Public Health Alert: Drug Resistant TB

TUBERCULOSIS, DRUG RESISTANCE - MARSHALL ISLANDS: REQUEST FOR INFORMATION
*************************************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


Date: Sat 30 Jan 2010
Source: Top News [edited]



A public health emergency has been declared in Marshall Islands. This
has happened following an outbreak of drug-resistant tuberculosis
(TB). The government is thinking of calling upon special powers of quarantine.

In less than 2 months the number of people with the drug-resistant
disease has risen from 6 to 10 in the western Pacific nation.
Everyone now fears that the situation would escalate and will reach
to 500. Majuro Hospital chief of staff Marie Lanwi-Paul, said, "We
are in the process of doubling the bed capacity" in the TB isolation unit."

Rachel Powel who is working with the World Health Organisation said,
"Drug resistance poses a serious threat to our ability to treat and
control TB." Marshall Islands Health Minister Amenta Matthew said she
was in the process of forming legislation that would give power to
the director of health to quarantine people who were not complying
with TB prevention requirements. Matthew felt that the drug-resistant
TB evolved because of people not following advice of taking medicines
despite physicians counseling them. It was reported that one patient
was taken to the court by health authorities for failing to take
treatment and remain in isolation.

[Byline: Anjali Singh]

--
Communicated by:
M. Randolph Kruger


[It is stated in the news release that the outbreak of drug resistant
TB in the Marshall Islands is secondary to improper management of the
TB cases, i.e., the TB drugs were not taken by patients as
recommended by the physicians. However, the exact drugs to which the
_Mycobacterium tuberculosis_ isolates are resistant and the extent of
the drug resistance is not specified in the above news release. Also
it is not specified if there is any epidemiological linkage among the
patients, if the isolates have similar drug resistance patterns, or
if they have been genotyped. Detailed discussions of drug-resistant
TB can be found in prior ProMED posts below.

The Marshall Islands is an island nation with a population of about
62 000 in the middle of the Pacific Ocean, just west of the
International Date Line and just north of the Equator
(). From 1946 to 1958,
the USA tested 67 nuclear weapons in the Marshall Islands.
Independence was completed in 1990, when the UN officially ended its
Trusteeship status. In 1986, the Compact of Free Association with the
USA provides for aid and USA defense of the islands in exchange for
continued USA military use of a missile testing range
(). The location of the
Marshall Islands in relation to other countries in the South Pacific
can be found on a map at
. - Mod.ML]

[see also:
2009
----
Tuberculosis, XXDR - USA: FL ex Peru 20091230.4387
Tuberculosis, MDR - China 20090114.0151
2008
---
Tuberculosis, XDR - Austria ex Romania 20080803.2373
Tuberculosis, MDR, XDR - Peru 20080412.1337
Tuberculosis, XDR - Namibia 20080403.1231
Tuberculosis, XDR - UK (Scotland) ex Somalia 20080322.1094
Tuberculosis, MDR, XDR - Worldwide: WHO 20080228.0813
Tuberculosis, MDR - South Africa 20080208.0521
Tuberculosis, MDR - Papua New Guinea 20080206.0478
Tuberculosis, XDR - Botswana, South Africa 20080118.0222
2007
----
Tuberculosis, XDR, MDR: genome sequences 20071122.3780
Tuberculosis - Uganda (02): MDR, susp. RFI 20071004.3284
Tuberculosis - Uganda: deadly strain, RFI 20071002.3255
Tuberculosis, XDR - South Africa (11): fugitives 20071002.3251
Tuberculosis, XDR - South Africa (10): Western Cape 20070627.2071
Tuberculosis, XDR - worldwide (02) 20070623.2034
Tuberculosis, XDR - South Africa (09): Western Cape 20070604.1805
Tuberculosis, XDR, airplane exposure - multicountry (03) 20070601.1778
Tuberculosis, XDR, airplane exposure - multicountry (USA, France,
Canada, Czech Rep.) 20070529.1738
Tuberculosis, XDR - South Africa (08): Western Cape 20070425.1349
Tuberculosis, XDR, 2003-2006 - Europe (Germany, Italy) 20070403.1132
Tuberculosis, XDR - South Africa (07): Eastern Cape 20070326.1044
Tuberculosis, XDR, 1993-2006 - USA 20070322.1005
Tuberculosis, XDR - South Africa (06) 20070319.0959
Tuberculosis, XDR, 1991-2003 - Spain 20070302.0738
Tuberculosis, XDR - South Africa (05) 20070228.0717
Tuberculosis, XDR - South Africa (04) 20070220.0638
Tuberculosis, XDR - South Africa (03) 20070209.0504
Tuberculosis, XDR - worldwide 20070205.0456
Tuberculosis, XDR - South Africa (02) 20070128.0375
Tuberculosis, XDR - South Africa: interventions 20070126.0349]
............................................ml/ejp/dk

*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Become a ProMED-mail Premium Subscriber at

************************************************************
Visit ProMED-mail's web site at .
Send all items for posting to: promed@promedmail.org
(NOT to an individual moderator). If you do not give your
full name and affiliation, it may not be posted. Send
commands to subscribe/unsubscribe, get archives, help,
etc. to: majordomo@promedmail.org. For assistance from a
human being send mail to: owner-promed@promedmail.org.
############################################################
############################################################