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Sun 1 Apr 2007 02:08 PM

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WHO seeks global action as XDR-TB cases rise

Infection control is failing, say experts, as deadly strain spreads west to developed countries.

The World Health Organisation (WHO) has called for urgent action on multidrug resistant (MDR) tuberculosis, after documented cases of extremely drug resistant tuberculosis (XDR-TB) were found in Europe, Canada and the United States.

"This is the most urgent thing I have seen in my 15 years of working on tuberculosis," said Mario Raviglione, director of the STOP TB program at the World Health Organisation. "If it keeps spreading, as in South Africa, then we are really in trouble."

The current XDR-TB definition is MDR plus resistance to fluoroquinolones and one or more of the injectable TB drugs; namely amikacin, kanamycin and capreomycin.

XDR-TB has been widely seen in Africa, where the country's large AIDS population is at particular risk from the strain. The emergence of the disease in developed countries reflects "the failure of infection control - one of the most pressing issues we are facing at the moment," according to Dr Karin Weyer of the South African Medical Resource Council. South Africa currently has about 5 million cases of TB, with 400,000 new cases, 10,000 of which are MDR, Weyer said. XDR-TB "has now been confirmed in all nine provinces," with a very high mortality rate among those coinfected with HIV.

Raviglione urged global action to halt the spread of the strain, appealing to developed countries to improve TB diagnosis and treatment.

"We have a clear plan on how to control XDR-TB, but countries are moving far too slowly on implementing this plan," he said. "Funding is an issue as well, and beyond that, research to identify new diagnostics, drugs and vaccines is more vital than ever."

To date, XDR-TB has been confirmed in 28 countries including 8 in Europe, up from 17 countries in March 2006, said Dr Paul Nunn, coordinator of WHO's TB/HIV and Drug Resistance programme.

Although definitive numbers of XDR-TB cases are not available, the major concentrations are estimated to be in countries with the highest rates of MDR infection, Nunn said. He added that the evidence suggests the increase of XDR-TB reflects similar resistance patterns arising in various regions, due to comparable poor infection control measures, rather than the spread of resistant strains.

Nunn estimates that at least US $42 million will be needed to set up global and regional coordination planning and technical support - and $604 million will be needed to scale up diagnosis and treatment of XDR-TB.

Emergence of XDR-TB is a "wake-up call for both strengthening basic TB and HIV care, prevention and control, and scaling up the management of drug-resistant TB," Nunn concluded.

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