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      High Prevalence of Multidrug-Resistant Tuberculosis, Swaziland, 2009–2010

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          Abstract

          One third of previously treated patients had MDR TB.

          Abstract

          In Africa, although emergence of multidrug-resistant (MDR) tuberculosis (TB) represents a serious threat in countries severely affected by the HIV epidemic, most countries lack drug-resistant TB data. This finding was particularly true in the Kingdom of Swaziland, which has the world’s highest HIV and TB prevalences. Therefore, we conducted a national survey in 2009–2010 to measure prevalence of drug-resistant TB. Of 988 patients screened, 420 new case-patients and 420 previously treated case-patients met the study criteria. Among culture-positive patients, 15.3% new case-patients and 49.5% previously treated case-patients harbored drug-resistant strains. MDR TB prevalence was 7.7% and 33.8% among new case-patients and previously treated case-patients, respectively. HIV infection and past TB treatment were independently associated with MDR TB. The findings assert the need for wide-scale intervention in resource-limited contexts such as Swaziland, where diagnostic and treatment facilities and health personnel are lacking.

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          Effect of highly active antiretroviral therapy on incidence of tuberculosis in South Africa: a cohort study.

          Robin Wood, Douglas Wilson, Motasim Badri (2002)
          Studies of the effect of highly active antiretroviral therapy (HAART) on the risk of HIV-1-associated tuberculosis have had variable results. We set out to determine the effect of HAART on the risk of tuberculosis in South Africa. We compared the risk of tuberculosis in 264 patients who received HAART in phase III clinical trials and a prospective cohort of 770 non-HAART patients who were attending Somerset Hospital adult HIV clinic, University of Cape Town, between 1992 and 2001. Poisson regression models were fitted to determine risk of tuberculosis; patients were stratified by CD4 count, WHO clinical stage, and socioeconomic status. HAART was associated with a lower incidence of tuberculosis (2.4 vs 9.7 cases per 100 patient-years, adjusted rate ratio 0.19 [95% CI 0.9-0 38]; p<0.0001). This finding was apparent across all strata of socioeconomic status, baseline WHO stage, and CD4 count, except in patients with CD4 counts of more than 350 cells/microL. The number of tuberculosis cases averted by HAART was greatest in patients with WHO stage 3 or 4 (18.8 averted cases per 100 patient-years, adjusted rate ratio 0. 22 [0.09-0.41]; p=0.03) and in those with CD4 counts of less than 200 cells/microL (14.2 averted cases per 100 patient-years, adjusted rate ratio 0.18 [0.07-0.47]; p,0.0001). HAART reduced the incidence of HIV-1-associated tuberculosis by more than 80% (95% CI 62-91) in an area endemic with tuberculosis and HIV-1. The protective effect of HAART was greatest in symptomatic patients and those with advanced immune suppression.
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            Worldwide Occurrence of Beijing/W Strains of Mycobacterium tuberculosis: A Systematic Review

            Judith R Glynn, Jennifer Whiteley, Pablo J. Bifani … (2002)
            Strains of the Beijing/W genotype family of Mycobacterium tuberculosis have caused large outbreaks of tuberculosis, sometimes involving multidrug resistance. This genetically highly conserved family of M. tuberculosis strains predominates in some geographic areas. We have conducted a systematic review of the published reports on these strains to determine their worldwide distribution, spread, and association with drug resistance. Sixteen studies reported prevalence of Beijing strains defined by spoligotyping; another 10 used other definitions. Beijing strains were most prevalent in Asia but were found worldwide. Associations with drug resistance varied: in New York, Cuba, Estonia, and Vietnam, Beijing strains were strongly associated with drug resistance, but elsewhere the association was weak or absent. Although few reports have measured trends in prevalence, the ubiquity of the Beijing strains and their frequent association with outbreaks and drug resistance underline their importance.
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              Epidemiology of antituberculosis drug resistance 2002-07: an updated analysis of the Global Project on Anti-Tuberculosis Drug Resistance Surveillance.

              Abigail Wright, Matteo Zignol, Armand Van Deun … (2009)
              The Global Project on Anti-Tuberculosis Drug Resistance has been gathering data since 1994. This study provides the latest data on the extent of drug resistance worldwide. Data for drug susceptibility were gathered from 90 726 patients in 83 countries and territories between 2002 and 2007. Standardised collection of results enabled comparison both between and within countries. Where possible, data for HIV status and resistance to second-line drugs were also obtained. Laboratory data were quality assured by the Supranational Tuberculosis Reference Laboratory Network. The median prevalence of resistance to any drug in new cases of tuberculosis was 11.1% (IQR 7.0-22.3). The prevalence of multidrug resistance in new tuberculosis cases ranged from 0% in eight countries to 7% in two provinces in China, 11.1% in Northern Mariana Islands (although reporting only two cases), and between 6.8% and 22.3% in nine countries of the former Soviet Union, including 19.4% in Moldova and 22.3% in Baku, Azerbaijan (median for countries surveyed 1.6%, IQR 0.6-3.9). Trend analysis showed that between 1994 and 2007, the prevalence of multidrug-resistant (MDR) tuberculosis in new cases increased substantially in South Korea and in Tomsk Oblast and Orel Oblast, Russia, but was stable in Estonia and Latvia. The prevalence of MDR tuberculosis in all tuberculosis cases decreased in Hong Kong and the USA. 37 countries and territories reported representative data on extensively drug-resistant (XDR) tuberculosis. Five countries, all from the former Soviet Union, reported 25 cases or more of XDR tuberculosis each, with prevalence among MDR-tuberculosis cases ranging between 6.6% and 23.7%. MDR tuberculosis remains a threat to tuberculosis control in provinces in China and countries of the former Soviet Union. Data on drug resistance are unavailable in many countries, especially in Africa, emphasising the need to develop easier methods for surveillance of resistance in tuberculosis. Global Project: United States Agency for International Development and Eli Lilly and Company. Drug resistance surveys: national tuberculosis programmes, the Government of the Netherlands, the Global Fund to Fight AIDS, Tuberculosis and Malaria, Japan International Cooperation Agency, and Kreditanstalt für Wiederaufbau.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Emerg Infect Dis
                Journal ID (publisher-id): EID
                Title: Emerging Infectious Diseases
                Publisher: Centers for Disease Control and Prevention
                ISSN (Print): 1080-6040
                ISSN (Electronic): 1080-6059
                Publication date (Print): January 2012
                Volume: 18
                Issue: 1
                Pages: 29-37
                Affiliations
                [1]Epicentre, Paris, France (E. Sanchez-Padilla, A. Ascorra, M. Bonnet);
                [2]National Tuberculosis Control Programme, Mbabane, Swaziland (T. Dlamini);
                [3]National Reference Center for Mycobacteria, Borstel, Germany (S. Rüsch-Gerdes, E. Richter);
                [4]Médecins Sans Frontières, Geneva, Switzerland (Z.D. Tefera, P. Calain, R. de la Tour, F. Jochims)
                Author notes
                Address for correspondence: Elisabeth Sanchez-Padilla, Epicentre, 8 Rue St. Sabin, 75011 Paris, France; email: elisabeth.sanchez@ 123456epicentre.msf.org
                Article
                Publisher ID: 11-0850
                DOI: 10.3201/eid1801.110850
                PMC ID: 3310109
                PubMed ID: 22260950
                SO-VID: 6c749461-9130-4b00-82d5-c306bb7f1ea7
                History
                Categories
                Subject: Research
                Subject: Research

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: cross-sectional studies,tb,mycobacterium tuberculosis,antimicrobial resistance,bacteria,swaziland,africa,tuberculosis,drug resistance,hiv,mdr,multidrug resistance
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: cross-sectional studies, tb, mycobacterium tuberculosis, antimicrobial resistance, bacteria, swaziland, africa, tuberculosis, drug resistance, hiv, mdr, multidrug resistance

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