Urgent need for stringent TB screening policies among South African healthcare workers

Healthcare workers in South Africa are at a significantly increased risk of developing drug-resistant tuberculosis, or XDR-TB, in a trend which threatens to further exacerbate the already beleaguered healthcare systems in sub-Saharan countries, according to results of a new study.

Researchers say the results underscore the urgent need for stringent TB screening policies among healthcare workers in these areas.

Keertan Dheda, M.D., Ph.D., Associate Professor of Medicine at the University of Cape Town in South Africa, and collaborators, Julie Jarand, M.D. from University of Calgary and Max O'Donnell, M.D. from the Boston University, will present their findings at the 105th American Thoracic Society International Conference in San Diego on Sunday, May 17.

XDR-TB is a potentially untreatable strain of tuberculosis that is resistant to all major primary and secondary anti-tuberculosis drugs. This retrospective study is the first to focus on healthcare workers who have contracted XDR-TB in a non-outbreak setting, said Dr. Dheda.

"The purpose of this study was to describe a series of healthcare workers in South Africa with extensively drug-resistant tuberculosis and to determine whether XDR-TB was prevalent among them," Dr. Dheda noted.

The study was based on a chart review of 270 patients in South Africa with passively detected XDR-TB, including 11 healthcare workers. Of those 11, eight were working in district hospitals, 10 had been treated for TB at least once previously and eight were negative for HIV. At the time these workers were diagnosed with XDR-TB, there were no standard infection control measures in place at the facilities where they were employed. In separate presentations Dr. O'Donnell and Dr. Dheda will present their findings from Kwa-Zulu Natal and four treatment centers in South Africa, respectively.

Dr. Dheda noted that although tuberculosis is a well-recognized occupational risk for healthcare workers in both low- and high-income countries, the prevalence and natural history of XDR-TB in these workers is unknown.

"The emergence and progression of XDR-TB is threatening to destabilize global tuberculosis control," he said. "The negative impact of XDR-TB is further exacerbated by a global shortage of healthcare workers, a shortage which has reached crisis levels in most of sub-Saharan Africa."

"XDR-TB is an important risk for healthcare workers globally, particularly for those who work or travel to high-burden areas, regardless of HIV status," Dr. Dheda added. "Implementation of infection control measures and rapid diagnostic testing for all healthcare workers suspected of TB needs to be undertaken urgently to minimize the risk of drug-resistant TB."