Possibility of quarantine measures to counter XDR TB

South Africa's government is deeply concerned after warnings by medical experts that an outbreak of extremely drug resistant tuberculosis (XDR TB) may have a severe impact on mortality in a country where health professionals are struggling to stem the tide of HIV/AIDS.

The new and virulent third-generation strain of TB is reported to have claimed lives of 52 people in KwaZulu-Natal Province, all of whom were confirmed to be co-infected with XDR TB and HIV.

XDR-TB's ability to kill people with HIV - usually within 16 days of being diagnosed - has also forced some members of the medical fraternity to consider quarantining as a preventative measure.

Prof Mary Edginton, of the medical school at the University of the Witwatersrand, in Johannesburg, told PlusNews that in light of the risk posed to the general public, urgent attention had to be paid to public health laws allowing people with the disease to be isolated.

"As it stands, individuals are protected under the [country's] constitution and have the right to opt out of treatment or discharge themselves from healthcare facilities ... but there needs to be a balance between public interest and individual rights in the presence of extremely contagious outbreaks, such as XDR TB," she pointed out.

Citing the use of similar laws in the United States to "incarcerate and forcibly treat" TB patients when it is considered to be in the public interest, Edginton said South Africa had similar legislation, but it did not seem to have been enforced for many years, possibly due to concerns that it was in conflict with the constitution.

However, the individual rights stipulated in the constitution were overruled on Wednesday after health officials confirmed a case of the new TB strain in Johannesburg, the country's economic hub.

An infected woman had refused to stay in hospital, stoking fears that XDR TB could spread rapidly through the city's population of over four million.

"In view of the serious public health implications, urgent steps have been taken to contain the situation.

While we recognise the rights of any patient to refuse hospital treatment, where there is a serious risk to public health, [we] have evoked Section 7 of the National Health Act, which limits the individual's rights in order to protect the public," a provincial health department statement read.

Although welcoming efforts by the government to bring the situation under control, Anita Kleinsmidt, a lecturer in medical law and bio-ethics the University of the Witwatersrand, told PlusNews: "While the Limitation of Rights Act dictates that the individual need could be superseded by that of public need, where an individual is deemed to be a public health risk, quarantining is only advised where it is a guaranteed to achieve its purpose."

The government recently met with international and regional medical experts to discuss ways of tackling the virtually untreatable TB strain, and announced that it could start distributing drugs to help treat the deadly pulmonary infection as early as next week.

Stavros Nicolaou, a senior executive of local pharmaceutical company Aspen Pharmacare, said they were "working together with the government in fast tracking the process of registration of Capreomycin with the Medical Control Council, and also for Para Amino Salicylic Acid" when they were able to import it from Hungary.

Although there was no guarantee that these drugs would be effective, Nicolaou was confident that they would increase the treatment options available to people infected with TB in South Africa.

The government said it was working around the clock to monitor the outbreak and patients would have to be closely observed over the next few months to assess the ability of the drugs to treat XDR TB.