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A Stuijt
Retired South African medical journalist, ex-Sunday Times of Johannesburg.
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Sunday, 7 February 2010

Dutch fans to WC2010 warned of TB-infection dangers

13:39 | Posted by A Stuijt | | Edit Post
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CensorBugbearAdrianaStuijt 

Dutch fans warned: “Test for TB before your trip to SA and again afterwards --  stay away from crowded, closed spaces…”

Dutch TB fund director Peter Gondrie warns in the Parool daily newspaper that Orange-team football supporters must be ‘aware’ of the very high level of infectious, multi-resistant, nearly incurable Tuberculosis in South Africa. “All travellers to South Africa risk infection with this deadly disease, which can hardly be treated with antibiotics,’ he warns.

Gondrie advises supporters and tourists travelling to South Africa to have TB tests done before and after their journey. A TB-vaccine exists but ‘its efficacy is not good’, he warned. The tests can be carried out at the government’s public-health clinics (GGD). “That’s the only way to determine whether you were infected with the bacterium. In that case an antibiotics-regimen could prevent the disease from devleoping.  The World Cup 2010 tournaments are held between 11 June and 11 July.

Zakumi WC2010 lies SA is dangerousThe TB fund offers more advice: ‘avoid heavy coughers as much as possible’. And the Travel Clinic – which vaccinates travellers going to at-risk areas, also advises to ‘avoid large gatherings in closed spaces’.

Gondrie warns that the number of infectious TB-sufferers in South Africa is spreading very rapidly. “With multiresistent-TB the bacteria hardly reacts at all to antibiotics, and with some new strains the existing drugs have no effect at all. A considerable proportion of the patients die.’

He advises that anyone who develops persistent coughs for longer than three weeks, and who suffers chronic fatigue and loses weight, should go to their GP – and mention during the consult that they have recently been on an overseas trip.

“There is a vaccine against TB but its efficacy is less than optimal,’ he warned. “The (symptoms) complaints can also show up quite a long time after return.”

He also believes that it will still take a long time to develop a better vaccine: perhaps by 2016…http://www.parool.nl/parool/nl/11/SPORT/article/detail/278280/2010/02/05/Risico-op-tbc-voor-WK-supporters-in-Zuid-Afrika.dhtml

South Africa: second-highest infectious TB rates in the world…

The website for the Dutch TB fund shows that the Dutch health authorities are very actively involved in trying to combat the rapid spread of TB in South Africa, with one of their reports dating from 2004 noting that  2.9% of the tested Cape Town children developed TB before the age of five – ‘which is one of the highest in the world” and which also indicates that they are surrounded by adults with infectious TB. Two years later, by the start of 2007, the infection rate amongst cildren had jumped to 4.9% -- so they are clearly still losing this battle.

In 2007, a total of 353.519 new TB cases were identified in South Africa – and 88,404 (25%) had died

These Cape Town children now would be 11 years old if they survived that long.  (Other articles on the same site are here and  also – as well as.) The site also reported that in 2007, a total of 353.619 new TB patients were diagnosed that year – 727 TB-patients per 100,000 residents – which is the second-highest TB infection rate in the world. http://www.kncvtbc.nl/Site/Components/SitePageCP/ShowPage.aspx?ItemID=c29db58a-3641-4624-bc32-40ae90d62843&SelectedMenuItemID=61c54275-6731-48ed-bfb7-7a2e673e5708

TB drug resistent Netherlands Feb62010 LeeuwarderCourant
The Dutch had  beaten TB  before the drug-resistent variety:

Until recently, the pro-active Dutch TB-prevention programme – launched from about 1913 – had worked a treat: however with illegal migration increasing local health authorities have also started noticing what they describe as a ‘worrying increase in drug-resistant Tuberculosis’.

For South Africans, with their more than 260,000 TB-deaths a year – the Dutch XDR-TB infection rates are downright laughable: between 2001 and 2008,  seven ‘super-resistent TB’ patients were identified in The Netherlands  –  by 2008, fourteen such patients were diagnosed that year alone - the incomplete records from 2009 show 19 such cases.

This incurable TB-strain’s  infection however spread very rapidly in South Africa once it took hold: in 2003, the first such patients were identified in KwaZulu-Natal – now tens of thousands of patients die of drug-resistant TB every year, including a great many hospital-staff.

This very rapid increase in drug-resistant TB in the Dutch population thus is of great concern to the Dutch health authorities, according to director Gondrie of the Dutch tuberculosis-fund.

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Leeuwarder Courant, 6 February 2010 – Dutch health-officials say that their specialist-doctors are defenceless against the drug-resistant versions of highly-infectious, airborne Tuberculosis – because it is nearly uncurable and easily transferrable from human-to-human. In 2009, nineteen new XDR-TB cases were diagnosed – up from 14 in 2008 and 7 for the previous six years...

An article on 6 February 2010 in the Leeuwarder Courant (picture above, and which does not appear on their online website) quotes Dr Martin Boeree, lung-specialist and director of the University Centre for Chronic Diseases Dekkerswald in Groesbeek, that he now gets an increase in TB-patients which are resistent to antibiotics. Most are homeless people, weakened by drugs- and alcohol abuse. “We prescribe one course of antibiotics after another, but the patient does not respond,’ he is quoted as saying.

director Peter Gondrie of the Dutch tuberculosis-fund as saying that ‘worldwide, an annual half-million new multi-resistant patients are diagnosed, especially in South Africa, India and China – and closer to home Eastern European countries such as Estland and Latvia. “

Even so – most people do still get cured of TB:  the world health organisation also reported  recently that in the past 15 years, about 36-million people were cured of TB . More

TB doesn’t stop at the borders:

The Dutch authorities are aggressive about fighting TB, saying that “TB doesn’t stop at the borders.’ Says Gondrie:  ‘(Drug-resistant TB)  threatens public health in all the EU countries.’ Before World War Two, the only remedy against TB was plenty of rest, good nutrition -- preferably in clean, very cold air where bacteria do not thrive (often Dutch patients were sent to specialist-treatment centres in the Swiss mountains, where they were forced to followa strict regimen in complete isolation). Despite this highly aggressive, pro-active approach,  up to half of all the TB patients in the Netherlands still died from the disease in those years, and the TB-infections amongst the population remained high until healthier homes, the introduction of free healthcare and better nutrition greatly improved their general health. And especially after antiobiotics were discovered, the cure-rates for TB soared; the medical fraternity felt that they had the disease beat -- until the recent arrival of drug-resistant Tuberculosis

  • Gondrie: “One of the main problems is that the treatment of MDR-TB is expensive and difficult, with the patient requiring to take at least four different antiobiotics for at least six months. In The Netherlands, patients do get the correct medications, however in poorer countries matters are entirely different – leading to large pools of drug-resistant TB-patients.”

The world has been asleep for 40 years about TB:

The Dutch patients who are identified with resistant TB  are treated in strict isolation at two specialist-centres: Dekkerswald in Groesbeek, and Beatrixoord in Haren. Both facilities employ  ‘virus-busting’ filters to clean the air and nursing personnel are required to always wear masks when dealing with the patients.
Treatment is difficult and very expensive: it can take as long as a year, with the less virulent varieties still curable with a strict regimen, doctors say.

However recently the Dutch also identified cases of super-drug-resistant TB which did not respond to any medicines at all with at least 19 new cases in 2009 alone. “In the Netherlands, especially the illegal migrants from Eastern-Europe are the greatest threat to spreading drug-resistant TB into the main-stream population, Gondrie pointed out. “They usually only end up in the TB-treatment centres after they have been walking around for several months with an infectious disease,’ he said.

Lung-specialist Dr Martin Boeree ( contact tel (024) 685 99 11) was also quoted as saying that’the world has been asleep for fourty years (about TB). “So it’s not surprising that things are going so badly wrong now’.

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Dutch TB-Fund - articles on high TB infection rates and spread of XDR-TB in South Africa:

Leeuwarder Courant, Friesland, 6 February 2010 Page 3 (GDP). bibu@lc.nl 

Tuberculose Centrum Dekkerswald ( since 1913) http://www.ulcd.nl/home/professionals/verwijzersinformatie/tbc

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