Fears of TB outbreak in Australia

Australia: Young woman's death sparks fears of a killer TB strain on our doorstep

AUSTRALIA'S first victim of a killer strain of drug-resistant tuberculosis has died amid warnings of a looming health epidemic on Queensland's doorstep.

Couier Mail,

15 March, 2013

Medical experts are seriously concerned about the handling of the TB epidemic in Papua New Guinea after Catherina Abraham died last Thursday of an incurable form of the illness, known as XDR-TB (extensively drug resistant TB) in Cairns Base Hospital.

The 20-year-old had been in an isolation ward since May last year after an outbreak of the highly-contagious mutated form of TB on Daru Island, off Cape York.

Some doctors fear she will become the first of a wave medical refugees heading to Queensland for treatment.

The State's Chief Health officer Jeanette Young has urged people not to panic about the threat of an outbreak on the mainland.

But respiratory physician Steve Vincent, who treated Ms Abraham, warned that there was a further threat of Totally Drug Resistant or TDR-TB "just around the corner".

"Her death is not unexpected given the fallout of this killer, incurable disease," Dr Vincent said. "Despite all the first-world medical treatment, it shows how difficult it is to control.

"It exemplifies the fact with such a high mortality rate, PNG is going to have an extremely difficult time in handling this epidemic."

He said doctors may soon face the ethical dilemma where it might be "more humane not to treat them and let them die" as the disease was untreatable.

Australian and Papua New Guinean authorities are trying to contain XDR-TB to the shanty towns of Daru Island as more than 14,500 TB cases are diagnosed in PNG's Western Province every year.

Federal MP Warren Entsch, whose electorate includes the Torres Strait, yesterday said the $31 million AusAid TB program in the Western Province was "riddled with corruption" and "completely inadequate".

He said Ms Abraham's death was a grim reminder of the "looming public health disaster on our doorstep".

XDR-TB is estimated to cost between $500,000 and $1 million a patient to treat in Australian hospitals, with a low cure rate and high death rate.

Dr Young said she supported efforts to contain the epidemic to the PNG side of the border and not reopen clinics on the Torres Strait islands of Boigu or Saibai.

She said re-opening health clinics on Boigu or Saibai islands would only increase the risk of cross-border infection in the Torres Strait.

TB - the new pandemic

TB continued: Drug-resistant strain of deadly disease alarms doctors worldwide

The world is in the middle of a tuberculosis pandemic, scientists say. What was once a disease of undeveloped nations has raced across continents, with thousands of cases in Asia and Europe. The disease may infect up to two million people by 2015.

RT,

30 August, 2012

An extensive international study published by the Lancet medical journal shows that the illness, once thought to be the stuff of books by the likes of Charles Dickens, is making a quiet comeback. Cases of tuberculosis in Africa, Asia, Europe and Latin America are on the rise, and many of them are of a strain resistant to vaccination.

The study examines two types of tuberculosis: Multi drug-resistant (MDR) and extensively drug-resistant (XDR), both of which are far more widespread than previously believed, experts claim.

Tuberculosis is a bacterial infection that destroys patients’ lung tissue. The disease is then spread through the air through coughing and sneezing. Anyone with active TB may infect an additional 10 to 15 people a year, experts say.

MDR tuberculosis is resistant to at least two first-line drugs – Isoniazid and Rifampicin – used as primary treatment in confirmed cases of the disease. XDR is resistant not only to these two, but also to an antibiotic used as second-line drug.

"Most international recommendations for TB control have been developed for MDR-TB prevalence of up to around five percent. Yet now we face prevalence up to ten times higher in some places, where almost half of the patients … are transmitting MDR strains," Sven Hoffner of the Swedish Institute for Communicable Disease Control wrote in a commentary on the study.

Afghan women look on as a child lies on a bed in a tuberculosis section of the main hospital in Herat (AFP Photo / Aref Karimi)

Presently, most seem to worry about diseases of the exotic type: Bird or swine flu, or West Nile virus generally tend to dominate headlines in the West. But scientists are warning that the world is in the midst of a tuberculosis pandemic.

In 2010, 8.8 million people were infected with TB, with 1.4 million dying from the disease.Treating TB is an arduous process. Patients often require a multitude of drugs, with treatment lasting for up to six months. Many patients fail to complete the process correctly – which researchers believe is a factor in the increase of cases of drug-resistant forms of TB.

Drug-resistant TB is not only more difficult to treat, but also more expensive. Chief Scientific Officer Tom Evans of Aeras, a non-profit group working on development of new vaccines, told Reuters that “without a robust pipeline of new drugs to stay one step ahead, it will be nearly impossible to treat our way out of this epidemic.” 

But the treatment, Evans said, is “limited, expensive, and toxic.”

Photomicrograph of a sputum sample containing Mycobacterium tuberculosis. Courtesy: Centers for Disease Control and Prevention's Public Health Image Library

In the US, a case of MDR tuberculosis can cost up to $250,000 per patient. In less developed countries, such costs will likely be unmanageable for patients and healthcare systems.

According to the study, TB strains resistant to any second-line drugs were found in nearly 44 percent of patients: From 33 percent of cases in Thailand to 62 percent of cases in Latvia.

XDR tuberculosis was found in 6.7 per cent of all patients in the study. Rates in South Korea and Russia, at 15.2 and 11.3 percent respectively, were more than twice the global estimate made by the World Health Organization.

The highest prevalence of MDR tuberculosis documented to date – 47.8 percent – was reported in 2011 in Minsk, Belarus, according to the Lancet study.

Though infection rates vary greatly between countries, scientists warn against stereotyping the disease as an issues solely of poorer, less developed nations: “MDR tuberculosis is not an issue isolated in one city or country, but reflects a wider public health threat resulting from severely resistant forms of M tuberculosis. To adequately address MDR tuberculosis, more solid epidemiological information is needed to increase overall understanding of disease development and transmission,” Sven Hoffner wrote in Lancet.

Tuberculosis outbreaks

With thanks to CollapseNet

TB outbreaks popping up in sections around the globe

-- Just something to be aware of and prepared for just in case, because TB stories are popping up more and more with frequency.

Florida accused of concealing worst tuberculosis outbreak in 20 years
"According to the Post, the coverup began as early as last February, “when Duval County Health Department officials felt so overwhelmed by the sudden spike in tuberculosis that they asked the U.S. Centers for Disease Control and Prevention to become involved. Believing the outbreak affected only their underclass, the health officials made a conscious decision not to not tell the public, repeating a decision they had made in 2008, when the same strain had appeared in an assisted living home for people with schizophrenia.”

Florida closes only tuberculosis hospital amid worst US outbreak in 20 years
"As a result, patients once deemed too sick for contact with the public were released into the community and others newly diagnosed with the disease, mostly from the homeless population, are being put up in local motels in an effort to keep them on their medications.

"The high number of deaths in this outbreak emphasises the need for vigilant active case finding, improved education about TB, and ongoing screening at all sites with outbreak cases," states the report written by Robert Luo, a senior doctor with the CDC's epidemic intelligence service, and obtained by the Palm Beach Post following a public records request.

The CDC confirmed it was one of the worst outbreaks of TB anywhere in the United States for at least two decades.

Meanwhile, the Florida department of health expects to save up to $10m a year by closing AG Holley, which had treated patients with the most severe cases of the disease since 1950. The hospital discharged its last patients a week ago.

In a statement, the department defended the closure, insisting that patients in need of hospitalisation would receive adequate care at public hospitals in Miami and Jacksonville, which also agreed to take some of the most severe AG Holley cases."

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78 TB cases reported at Tokyo elderly care center

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TB outbreak continues in Northern Quebec community
"The number of active tuberculosis cases continues to climb in a northern Quebec community, where almost eight per cent of the population has been infected."

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Doctors fight major TB outbreak at school (UK)
Public health officials said they were battling against a "particularly virulent" strain of the disease, described as the largest outbreak in the UK in recent times.