Drug-Resistant TB Spreads: Homeless & Prisoners' Risk High,

Tom Boland (wgcp@earthlink.net)
Fri, 29 Oct 1999 20:32:28 -0700 (PDT)

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Depriving, warehousing and criminalizing the poor carries a cost in public
health for everyone worldwide.  See below for a related article:

FWD  Reuters News Service - 05:58 p.m Oct 28, 1999 Eastern


     By Grant McCool

NEW YORK, Oct 28 (Reuters) - Six years after health officials declared
tuberculosis a global crisis, deadly strains that are resistant to various
drugs are spreading faster than anticipated, Harvard Medical School
researchers said on Thursday.

In a report released in New York entitled, ``The Global Impact of Drug
Resistant Tuberculosis,'' doctors said the phenomenon was a ``man-made
problem'' unknown five decades ago. They said ``multidrug-resistant
tuberculosis'' has been reported in 104 countries -- mostly in the
developing world but threatening to spread to Western Europe and North

``There is debate about quantifying infectiousness but there are a number
of experiences now from airplanes so that someone with active pulmonary
tuberculosis on an airplane can readily infect other passengers,'' the
report's primary author, Dr Paul Farmer, said at a news conference.

``As some of my colleagues have noted, upgrading yourself to first class
will not necessarily protect you.''

In 1993, the World Health Organisation (WHO) warned the world that the
airborne bacteria that can afflict almost any tissue in the body but
especially the lungs, was a global emergency. The disease infects about
eight million people worldwide a year and kills up to two million.

``The rapid rise of multidrug-resistant tuberculosis is a public-health
catastrophe of the first order,'' Farmer said ``The rapid rise of
multidrug-resistant tuberculosis is a public-health catastrophe of the
first order,'' Farmer said in a statement accompanying the report. ``When
patients stop taking or don't take enough of the right medications, they
develop resistance to the drugs, and then spread new drug-resistant strains
of the bacteria.''

The Harvard doctors recommended that health agencies immediately carry out
WHO's Directly Observed Therapy Shortcourse (DOTS) to all tuberculosis
patients and urged a more intensive treatment called DOTS-Plus in areas
where the bacteria resistant to drugs is already prevalent.

In August, researchers from the U.S. Centres for Disease Control and
Prevention said that even DOTS, the best-known strategy for treating TB --
making patients take a cocktail of drugs and watching them swallow them --
had failed to stop an epidemic in one Russian district. The researchers
said cases of multidrug-resistant TB even rose during their experiment.

Those with the drug-resistant form were more likely to have been homeless.

The DOTS-Plus regimen recommended in Thursday's report requires patients to
take more drugs over a longer period of time.

The intensified treatment was successful in New York City during the early
90s and for the past three years in Peru, said Farmer, professor of the
Harvard Medical School's Infectious Disease and Social Change programme. He
also said the treatment was cheaper per patient in the South American

Harvard's study was financed by the New York-based Open Society Institute,
a foundation backed by international financier George Soros. It stemmed
from the Institute's assistance to Russian prisoners, who are among the
highest carriers with some 100,000 diagnosed with active TB.

Researchers said that without at least $1 billion in new funding for
tuberculosis treatment, strains of the bacteria resistant to drugs ``will
spread to all corners of the earth.'' The development of new drugs was also
needed, they said.

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