XDR-TB Alarm Bells on World Tuberculosis Day

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Kenya: Experts Sound Alarm Bells Over Deadly Strain of Drug-Resistant

TB. The Nation (Nairobi), 27 March 2008.

Mike Mwaniki, Nairobi

As Kenya on Thursday commemorates the World Tuberculosis Day, health

experts have warned about a deadly strain of the highly infectious

disease.

It will cost up to Sh1.3 million to treat one case of the

multi-drug-resistant TB compared to Sh6,000 for treatment of an

" ordinary " case of the disease.

Patients undergoing treatment for the disease are expected to be

injected daily for the first six months before completing their

treatment in two years compared to the six months it takes to treat

the other strains.

About 289 cases of multi-drug-resistant TB had been detected in the

last six years. According to experts, this form of TB does not respond

to the standard treatments using first-line drugs like Rifampicin and

Isoniazid.

Addressing a press conference at his Afya House office in Nairobi last

week, the Director of Medical Services, Dr Nyikal said: " When

resistance emerges to the major TB drugs, we're forced to go back to

using older less effective ones.

Expensive treatment

" This means a much longer and expensive treatment course while also

relying on drugs that are toxic with serious side effects " .

Last year, 116,723 cases of TB were detected in the country compared

to 115,234 in 2006. The new figures indicated a seven per cent increase.

In 2004 for example, Kenya was ranked 10th among the 22 countries

which account for about 80 per cent of the world's TB cases. Locally,

the disease causes an estimated 74,000 deaths each year - which

translates to an average of 200 deaths a day.

Globally, the highly infectious but curable disease, kills about two

million people each year and is spread through coughing and sneezing.

Following the increasing cases of the disease, the Government declared

TB a national emergency in 2006 and blamed it on rapid urban

population growth, overcrowding in slums and prisons and malnutrition.

The TB, Leprosy and Lung Diseases division head, Dr ph Sitienei,

blames the Aids epidemic for the rise in TB cases because it weakens

the immune system.

" The daily death toll from TB is similar to three bus loads of

passengers crashing every day... But because a majority of those who

die are poor and voiceless, their deaths go largely unnoticed, " Dr

Sitienei said.

According to him, the Government planned to involve communities in the

fight against TB.

Dr Sitienei identified Nairobi, Coast, Nyanza and North Eastern

provinces as some of the areas with the highest incidents of TB in the

country.

" The Health Ministry is encouraging communities to report any people

suspected to be infected by the disease.

" This is the only way we can bring the cases down since the disease is

curable whether an individual is an Aids patient or not, " he said.

TB affects all parts of the body except the hair, teeth and nails.

" The disease affects all age groups but 80 per cent of the cases occur

among 15 to 44 year-olds. Men are more vulnerable to infection

compared to women.

Globally, the World TB Day was marked on March 24 but health officials

in Kenya pushed their celebrations to today since Monday was a public

holiday.

The theme for this year is: " I'm Stopping TB " .

Speaking during a press conference held last week, Dr Nyikal said the

Government had set up isolation wards and treatment facilities for the

new strain at Kenyatta National and Moi Teaching and Referral

hospitals. A total of 21 patients were already on treatment at the

hospitals.

Meanwhile, the World Health Organisation (WHO) says TB continues to be

a threat to the developed and developing world alike.

A report released last week by the organisation, titled " Global

Tuberculosis Control 2008 " , concluded that global efforts to combat

the disease had slowed in recent years, causing WHO to call for

renewed commitment to fighting tuberculosis around the world.

The emergence of new, drug resistant strains of tuberculosis is of

particular concern. Of the 9.2 million new cases of TB in 2006, WHO

estimates that 500,000 were of the deadly strain.

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Treatment of MDR-TB requires so-called " second line drugs " , which can

take years to effectively treat TB and are 100 times more expensive

than first line drugs.

While some countries, such as Hong Kong, have shown significant

decreases in incidence of MDR-TB, and the MDR-TB rates in several

other nations are holding steady, Multi-Drug Resistant Tuberculosis is

on the rise globally. Countries such as Peru, the Republic of Korea

and the Russian Federation have seen what the WHO calls " concerning

increases. "

" Because MDR-TB can be passed between individuals as easily as

drug-sensitive TB, the emergence of MDR-TB anywhere is cause for

concern everywhere, " the report says.

Says Dr Abigail , the WHO TB specialist and author of the

report: " TB and drug resistant TB affect the public, and this disease

does not honour any borders...

" Governments and health systems of all countries must therefore take

drug resistance seriously. "

She adds: " There are a variety of reasons for an increase in

resistance, but most are programme-related.

" Increases in resistance, for example, could be due to weakness in

health systems " .

According to Dr Nardell, a physician and TB expert with

Partners in Health, a Boston-based NGO that specialises in addressing

and treating MDR-TB around the world, overcoming these weaknesses is a

complex process.

" The barriers are financial but (there are) also implementation

bottlenecks even if the money were to appear.

" Many programmes wait for treatment failure, and many still follow the

discredited old WHO policy of using regimen 2, which is adding just

one drug (streptomycin) to the failed standard regimen. This leads to

more drug resistance and allows transmission to other patients of

MDR-TB because the patient is still not effectively treated. "

In the absence of laboratories where strains can be analysed for drug

resistance, MDR-TB is often simply not identified at all.

In Kenya for example, TB diagnosis and treatment is carried out in

1,800 health facilities while 777 diagnostic sites have been

established countrywide.

Presence of Aids

According to experts, however, in many African countries, the

prevalence of MDR-TB is likely to be high both because of poor health

care infrastructure, and because of the presence of Aids.

While many people are infected with the bacterium that causes TB, it

very often remains inactive in the body.

However, because Aids weakens the immune system, people with Aids are

far more likely to become sick with TB if infected.

Of the 9.2 million new TB cases in 2006, the WHO reports that 700,000

were among people living with HIV. WHO further estimates that TB is

responsible for up to a third of all Aids deaths, making it the

leading cause of death among HIV-infected people. In 2006 alone,

200,000 people died from HIV-associated TB.

Because people with weakened immune systems are more vulnerable to

tuberculosis, they are more likely to pass the disease on to others.

" Lack of testing and treatment of HIV fuels the (TB) epidemic, " Dr

Nardell says.

Already cases of extensively drug resistant TB (XDR-TB) have been

reported, and there has been at least one confirmed case of

tuberculosis that was resistant to all existing treatments, the WHO

report says.

Were TB to become completely drug resistant, even developed countries

would be essentially powerless to fight the disease.

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