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South Africa must use tough isolation measures to stop drug-resistant tuberculosis from turning into an epidemic, say doctors and medical ethicists.

The authors of a report, published in PLoS Medicine yesterday (22 January), say there is no time for government complacency and doctor uncertainty over forcibly isolating patients.

"Ultimately in such crises, the interests of public health must prevail over the rights of the individual," write Jerome Amir Singh of the Centre for the AIDS Programme of Research in South Africa (CAPRISA) and colleagues.

They argue that extensively drug resistant tuberculosis (XDR-TB) and multi-drug resistant tuberculosis should be given priority over HIV/AIDS in terms of hospital resources. XDR-TB is an airborne disease, so its transmission and progression is easier and quicker than HIV.  

The authors warn that XDR-TB could derail global efforts to contain HIV/AIDS and become the world's most serious threat to public health, if allowed to spread.

They call for humane isolation, enforced if necessary, of carriers of the disease, and for the international community to be vigilant in monitoring the health department's response to the crisis. 

Over 400 cases of XDR-TB have been reported in South Africa to date, with at least 30 new cases detected each month in KwaZulu-Natal alone. 

An outbreak in the rural province last year killed all but one of 53 patients identified,  44 of whom were HIV positive.

According to the report, South Africa urgently needs to fast track diagnostic tests, expand surveillance of XDR-TB, address inadequate infection control in institutions and rethink counseling, treatment, reporting and tracing strategies.

Singh told SciDev.Net that public health officials had become "paralysed" over questions of human rights and ethics. 

"There is no time to dither over this highly contagious disease. We are ethically and legally justified in isolating patients with XDR-TB who refuse to remain in hospital and comply with treatment." But enforced isolation was, he added, a last resort.

Nesri Padayatchi, also of CAPRISA, said hospital beds urgently needed to be freed for XDR-TB patients. She said poorly implemented tuberculosis control programmes were the cause of XDR-TB and the government "must take responsibility".

Link to full paper in PLoS Medicine

Reference: PLoS Medicine doi:10.1371/journal.pmed.0040050