Published Date: 2008-02-06 10:00:16
Subject: PRO/EDR> Tuberculosis, MDR - Papua New Guinea
Archive Number: 20080206.0478
TUBERCULOSIS, MDR - PAPUA NEW GUINEA
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Date: Tue 5 Feb 2008
Source: ABC News [edited]
<http://www.abc.net.au/news/stories/2008/02/05/2154765.htm?section=justin>
A far north Queensland tuberculosis (TB) expert says a dramatic
overhaul of health services in Papua New Guinea [PNG] is needed to
stop the disease spreading to Australia. Dr. Graham Simpson
co-authored a study published in the Medical Journal of Australia
[MJA], which examined strains of [_Mycobacterium tuberculosis_] in
PNG that are resistant to antibiotics.
The report noted that many people with the disease go to the Torres
Strait Islands under a treaty allowing free movement between the
regions. Dr. Simpson says more than 70 TB patients were treated in
Cairns [60 patients were apparently treated in the Torres Straits
Islands according to the MJA article - see below] last year [2007]
and about 15 cases were drug resistant. "We're going to see
increasing number of cases for some years to come and I think we've
just got to deal with that," he said. "It's not going to change until
the facilities and the health care facilities improve dramatically. A
lot of the drugs that we used to treat the drug-resistant TB are just
not available at all in PNG."
--
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[Papua New Guinea (PNG), which gained its independence from Australia
in 1975, is called officially the Independent State of PNG. It
occupies the eastern half of the island of New Guinea and numerous
offshore islands (the western portion of the island is occupied by
the Indonesian provinces of Papua and West Papua). The majority of
its population of almost 6 million lives in traditional societies and
practises 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 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.
Although the above news release does not state whether the TB
isolates were multidrug resistant (MDR) (i.e., resistant to INH and
rifampin) or extensively drug resistant (XDR) (i.e., additionally
resistant to fluoroquinolones, and at least one of the 3 injectable
second-line anti-tuberculosis drugs capreomycin, kanamycin, and
amikacin), it refers to a recent publication in the Medical Journal
of Australia (MJA)
(<http://www.mja.com.au/public/issues/188_03_040208/gil10334_fm.html>)
that reviewed the molecular epidemiology of 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 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 one 3rd originating from the Western
province of PNG.
An accompanying editorial in the MJA
(http:www.mja.com.au/public/issues/188_03_040208/gil10334_fm.html)
noted that about 85 percent of TB cases in Australia in 2006 occurred
among foreign-born persons, who originate mostly from Africa, the
Indian subcontinent, China, and Southeast Asia. Although noting that
transmission from the immigrant communities to the general population
of Australia has been negligible, this editorial reports a recent
increase of TB among health care workers, who have been mainly
recruited from high-incidence tuberculosis countries. To reduce TB
among immigrants from neighboring high-incidence countries, this
editorial suggests that Australia should fund expansion of clinical
and laboratory TB control into these neighboring countries (see also
for an article relevant to the U.S., 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; 353:1008-20).
A separate study published in the same edition of MJA
(http://www.mja.com.au/public/issues/188_03_040208/gra10272_fm.html)
found among 1147 illegal alien fisherman (over 90 percent from
Indonesia), who were detained in Australia, 8 smear-positive
(contagious) cases of tuberculosis, one MDR-TB case, and a very high
prevalence of culture-positive TB (1020 per 100 000 people).
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 U.S. CDC, the annual
incidence of TB in the U.S. in 2006 was 4.6 per 100 000 population
<http://jama.ama-assn.org/cgi/reprint/297/16/1765.pdf>). 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/country/png/hivaids.cfm>). The HIV
infection status was not given for the 15 PNG patients with MDR-TB
reported from Australia's Torres Strait Island region
(<http://www.mja.com.au/public/issues/188_03_040208/gil10334_fm.html>).
In recognition of the threat that HIV poses for PNG, Australia is
incorporating HIV prevention and education components into all its
PNG aid projects, which is being complemented by key partnerships
with international HIV/AIDS partners and the private sector, e.g.,
the Clinton Foundation HIV/AIDS initiative, the Asian Development
Bank, and the Asian Pacific Business Coalition on HIV/AIDS
(<http://www.ausaid.gov.au/country/png/hivaids.cfm>).
A map of this region can be found at
<http://en.wikipedia.org/wiki/Image:LocationPapuaNewGuinea.svg> and
<http://www.mja.com.au/public/issues/sep2/hanna/hanbox1.html>. - Mod.ML]
See Also
Tuberculosis, XDR - Botswana, South Africa 20080118.02222007
----
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
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