The New Profile of Drug-Resistant Tuberculosis in Russia A Global and Local Perspective: Summary of a Joint Workshop by the Institute of Medicine and the Russian Academy of Medical Science (2011) / Chapter Skim
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4 Transmission and Infection Control of Drug-Resistant TB
4 Transmission and Infection Control of Drug-Resistant TB
Pages 37-48
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From page 37... ...
• here appears to be less transmission of XDR TB, although some T clusters of XDR TB point to episodes of transmission. • rompt and effective treatment stops transmission, even among P patients who remain smear positive.
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From page 38... ...
In most parts of the world, however, new cases make up more than half of MDR TB incidence. In Shanghai, for example, from 2002 to 2006, 59 percent of the MDR TB cases were among new TB patients, indicating the transmission of drug resistance.
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From page 39... ...
The first documented case of XDR TB in South Africa was detected in 1997. In 2008 a study of about 700 MDR TB cases showed that 14 percent were pre-XDR -- that is, MDR with one of the markers for XDR -- and 6 percent were already XDR (Mlambo et al., 2008)
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From page 40... ...
More alarming, a single Beijing strain, the R220 sublineage, is responsible for 42 percent of the total drug resistance epidemic and has a doubling time of only 2.38 years. Furthermore, 90 percent of patients infected with MDR TB strains are smear positive, which indicates that they have the potential to spread these resistant strains rapidly.
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From page 41... ...
MDR TB is evolving into XDR TB in common strains in a number of places in South Africa. MDR TB in these settings is largely transmitted, whereas there is currently less transmission of XDR TB and more development of XDR TB from the large pool of MDR TB cases.
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From page 42... ...
"We are losing the battle against resistant TB," he suggested. And although transmission of XDR TB is relatively uncommon at present, Gey van Pittius believes that, given the rapid spread of MDR TB, XDR TB is likely to take hold among susceptible populations.
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From page 43... ...
In places such as Tomsk, data showing a downward trend in MDR TB are encouraging, said Nardell. Yet he also cited a study based on the hypothesis that an association between substance abuse and nonadherence increased MDR TB in Tomsk; however, the major driving factor behind MDR TB appeared instead to be hospitalization (Gelmanova et al., 2007)
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From page 44... ...
To prevent the transmission of TB, then, health care institutions need to take systemic and long-term measures based on prioritization of resources and analyses of transmission risks. Before 2002, the wards at the TB Dispensary in Vladimir Oblast had beds with no separation, neither active ventilation nor respirators were in use, and personnel had limited awareness of appropriate infection control measures.
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From page 45... ...
Among the infected guinea pigs from which spoligotypes could be obtained, all were infected by three patients later found to have had XDR TB and not to be on effective treat
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From page 46... ...
Even in TB hospitals, undiagnosed drug-resistant TB is transmitted during the months it takes to receive the results of drug susceptibility testing. And in MDR TB wards, the patients who will be spreading TB are the undiagnosed, unsuspected, untreated XDR TB patients.
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From page 47... ...
, a free online resource on MDR TB and TB transmission control. This website contains discussions on topics monitored by international experts and free guidelines and documents.
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