|
Karl Schembri
Malta tops the list of countries that are successfully preventing tuberculosis as new drug-resistant strains of the germ that causes it are affecting Eastern European countries poised to join the European Union in May.
A special World Health Organisation report published last week confirms Malta’s successful prevention of TB, in a study collating data from 67,657 TB in 77 countries and regions between 2000 and 2002.
But the same study finds that Estonia, Latvia and Lithuania, together with China, Israel, South Africa and parts of central Asia, are suffering high rates of potential fatal strains of multi-drug resistant TB (MDR-TB) which are very difficult and a hundred times more expensive to treat.
“In Malta drug resistant strains have not yet featured among the Maltese population,” said Dr Analita Pace Asciak, a specialist in Public Health Medicine at the Qormi Health Centre’s Chest Clinic. “However we are still open to imported TB, including multi-drug resistant strains which are very difficult and expensive to treat. That is why we screen all foreigners from countries with a high incidence of TB, on entry.”
According to the report, the chances that a person suffering from tuberculosis in an Eastern European or Central Asian country is 10 times more likely to develop resistance to drugs than in the rest of the world.
The authors of the report suggest that the reason for this is that diseases develop drug-resistant strains in cases where patient supervision is poor and where there is a large proportion of migration between those countries where drug-resistant tuberculosis is common.
The Maltese authorities screen all foreigners coming from countries with high TB incidences by submitting them to chest x-ray on entry.
“Influx of foreigners from countries with a high incidence of TB like illegal immigrants and Eastern European countries would pose a problem for the control of TB if the necessary precautions were not taken,” Dr Pace Asciak said. “One person with active pulmonary TB can be infectious enough to cause an outbreak if the case is not detected and given curative treatment and contact tracing is not done. Contact tracing is the TB screening of people exposed to a case of infectious TB.”
The incidence of TB in Malta remains one of the lowest in the world, as opposed to the upward trend in many countries in the eighties and nineties.
According to the Disease Surveillance Unit, the number of cases of TB in Malta has been continually on the decline at least since the beginning of the twentieth century, mainly because of better housing and nutrition and the introduction of antibiotics in the 1950s. TB inoculation provided by the national health service called BCG protects against the serious forms of TB like TB meningitis and miliary TB.
This year, two Maltese and one foreigner have been notified and are being treated till now for TB by the health authorities.
The WHO estimates there are 300,000 new cases per year of MDR-TB around the world. WHO defines MDR-TB as any strain of the disease which is not affected by two or more of the main drugs usually used to treat it: isoniazid and rifampicin. Close to 80 percent of all the cases of MDR-TB cases are now considered a superstrain, resistant to three or four drugs.
Tuberculosis is primarily a disease of the respiratory system, and is spread by coughing and sneezing. Each year 2 million people die from this curable disease.
WHO says curing ‘normal’ TB is cheap and effective: a six month course of medicines costs $10. Treating drug-resistant TB is a hundred times more expensive, however, and even then a cure is not guaranteed.
The spread of MDR-TB correlates with HIV infection rates in Eastern Europe and Central Asia. People whose immune systems are compromised with HIV are many times more susceptible to contracting all forms of TB.
|
