spread of virulent tuberculosis
By using a combination of inexpensive infection-control measures, hospitals around
the world could prevent half of the new cases of extensively drug resistant tuberculosis
(XDR TB), according to a new study in The Lancet by researchers at Yale School
of Medicine. — By Karen Peart
T H I S
SCHOOL OF MEDICINE NEWS
Dubbed “Ebola with Wings” for its ability to spread and kill rapidly,
XDR TB has been reported in 37 countries and has been identified in all regions
of the world, including the United States.
The disease has become an epidemic among hospitalized patients in South Africa,
according to the Yale researchers. Cases of XDR TB have been diagnosed in every
province of South Africa and are particularly concentrated in the area surrounding
Tugela Ferry. The Yale study provides the first estimates of the spread of XDR
TB in South Africa.
To assess the spread of XDR TB, a Yale research team led by M.D./Ph.D. student
Sanjay Basu developed a computer model of a virtual world that incorporated over
two years of data from Tugela Ferry. The model was 95% accurate at predicting
the trends in XDR and other forms of TB in the region. According to the model,
over 1,300 cases of XDR TB could arise in the Tugela Ferry region by the end
of 2012.
“It is critically important to take steps now to prevent further spread
of XDR TB,” says Basu. “If we wait to act, this form of TB will spread
further in the community and beyond borders. When a drug-resistant strain hit
New York in the 1990s, it cost over $1 billion to bring under control.”
Tuberculosis is caused by bacteria that target the lungs, and it is spread through
the air when an infected person coughs or sneezes. HIV-positive people constitute
a vast majority of the XDR TB cases, given their greater risk of infection.
The authors write that the best way to address this type of TB effectively is
to change the healthcare environment. Use of masks alone would prevent fewer
than 10% of cases in the general epidemic, though they would help many healthcare
workers, say the researchers. Reducing time spent in the hospital and shifting
to outpatient therapy could prevent nearly one-third of cases, they note. About
half of XDR TB cases could be prevented by addressing hospital overcrowding,
improving ventilation, enhancing access to HIV treatment and providing faster
diagnostic tests, say the study authors.
Basu notes that the problem is compounded in South Africa where there are long
waiting lists of up to 70 patients hoping to gain admission to hospitals, and
crowded wards with as many as 40 people packed into one room. Some of these patients
have to sleep on the floor, and many travel for days to reach the hospital.
“We can do a lot to change what is going on,” says senior author
Dr. Gerald Friedland, a professor of medicine at Yale. “This is a train
crash between the two epidemics of HIV and TB, and we have to address both problems
together to fix this situation.”
Other authors on the study included Jason R. Andrews, Eric M. Poolman, Neel R.
Gandhi, N. Sarita Shah, Anthony Moll, Preshnie Moodley and Alison P. Galvani.
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