Experts urge strongest isolation for new drug-resistant tuberculosis cases appearing in South Africa

Medical ethics and other experts say tough isolation measures, involuntary if need be, are justified to contain a very deadly, highly-contagious and drug-resistant mutant strain of tuberculosis and to prevent "a potentially explosive international health crisis" brewing most dangerously in South Africa.

They warn that new variations of the disease now defeat many of the world's existing drugs and "the forced isolation and confinement of XDR-TB (extensively drug resistant tuberculosis) and MDR-TB (multiple drug resistant tuberculosis) infected individuals may be a proportionate response in defined situations given the extreme risk posed."

Writing in the peer-reviewed online journal PLoS Medicine, co-authors Ross Upshur, MD, Director of the University of Toronto Joint Centre for Bioethics, and South Africa-based HIV-AIDS experts Jerome Amir Singh and Nesri Padayatchi, MD, say the world community urgently needs to help isolate and contain the threat.

"The South African government's initial lethargic reaction to the crisis and uncertainty amongst South African health professionals concerning the ethical, social and human rights implications of effectively tackling this outbreak highlights the need to address these issues as a matter of urgency lest doubt and inaction spawns a full-blown XDR-TB epidemic in South Africa and beyond," the paper says.

The World Health Organization (WHO) announced Sept. 1, 2006 that yet another deadly new strain of extensively drug resistant tuberculosis (XDR-TB) had been detected in Tugela Ferry, a rural town in KwaZulu-Natal (KZN) province, epicenter of South Africa 's HIV / AIDS epidemic. Eight days later, the WHO urged a response to the outbreak akin to recent global efforts to control SARS and bird flu.

The new strain in September appeared within a year of a study showing 221 of 544 TB patients in KNZ province had multi-drug resistant tuberculosis (unresponsive, at a minimum, to front-line

Contact: Terry Collins
University of Toronto Joint Center for Bioethics

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