South Africa should forcibly isolate patients infected with a deadly strain of TB to stop the disease spreading on the HIV-hit continent, experts say.
South Africa should forcibly isolate patients infected with a deadly strain of TB to stop the disease spreading on the HIV-hit continent, experts say.
South Africa's outbreak of the multi drug-resistant XDR-TB has killed at least 74 people in the past few months.
South Africa's outbreak of the multi drug-resistant XDR-TB has killed at least 74 people in the past few months.
Writing in the PLoS Medicine journal, the ethicists and HIV experts said the outbreak represented a "major threat"
Writing in the PLoS Medicine journal, the ethicists and HIV experts said the outbreak represented a "major threat"
They said it may force authorities to override personal rights for the greater good.
They said it may force authorities to override personal rights for the greater good.
Ultimately in such crises, the interests of public health must prevail over the rights of the individual Jerome Singh, of the Centre for Aids Programme of Research
Ultimately in such crises, the interests of public health must prevail over the rights of the individual Jerome Singh, of the Centre for Aids Programme of Research
Jerome Singh, a lawyer at the Centre for the Aids Programme of Research in Durban, South Africa, said: "XDR-TB represents a major threat to public health. If the only way to manage it is to forcibly confine then it needs to be done.
Jerome Singh, a lawyer at the Centre for the Aids Programme of Research in Durban, South Africa, said: "XDR-TB represents a major threat to public health. If the only way to manage it is to forcibly confine then it needs to be done.
"Ultimately in such crises, the interests of public health must prevail over the rights of the individual."
"Ultimately in such crises, the interests of public health must prevail over the rights of the individual."
TB, an airborne bacillus spread through coughing or sneezing, can usually be cured through treatment.
TB, an airborne bacillus spread through coughing or sneezing, can usually be cured through treatment.
However, the XDR-TB strain may have mutated when patients skipped treatment or were dispensed inadequate antibiotic cocktails.
However, the XDR-TB strain may have mutated when patients skipped treatment or were dispensed inadequate antibiotic cocktails.
The study, co-authored by the Aids programme and the University of Toronto's Joint Centre for Bioethics, said South Africa has logged almost 400 cases of XDR-TB, which is virtually impervious to treatment by most common TB drugs, and an unprecedented 30 new cases are diagnosed every month.
The study, co-authored by the Aids programme and the University of Toronto's Joint Centre for Bioethics, said South Africa has logged almost 400 cases of XDR-TB, which is virtually impervious to treatment by most common TB drugs, and an unprecedented 30 new cases are diagnosed every month.
At present, it has killed 98% of those infected within about two weeks.
At present, it has killed 98% of those infected within about two weeks.
The outbreak has alarmed medical experts who say XDR-TB poses a particular danger to HIV-positive people whose immune systems are already severely compromised by the AIDS virus.
The outbreak has alarmed medical experts who say XDR-TB poses a particular danger to HIV-positive people whose immune systems are already severely compromised by the AIDS virus.
South Africa has one of the highest HIV rates in the world with about 5.5m people infected in a population of 45m.
South Africa has one of the highest HIV rates in the world with about 5.5m people infected in a population of 45m.
Most of those who died of XDR-TB have tested positive for HIV.
Most of those who died of XDR-TB have tested positive for HIV.
Mr Singh said South Africa's highly mobile workforce, rising overseas tourism, and the prevalence of XDR-TB in Johannesburg, the main transportation hub, increases the chance of XDR-TB spreading past national borders and into other African countries struggling with high HIV/AIDS infection rates.
Mr Singh said South Africa's highly mobile workforce, rising overseas tourism, and the prevalence of XDR-TB in Johannesburg, the main transportation hub, increases the chance of XDR-TB spreading past national borders and into other African countries struggling with high HIV/AIDS infection rates.
Duty
Duty
And he added it was the public's duty to press the government into opening the debate.
And he added it was the public's duty to press the government into opening the debate.
In South Africa, XDR-TB patients may visit hospitals as out-patients and then go home, which means they can easily pass the disease in their community.
In South Africa, XDR-TB patients may visit hospitals as out-patients and then go home, which means they can easily pass the disease in their community.
However, the experts said the challenge to control XDR-TB requires not just policy changes but also more state spending.
However, the experts said the challenge to control XDR-TB requires not just policy changes but also more state spending.
Mr Singh said long-term hospital stays increase the national health-care tab and burden overstretched clinics particularly in rural areas with heavy patient loads, adding hospitalized XDR-TB patients should automatically qualify for a social grant.
Mr Singh said long-term hospital stays increase the national health-care tab and burden overstretched clinics particularly in rural areas with heavy patient loads, adding hospitalized XDR-TB patients should automatically qualify for a social grant.
The World Health Organization has called for the world to prioritise XDR-TB on par with bird flu and recommended governments in impoverished sub-Saharan Africa develop one strategy to deal with the twin challenges of HIV and TB.
The World Health Organization has called for the world to prioritise XDR-TB on par with bird flu and recommended governments in impoverished sub-Saharan Africa develop one strategy to deal with the twin challenges of HIV and TB.
South Africa's health department said it had discussed the possibility of enforced isolation with the World Health Organization, but had not yet reached a conclusion.
South Africa's health department said it had discussed the possibility of enforced isolation with the World Health Organization, but had not yet reached a conclusion.
Is it right to forcibly isolate XDR-TB patients or are a person's human rights more important than the threat to public health? Send your views using the form below and if you would like to take part in our global phone-in programme World Have Your Say at 1800GMT today please include your phone number. It will not appear online.
