Tamar Kahn: Business Day, 25 October 2006

HEALTH Department director-general Thami Mseleku has told parliament that authorities would use their legal powers to quarantine patients with extremely drug-resistant tuberculosis (XDR-TB) who refused to stay in hospital and comply with treatment. He said that the department would ask for court orders to quarantine patients if need be. Patients would be released when their disease was under control (making them less infectious), provided they agreed to complete their course of medication, he said. The recent emergence of XDR-TB in SA has alarmed public health experts around the world, as it appears to pose a particularly high risk to people infected with HIV. All of the 78 confirmed cases in KwaZulu-Natal, 74 of which have so far proved fatal, tested positive for HIV, said Mseleku. Documents presented in Parliament detailed low cure rates (51%) for ordinary TB, and even lower rates for multi-drug-resistant MDR-TB (23%). The papers also highlighted problems in handling patients with MDR-TB, which is resistant to first-line treatment drugs rifampicin and isoniazid. Often patients with MDR-TB discharged themselves from hospital or stopped taking their pills - due to drug or alcohol abuse problems, or because they suffered side-effects. The latest strain of TB to emerge in SA, XDR-TB, does not respond to first-line drugs and is also resistant to at least three of the six classes of second-line drugs. It is tackled with older, less effective drugs, such as capreomycin and para amino salicylic acid. Mseleku said doctors could obtain a court order to confine infectious patients to hospital in the interests of public health, but this was considered a measure of last resort. He said more emphasis needed to be placed on raising public awareness of the dangers of not completing the standard six-month course of antibiotics for combating ordinary TB, as failure to do so increased the risk that patients would develop drug resistance. Patients infected with such drug-resistant strains could transmit the disease to other people by sneezing or coughing, thus posing a public health threat. Mseleku said that if people developed resistance to those drugs (capreomycin and para amino salicylic acid), nothing else was left. He noted that the new TB drugs were not expected to reach the market before 2015.