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Published Date: 2013-05-24 16:46:43
Subject: PRO/EDR> Tuberculosis - Australia (02): (QL) ex Papua New Guinea, XDR, fatal, RFI
Archive Number: 20130524.1735824

TUBERCULOSIS - AUSTRALIA (02): (QUEENSLAND) ex PAPUA NEW GUINEA, XDR, FATAL, REQUEST FOR INFORMATION
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Date: Fri 24 May 2013
Source: ABC News [edited]
http://www.abc.net.au/news/2013-05-24/hunt-continues-for-people-exposed-to-drug-resistant-tb/4711180?section=qld


Queensland Health is still searching for people in the state's far north who may have been exposed to an [extensively] multi-drug resistant (XMDR) strain of tuberculosis (TB).

Last month [April 2013], a woman died in Cairns Base Hospital while being treated for TB. Chief health officer Jeannette Young says anyone who was in contact with the woman for more than 8 hours is being screened.

"The last number I got was something like 60 or so out of the 70-80 or so people, because as we go and contact-trace people, then they give us information about other people, so the number slowly gets bigger," she said.

[Byline: Ashleigh Stevenson]

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[The news report above concerns the tracing of contracts of a 20-year-old woman from Papua New Guinea (PNG) who had been hospitalized in Queensland in an isolation ward since May 2012 and who died on 14 Mar 2013 in Cairns Base Hospital with XDR-TB (extensively drug resistant TB). She was said to be part of an ongoing TB epidemic in PNG on Daru Island, capital of PNG's Western Province that is located just north of the Torres Strait and Cape York Peninsula (Far North Queensland) at the tip of the state of Queensland, Australia. ProMED-mail previously posted news reports on this case in 2012 and 2013 (Tuberculosis - Australia: (QL) ex Papua New Guinea 20121020.1355085 and Tuberculosis - Australia: (QL) ex Papua New Guinea, XDR, fatal 20130318.1591289). The news report, however, fails to say whether any of the patient's approximately 60 contacts was thought to have developed latent or clinically active TB and if found, how the infection was managed.

The following has been mostly extracted from moderator ML's comments in a prior ProMED-mail post, Tuberculosis - Australia: (QL) ex Papua New Guinea, XDR, fatal 20130318.1591289:

Papua New Guinea (PNG), which gained its independence from Australia in 1975, is called officially the Independent State of Papua New Guinea. It occupies the eastern half of the island of New Guinea and numerous offshore islands. (The 2 Indonesian provinces of Papua and West Papua occupy the western portion of the island of New Guinea). The majority of the PNG's population of about 6.3 million lives in traditional societies and practices subsistence-based agriculture (see http://en.wikipedia.org/wiki/Papua_New_Guinea).

The Torres Strait Islands, which Australia officially annexed in 1879, are situated in the Torres Strait between the far northern mainland Australia (Queensland) and PNG (http://www.abc.net.au/ra/pacific/places/country/torres_strait_islands.htm). The Torres Strait Islands Treaty signed by Australia and PNG allows for free movement of people (without passports or visas) between the Torres Strait Islands and PNG for traditional activities. The Torres Strait Islanders, who are culturally akin to the coastal peoples of PNG, became citizens of Queensland, Australia in 1967 with full access to health and social services and freedom to travel and work in Australia (http://en.wikipedia.org/wiki/Torres_Strait_Islanders). Many thousands of Torres Strait Islanders are said to live in Queensland today.

A publication in the Medical Journal of Australia (MJA) (http://www.mja.com.au/public/issues/188_03_040208/gil10334_fm.html) reviewed the molecular epidemiology of multidrug resistant TB (MDR-TB) strains isolated from patients living in the Western Province of PNG, who sought treatment between 2000 and 2006 in the Torres Strait Islands because of limited access to health care in the Western Province of PNG. Of the 60 TB isolates, 15 (25 percent) were MDR. Because travel from PNG to the Torres Strait Islands is difficult and costly, only the more affluent and those in better clinical condition likely made the trip. Nevertheless, of the 15 patients with MDR-TB, 6 were known to have died, and 2 were presumed to have died. The MJA article states that none were XDR-TB. Genotyping identified in 14 of the 15 isolates a single type ("Beijing-family"), said to be the most prevalent type in Southeast Asia. The frequency of MDR-TB in PNG is unknown; however, the authors say that in the past 2 years, 30 MDR-TB strains have been identified in Australia, with 1/3rd originating from the Western province of PNG.

An accompanying editorial in the MJA (https://www.mja.com.au/journal/2008/188/3; subscription required) noted that to reduce TB among immigrants to Australia from neighboring high-incidence countries, Australia should fund expansion of clinical and laboratory TB control in these neighboring countries (see also for an article relevant to the USA: Schwartzman K, Oxlade O, Barr RG et al. Domestic returns from investment in the control of tuberculosis in other countries. N Engl J Med 2005; 353(10): 1008-20; available at: http://www.nejm.org/doi/full/10.1056/NEJMsa043194).

The annual incidence of TB in PNG is estimated to be 233 per 100 000 population, and TB is one of its 3 leading causes of death (<http://www.mja.com.au/public/issues/188_03_040208/gil10334_fm.html).
As a point of reference, according to the US CDC, the annual incidence of TB in the USA in 2011 was 3.4 cases per 100 000 population (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6111a2.htm).

We are not told whether this 20-year-old woman from PNG with XDR-TB was HIV co-infected. TB is a major problem for people whose immune system is disabled by HIV/AIDS. Although HIV/TB co-infection has not been considered a problem in Australia, PNG has the highest incidence of HIV infection in the Pacific region; it is estimated that 2 percent of the adult population of PNG, approximately 64 000 people, are HIV-positive (http://www.ausaid.gov.au/Publications/Documents/impacts_hiv.pdf).

Maps of this region can be found at http://healthmap.org/r/5Z9a and http://www.janeresture.com/torres_strait/torres%20strait%20map.gif. - Mod.ML

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1KlS.]

See Also

Tuberculosis - Australia: (QL) ex Papua New Guinea, XDR, fatal 20130318.1591289
2012
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Tuberculosis - Australia: (QL) ex Papua New Guinea 20121020.1355085
2008
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Tuberculosis, MDR - Papua New Guinea 20080206.0478
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