Quarantine Sought For Harsh TB Strain

People infected with a deadly, virtually untreatable new form of tuberculosis should be isolated and confined -- against their will, if necessary -- to prevent a "potentially explosive international health crisis," according to a group of Canadian and African scientists.

These harsh measures are justified given the "extreme risk" posed by an ongoing outbreak of extensively drug-resistant TB (XDR-TB) in South Africa, they argue in today's edition of the medical journal Public Library of Science Medicine.

"We're not saying put people in leper colonies," Ross Upshur, director of the University of Toronto Joint Centre for Bioethics and co-author of the paper, said in an interview. "But if voluntary measures fail, we need systems in place to contain the spread."

Dr. Upshur said the call for draconian restrictions on the movements of people infected with XDR-TB is not made lightly -- it reflects the severity of the outbreak.

He also stressed that people who are isolated or detained should be compensated, to ensure they do not remain in the community and spread the illness to others.

"Right now, all the incentives are the wrong way," Dr. Upshur said, noting that when patients are in hospital in South Africa, they lose their social-welfare benefits.

TB is one of the oldest scourges known to humanity, and one-third of the world's population is believed to be infected. It is caused by a bacterium called Mycobacterium tuberculosis, which is spread through coughing or sneezing.

The disease can be easily cured with cheap antibiotics, but misuse has resulted in mutations that have rendered the drugs ineffective and made resistant TB a growing public health challenge.

Last September, the United Nations World Health Organization said there were 53 cases of XDR-TB in South Africa, of which 52 proved fatal, an unprecedented rate.

In total, more than 300 cases of XDR-TB have been identified, including one case in Canada. People infected with HIV-AIDS are particularly susceptible because of their depressed immune systems, heightening the risk of rapid spread throughout AIDS-ravaged Africa.

"This is a very, very bad situation," said Nesri Padayatchi, deputy director of the Durban-based Centre for the AIDS Program of Research in South Africa. "We're not even sure XDR-TB can be treated, but we are sure that it is spreading."

Jerome Amir Singh, a human-rights lawyer at CAPRISA and a co-author of the journal paper, said what is being proposed are the same measures as public-health officials took in Canada to contain severe acute respiratory syndrome. During the outbreak in Toronto, 30,000 people were quarantined, including 27 who were confined to their homes by court order.

"Like SARS, stringent measures need to be put in place to contain the outbreak," Mr. Singh said.

The WHO said last year that XDR-TB poses as serious a threat to global health as either SARS or bird flu. But officials have stopped short of endorsing forcible confinement.

Dr. Upshur said he understands the proposals will make people uncomfortable, but the alternative is just as unpalatable.

"Restricting freedoms is serious but so is letting the disease spread," he said. "The failure to act would have as many consequences as acting, so this is truly a dilemma."

Source: Bio-Bio Technology
SRI