"brainfart" <fart@brain.org> wrote in message

Here is a little something I came across:

S.Africa urged to isolate "killer" TB patients
Tue Jan 23, 2007 9:54am ET
By Sarah McGregor

JOHANNESBURG (Reuters) - South Africa may forcibly isolate patients being treated for a highly
drug-resistant form of tuberculosis to prevent new infections from spreading on the AIDS-hit
continent, health officials said.

"Holding the patient against their will is not ideal but may have to be considered in the
interest of the public," Ronnie Green-Thompson, a special advisor to the Health Department,
said in a statement.

A new study out this week urged South Africa to consider mandatory isolation to control extreme
drug resistant tuberculosis (XDR-TB), which has killed at least 74 people in the country since
2005.

The study published in the journal PLoS Medicine said the government must consider all options
as it fights "a major threat to public health".

TB, an airborne bacillus spread through coughing or sneezing, can usually be cured through
treatment. However, the XDR-TB strain may have mutated when patients skipped treatment or were
dispensed inadequate antibiotic cocktails.

South Africa has logged almost 400 cases of XDR-TB, which is virtually impervious to treatment
by most common TB drugs, and an unprecedented 30 new cases are diagnosed every month, according
to the study in PLoS Medicine.

The outbreak has alarmed medical experts who say XDR-TB poses a particular danger to
HIV-positive people whose immune systems are already severely compromised by the AIDS virus.
Continued...

© Reuters 2007.

"brainfart" <fart@brain.org> wrote in message

S. Africa Must Isolate
Patients With Deadly
TB Strain: Study
Helen Branswell
1-24-7

TORONTO - South African authorities should isolate - with or without their consent - patients
infected with extensively drug resistant tuberculosis in a bid to avert what experts believe
may be a brewing global health crisis, researchers from Toronto and South Africa argue in a
discussion paper released Monday.

While the proposal brings to mind images of leper colonies and medieval streets walled up to
prevent spread of the plague, the authors insist there really is no other option for the
treatment of people who are a risk to virtually all around them and to the global community.

In their article, published in the journal Public Library of Science Medicine, they argue
patients with XDR TB, as it is called, should be given first priority for medical treatment,
even above patients with full-blown AIDS. And the South African government should compensate
them for the wages or social assistance benefits they would lose by being isolated in a
sanatorium or other facility during treatment.

"We're not saying confine people and leave them there to rot and die. We're saying confine
people but ensure that their needs are taken care of," said first author Jerome Singh, a lawyer
and ethicist who has appointments both with the Center for AIDS Programme of Research in South
Africa and with the University of Toronto's Joint Centre for Bioethics.

"We're not speaking of dropping them off in some sort of colony akin to a leper colony."

XDR TB poses enormous treatment challenges as it is not susceptible to most of the antibiotics
typically used in the treatment of tuberculosis. The few drugs that work are expensive, are
associated with more side-effects and must be taken over longer periods of time.

Spread of the extensively drug resistant strain is particularly worrisome in South Africa, with
its high rate of HIV infection. The two diseases create a deadly synergy, with rapid death
following TB infection.

A specialist treating XDR TB cases in Ontario said Monday the right cocktail of drugs can
"cure" patients - though she insisted this form of TB is so new it's not known what the
long-term prognosis is. But in South Africa - where only one drug is available for these
patients - it's not at all clear that the isolation recommended in this discussion paper isn't
simply a way station to death at present.

"We don't know," admitted another of the authors, Dr. Nesri Padayatchi, when asked if XDR TB is
treatable in the South African setting. The authors do suggest patients should be released from
isolation if and when tests show they are no longer infectious.

Public health authorities around the world are gravely concerned that the emergence of XDR TB
may be an "explosive international health crisis" in the making, with nothing to stop global
spread of this difficult-to-treat strain. In fact, such spread is already under way.

About a half-dozen cases of XDR TB have been diagnosed in Toronto in the past two years -
people who either caught the disease abroad or who caught it here from people infected
overseas, Dr. Monica Avendano, a physician responsible for the treatment of these cases for
Ontario, said Monday.

In Ontario, these patients are confined while they are infectious, either voluntarily or by
court order. One of the Ontario patients refused to comply with the strictures of treatment and
is currently being forcible confined in West Park Healthcare Centre, the province's TB
hospital.

While the extent of XDR TB infection in Canada is not currently known, other provinces and
territories have similar legal powers, said Dr. Edward Ellis, manager of tuberculosis
prevention and control with the Public Health Agency of Canada.

The authors of the paper - two ethicists and an infectious diseases physician - said
restricting the movement of infected individuals is defensible because of the need to protect
society at large.

A leading U.S. ethicist concurred, saying there are times when individual rights must give way
to the need to keep the public safe from infectious diseases.

"It's not something that can be taken lightly. You wouldn't want to do it unless your hand is
forced and nothing else seems to work," said Dr. Ezekiel Emanuel, chair of the department of
clinical bioethics of the Clinical Center of the National Institutes of Health.

"On the other hand, there are some times where we probably have to do it. And this is as close
to one that I can imagine." Dr. Emanuel stressed his views were his own, and not the policy of
the NIH.

There has been reluctance to take such draconian measures in South Africa.

"Many officials in South Africa have been very hesitant about recommending forcible confinement
for fear of violating human rights," Mr. Singh said in an interview from Durban, South Africa.

Meanwhile, public health experts fear the strain may be spreading rapidly.

When the World Health Organization announced last September that a new and deadly strain of XDR
TB had been detected in Tugela Ferry, a town in the South African province of KwaZulu-Natal, it
noted that 53 people had been found to have been infected with the strain. Of those, 52 had
died; most lived less than a month after testing positive for the strain.

By November, the number of infected there had swelled to at least 300 known cases, though it is
assumed those cases may represent a tip of the iceberg.

Ross Upshur, head of the Joint Centre for Bioethics, said with the frequent movement of
migratory workers throughout the countries of southern Africa, it is feared the strain may be
spreading faster than authorities can track it.

He acknowledged there are negative mental connotations to forced confinement, but said any
other approach would doom more people to die.

"There are no other options," he insisted.

"There's the magical thinking of a magic-bullet technical solution. But that's not here."

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