Experts warn over rise in resistant TB

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Experts warn over rise in resistant TB

By Danny Rose, AAP Medical Writer, AAP March 24, 2011, 12:02 am

After a couple of generations at the fringe of public health concerns in

Australia, tuberculosis looks intent on making a comeback.

There was a 30 per cent jump in Australian cases of multi-drug resistant

tuberculosis (MDR-TB) from 2007 to 2009, while last year saw the nation record

another rare case of even harder to kill XDR-TB.

The bacteria, which can cause a lethal lung infection, is apparently no longer

the disease that modern medicine, and Australia's extra efforts at infection

control, was supposed to make " just disappear " .

" The trend has been an increase in multi-drug resistant TB in Australia over the

last 10 years, which is worrying, " Dr Bernadette Saunders, from Sydney's

Centenary Institute, said to mark World TB Day on Thursday.

" Many people thought tuberculosis would just disappear over time but, really, TB

levels have been rising since the 1990s.

" It's a disease that we need to be aware of, certainly in terms of MDR-TB and,

in the last few years, there has been what we call `XDRs` which are extreme-drug

resistant strains. "

About 1200 Australians fall ill with TB every year, and usually they pick up the

respiratory infection while travelling overseas.

While this number has remained stable, the proportion of MDR-TB infections seen

in Australia has risen steadily - up from just eight cases in 2000 to 24 in

2007, and 31 in 2009.

People with non-resistant TB are given an array of antibiotic tablets for up to

12 months before they clear the infection.

Those with MDR-TB are quarantined in hospital for at least six months, where

their doctors are faced with an increasingly narrow band of antibiotic options.

Without such efforts, infection with TB and its increasingly resistant strains

would rise uncontrollably in Australia.

Dr Saunders said many older Australians would remember the public health

initiatives leading up to the 1960s that all but eradicated the community-level

spread of TB.

" We had very active campaigns to try and reduce TB levels, buses would go around

and people would go in and have chest X-rays and if their X-rays weren't clear

they were given antibiotics, " she said.

" You talk to people who were older and they will say I remember the buses, or

going with mum to stand in line for the chest X-ray. "

There is a vaccine to prevent TB - recommended to those headed for an extended

stay in developing countries - and it is not included in the array of

inoculation given to Australian children.

It is thought about a third of the world's population is carrying TB bacteria,

although it remains dormant in around 90 per cent of infected people as their

immune system controls it.

The 10 per cent who do fall ill can pass on the bacteria by coughing.

About a quarter of all people infected with MDR-TB globally die from it - more

than double the mortality rate of non-resistant TB.

Around the world, about eight to nine million new cases of TB infection are

reported each year, with about 1.7 million deaths.

" It is a major, major health issue, across the globe, " Dr Saunders said.

" In some parts of the world levels of multi-drug resistance is very high and if

we're not vigilant, and continue to work very hard, to keep drug resistance low

and treat people who are multi-drug resistant, there is a strong potential for

it to spread. "

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