Brussels, 08 Sep 2006

The World Health Organisation (WHO) has issued a stark warning - to act immediately to stop the spread of a tuberculosis strain with extreme drug resistance (XDR-TB), which has killed 52 out of 53 patients diagnosed with the disease in South Africa. While the strain has been found around the world, it has been particularly prevalent in Asia and the former Soviet Union until now. An outbreak in South Africa's KwaZulu-Natal region rapidly killed 52 of 53 patients diagnosed with the disease. All of those tested were also infected with HIV.

The outbreak has caused considerable alarm, prompting an emergency meeting of African health experts from 11 African countries and the WHO to discuss the problem. The WHO representatives call for rapid interventions to limit the spread of this disease, akin to those in response to avian flu and the SARS outbreak, to stop the spread of the strain as soon as possible.

'This must be taken with the same degree of seriousness. There is no time to wait,' said Ernest Jamarillo from the WHO at the Johannesburg conference.

The fear in Africa, especially southern Africa, is that XDR-TB has probably already spread. The disease may be common in mining areas, where it could be spread very easily through close personal contact. When XDR-TB is combined with HIV, the results are devastating, especially to populations only just beginning to feel the benefits of combination retroviral treatments.

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Only 44 of the 52 deaths in KwaZulu-Natal were tested for HIV infection, but all carried this second disease. XDR-TB is so-called because it has developed resistances to both first line treatments, and at least two of the six second-line treatments, severely reducing the number of possible interventions available.

The South African Medical Research Council, the United States Centres for Disease Control, and the WHO issued a seven-point action plan to tackle the disease now:

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- conduct rapid surveys of XDR-TB;
- increase laboratory capacity;
- improve the capacity of health managers to respond to XDR-TB outbreaks;
- implement infection control precautions;
- increase research support for anti-drug development;
- increase research support for rapid diagnostic test development;
- promote universal access to antiretroviral drugs under joint TB-HIV activities.

The bacterium would have only had the opportunity to mutate and develop further resistances through improper application of existing measures to treat the disease. This could be either through poor monitoring, or through lack or resources.

Most alarming is that the 53 cases so far identified are just the confirmed cases. 'We have no surveillance systems at the moment, so we don't really know how many people are infected,' said Prof Willem Sturm, who identified the strain in KwaZulu-Natal.

The EU was instrumental in pushing for effective measures to prevent the spread of both SARS and avian flu, and these strategies could be adapted to halt the spread of XDR-TB.

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In addition, the EU' Sixth and seventh Framework Programmes (FP6) continues research into TB, and is active in running trials through the European Developing Countries Clinical Trials Partnership (EDCTP) scheme, which aims to increase the number of effective interventions that could be effective against TB. The development of a new antibiotic, Platensimycin, by Merck, Sharp and Dohme in the US may also offer an effective treatment, should it successfully make the transition to human clinical trials.