Seven point emergency action plan* to combat XDR-TB
issued by global health agencies
Johannesburg 7 September 2006 - Leading health experts today called for dramatic improvements in TB control to contain and combat the spread of a deadly new form of the disease, XDR-TB (extensive or extreme drug resistant TB). The measures were outlined in an emergency consultation called by the South African Medical Research Council (SAMRC), World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC).
Among the actions required are urgent and rapid surveys in high risk countries to assess the full extent of XDR-TB globally, matched by increased laboratory capability to carry out vital culture and drug resistance testing especially in countries where such facilities do not exist.
Representatives from 11 Southern African countries joined international experts in the call for increasing the capacity of clinical and public health managers and their teams to provide appropriate treatment programmes and train staff to identify, investigate and combat future XDR-TB outbreaks.
A global survey reported earlier this year that XDR-TB is present in every region of the world. However, a recent outbreak in the KwaZulu Natal province in South Africa highlighted the risk of XDR-TB for HIV-infected people. In this outbreak, all but one of 53 patients died within an average 25 days from the point when resistant TB was first suspected. This extremely high mortality is in part explained by the fact that 44 patients tested were all HIV infected; 15 of these were receiving ARVs. Nevertheless all died with XDR-TB.
“HIV has the potential to fast track XDR-TB into an uncontrollable epidemic,” warned Dr Karin Weyer, TB Research Director from the SAMRC. “Infection control precautions are needed now, and must be scaled up without delay in settings where HIV patients are brought together.”
New anti-TB drugs are desperately required to treat XDR-TB patients. Research into these new agents has only recently been revitalised and despite promising drugs in the pipeline, these will not be available for at least five years. Further investment in new drug research and development will be necessary to ensure an adequate number of effective drugs.
“Crucial to fighting drug resistant TB will be rapid diagnostic tests - with results available in days rather than months. Sadly, many HIV infected patients have died from XDR-TB while waiting for TB test results,” said Dr Ken Castro, Director, CDC’s Division of Tuberculosis Elimination, U.S. Department of Health and Human Services.
Similar calls for priority action were made by Dr Ernesto Jaramillo, Manager of the WHO’s Anti-TB Drug Resistance team: “Countries are requesting technical support and we must be ready to provide the expertise and skills. WHO will therefore convene a global task force to develop detailed recommendations for countries to respond to XDR-TB effectively.”
TB kills 1.7 million people a year. Just over a year ago, African Health Ministers declared TB an emergency, and unanimously called for “urgent and extraordinary” measures to be put in place to strengthen TB control. Combating XDR-TB must now be added to national TB emergency plans, together with promotion of universal access to ARVs under joint TB/HIV activities.
XDR-TB is defined as resistance to the two most potent anti-TB drugs, isoniazid and rifampin, together with resistance to at least three of six classes of reserve second-line drugs.
* Seven Point XDR-TB Action Plan
- Conduct rapid surveys of XDR-TB
- Enhance laboratory capacity
- Improve technical capacity of clinical and public health managers to effectively respond to XDR-TB outbreaks
- Implement infection control precautions
- Increase research support for anti-TB drug development
- Increase research support for rapid diagnostic test development
- Promote universal access to ARVs under joint TB/HIV activities
For more information please contact:
Dr Karin Weyer, SAMRC,
Tel +27 12 339 85 50,
Mobile tel +27 82 460 88 36
Mr. Glenn Thomas, WHO Stop TB,
Mobile tel. +41 79 509 06 77