By GREGORY DL MORRIS, an independent business journalist with more than 20 years' experience covering finance, industry and commerce worldwide.
A dozen cases in India hardly constitute an apocalyptic pandemic out of some science fiction novel, but reports of totally drug-resistant tuberculosis (TDR-TB) has certainly raised the eyebrows of civic leaders and health underwriters around the world.
Complicating the issue, there is no official international recognition that totally drug-resistant tuberculosis exists. The only defined conditions are multi-drug resistant (MDR) and extensively drug-resistant (XDR) forms of the virus. Nevertheless, insurance companies are having to make both interim and long-term risk management plans in case this disease turns out to be totally resistant to medications.
Health carriers stress that even if totally drug-resistant tuberculosis is recognized and cases are confirmed, the threat to the U.S. is vanishingly small. Any instances would most likely be through an infected person travelling to the U.S. before the condition was obvious.
Early in January, Hinduja Hospital in Mumbai reported as many as a dozen cases of totally drug-resistant tuberculosis, detailing that three patients had died and that the prognosis for the others was grim.
The immediate response from the Ministry of Health and the Directorate of Health Services was that neither the officials nor the doctors at the hospital were accredited to diagnose the disease, and that no such disease was recognized by the World Health Organization. The hospital was ordered to reclassify the cases as extensively drug-resistant tuberculosis, and national officials were sent to investigate.
The outbreak in India is not the first instance of totally drug-resistant tuberculosis being reported. It was first discovered in Italy in 2003. There have also been cases in Iran and previous instances in India, according to news reports.
The resistant strains of "the white plague" result from incomplete or improper courses of treatment, according to the medical literature. Tuberculosis is caused by bacteria, and patients are supposed to take antibiotics for six months to nine months.
Impoverished areas that are the most likely incubators for the disease are likely to lack sufficient medical treatment. Patients may be taken to a clinic and given antibiotics that could initially make them better. But barring the full treatment schedule, the bugs that resisted the first doses are then free to reproduce.
The WHO said that tuberculosis is estimated to be present but dormant in as much as a third of the world's population. About 10 percent of people exposed to the disease eventually manifest active symptoms.
A fifth of all diagnosed cases worldwide occur in India. About 2 million people worldwide each year die of tuberculosis, and the WHO estimates that each victim infects, on average, as many as 15 others through contact with saliva or mucous.
In a statement, WHO reiterates that "the term 'totally drug-resistant' has not been clearly defined for tuberculosis." For now, these cases are defined as XDR-TB, WHO said. That assertion was essentially technical, saying that clinical tests indicating total resistance does not necessarily mean that the strain is totally resistant in any given patient.
On a positive note, the WHO added that, "new drugs are under development, and their effectiveness against these 'totally drug-resistant' strains has not yet been reported." That said, the organization stresses that the best approach is careful and thorough treatment of known cases.
January 24, 2012
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