Monday, 6 June 2011

TUBERCULOSIS: Australia: Refugees Can Be Effectively Treated To Prevent Tuberculosis

04 Jun 2011 : The Medical Journal of Australia
Almost one in three recently arrived refugees in Darwin tested positive for latent tuberculosis infection (LTBI), research published in the latest Medical Journal of Australia has found.
Researchers from the Centre for Disease Control, Northern Territory (CDC-NT) found that of 458 refugees screened between 1 February 2006 and 31 January 2009, 146 (31.9 per cent) were diagnosed with LTBI. LTBI implies past exposure to tuberculosis, leaving the individual susceptible to active infection later in life if not treated.
More than three in four of those diagnosed accepted treatment, and about half of those completed treatment.
All refugees aged 11 years and older who are being considered for entry into Australia are screened for active tuberculosis, and must be treated and cured before arriving in Australia.
Refugees are then screened on arrival in Darwin for latent tuberculosis.
LTBI was more prevalent among refugees from the Eastern Mediterranean region, yet those refugees had the lowest rate of treatment acceptance, CDC-NT Tuberculosis/Leprosy Unit registrar Dr James Trauer said.
"Our findings show that timely screening and treatment of LTBI in refugee groups is feasible," Dr Trauer said.
"Measures directed at maintaining contact with refugees after arrival, provision of culturally and linguistically appropriate support, better understanding of treatment barriers, and care for individuals with medication-related side effects are all likely to be effective strategies for improving treatment completion."
In a case study also published in the latest issue of the MJA, doctors from Dunedin Hospital reported that in 2010 an immigrant from Burma became the first person to be diagnosed in New Zealand with extensively drug-resistant tuberculosis (XDR-TB).
The 29-year-old man, who emigrated in 2006, had no personal history of TB. It took 66 days from the initial sample collection for a final laboratory report to confirm that the strain was XDR-TB, and the cost of the second-line drugs used to treat the man was NZ$10 000 per month, Dunedin Hospital Respiratory Consultant Dr Colin Wong said. "Although our experience indicates that there is potential for treatment success, definitive treatment guidelines are needed and more data are required to inform treatment and help contain spread," Dr Wong said.
"Confirming XDR-TB in a young man from Burma who had no history of previous TB treatment suggests that XDR-TB may be more common in Burma than has been widely believed, reinforcing the need for strengthening laboratory support networks and TB surveillance systems in South-East Asia."
In an accompanying editorial, infectious diseases expert Associate Professor Paul Johnson, Infectious Diseases Department, Austin Health said that while Australia was a low-risk country for XDR-TB, having recorded one case of XDR-TB in 2004 and one in 2010, a national response was needed.
That strategy must include sustaining and extending existing overseas programs that helped neighbouring countries control TB, while the next line of defence was the primary care clinician.
"Rapid diagnosis of pulmonary TB minimises secondary transmission, whatever the resistance pattern of the isolate," Professor Johnson said.
"Then we need to strengthen our local TB public health services and recognise that as TB resistance increases linearly, the cost and complexity of managing these cases increases exponentially.
"Finally, we need to keep up to date with new technology ... Molecular diagnostics are not yet perfect - we will need to retain culture-based methods for a while yet - but they are now becoming widely available and progressively cheaper.
"We need to be organised and up to date if we want to stay ahead of TB."

No comments:

Post a Comment