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4 Preventing Transmission of Drug-Resistant TB
4 Preventing Transmission of Drug-Resistant TB
Pages 49-58
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From page 49... ...
• nsuspected TB and MDR TB patients are the groups most likely U to transmit infection to others. If DST could be completed quickly and early, patients could be treated immediately and transmission of disease reduced.
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From page 50... ...
Presentations on this topic addressed some of the steps India is taking to prevent transmission of MDR TB, the potential for drug-resistant TB to spread both in health care institutions and in the community, the evolutionary forces that shape fitness in M.tb., and the contributions molecular epidemiology can make to understanding the spread of drug-resistant TB. INDIA'S PROGRAM EFFORTS TO PREVENT TRANSMISSION OF DRUG-RESISTANT TB1 India's program efforts to prevent transmission of drug-resistant TB include the development of infection control guidelines, strengthening of laboratory capacity, and rational use of anti-TB drugs.
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From page 51... ...
The translation of the pilot to practice will involve follow-up assessments, revision of national guidelines based on the feasibility and effectiveness of the measures implemented, integration of infection control into hospital accreditation and routine health system reporting, and integrated infection control training materials for front-line health care workers. Strengthening of Laboratory Capacity Four national reference laboratories -- the National Institute for Research in Tuberculosis, Chennai; the National Tuberculosis Institute in Bangalore; the LRS Institute in New Delhi; and the Central Jalma Institute for Leprosy and Other Mycobacterial Diseases in Agra -- are working closely with intermediate reference laboratories, medical college laboratories, and private laboratories.
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From page 52... ...
For that reason, treating MDR TB cases in hospitals can be a risk factor for transmission, and minimizing the time patients are in hospitals is desirable, said Edward Nardell, Harvard Medical School. Community-based MDR TB treatment programs, which now exist in many parts of the world (e.g., Cambodia, Ethiopia, Haiti, Lesotho, Pakistan, Peru [Shin et al., 2004]
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From page 53... ...
With sputum cultures, in contrast, there is no evaporation, and growth support is optimized. A recent similar study from Peru found that almost all the transmission that occurred on a TB ward was due to 9 unsuspected and inadequately treated MDR TB patients among 97 HIV-positive pulmonary TB patients, to whom 292 guinea pigs were exposed over 505 days (Escombe et al., 2008)
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From page 54... ...
It may be that XDR TB requires prolonged isolation while the patient is still coughing. Nardell noted that XDR TB patients are a far smaller group of patients to isolate than all TB and MDR TB patients, who can be treated safely in the community.
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From page 55... ...
When drug-resistant strains from TB patients were compared with drug-susceptible counterparts from the same patients, however, at least some of the drug-resistant strains showed no fitness loss. The authors hypothesized that the clinical strains had undergone additional mutations over time that compensated for the initial fitness cost.
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From page 56... ...
THE MOLECULAR EPIDEMIOLOGY OF M.tb.7 According to S Siva Kumar, Technical Research Assistant, National Institute for Research in Tuberculosis, molecular epidemiological studies are essential to efforts to curtail the epidemic of TB and MDR TB.
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From page 57... ...
Understanding these rates of recurrence and reinfection is essential to preventing the spread of MDR TB, said Siva Kumar. POTENTIAL INNOVATIONS AND ACTION ITEMS Through the presentations provided in this session and the subsequent discussions, individual workshop speakers and participants noted key innovations and action items.
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