problem is wider than MDR-TB and accordingly the government has implemented a number of new plans to combat TB as a whole. They are implementing a better surveillance system to catch more cases sooner, in part by initiating free testing in high risk areas. Because the link between TB and HIV is so strong, they have combined the groups responsible for watching these two illnesses together. India has also provided strictly applied medicine to its people in hopes of preventing a wider epidemic. They have also invited unprecedented foreign help to educate doctors and provide relief on the front lines. India is providing an example for all nations when combating any disease.
South Africa’s Struggle
South Africa has one of the fastest grown MDR/XDR-TB populations in the world. Its health system is taxed by the strain of HIV/AIDS as is. Its government is undergoing massive internal problems in the face of politcal instabitly in its northren neighbor, Zimbabwe. Still, it has organized a response that counters the problems of its situation. It provides medicine for its people in a “community based” approached. Doctors are assigned to an area as opposed to patients coming to them–think of the old house-call system in the United States. There is some evidence that this reduces the dangers of creating a ‘focus point.’ Typical of many outbreaks, especially in Africa, is a pattern of epidemic that is magnified like the sun through a lens through hospitals. Regardless, it significantly reduces costs. The South African system may be the best option for many developing nations.
Looming Problem in Kenya
At this point I’ve established that interupting treatment of any form of TB might have catostrophic consequences for all of us–namely the creation of untreatable strains. Therefore it is paramount that we support the continuation of treatment world-wide. However, the Internatinal Monetary Fund has cut spending in Kenya, essetially cutting of medicine to patients mid-regimen. The result is two-fold. First of all it condemns these people. Their chances of surviving TB are greatly deminished. Second, it increases the risk of fortifying the bacterium against the medicine in use. This policy is ill-advised and redefines the concept of a ticking time bomb.
A New Weapon
It has been decades since last we added a new drug to the arsonal against TB. Preliminary reports of a new drug were pulbished as an abstract and oral presentation. This drug is well tolerated and shows a good deal of promise in fighting MDR-TB. Of course, there is no reason to expect that this one won’t be abused and quickly added to the list of drugs that do us no good. Nonetheless, the last drug created came into the world at a time when it was believed that medicine was the infalible answer to medical problems. Perhaps with the wisdom of the current crisis behind us we can use this drug appropriately.
I almost did this blog on AIDS itself. One of the most prevailent themes of AIDS is the marginalization of its victems. This is a theme recurrant throughout the history of contagious disease and often results in cataclysmic results for both the infected and the healthy. Syphilus victems had a hard time integrating into society and there were proposals in the American Congress to turn Hawaii into a leper colony for AIDS patients. Now with MDR-TB we are seeing the beginnings of this pattern. It is common practice in South Africa to simply dump TB patients over the border–perversely, they’re no longer South Africa’s problem. Even if we ignore the moral implications of this practice, it is simply not true. This practice spreads MDR-TB across boarders. It can only boomerang and damage South Africa in a few years. It harkens back to the time when Africa ignored AIDS because it was supposedly a gay, western disease. Now millions of people are paying the price.