South Africa has one of the highest tuberculosis (TB) rates in the world and the problem is exacerbated by the HIV/AIDS pandemic. In addition, the disease is poverty-driven and the situation is further worsened by the fact that TB cases present very late with advanced disease and that undetected patients are infecting many others.
Many experts advocate that managing the infected individual will stop the cycle of infection, however many patients are unemployed and therefore access to medication is limited to public sector clinics which in rural settings may be difficult and expensive to reach. Also, many do not complete their six month treatment course and falter on the programme as many cannot tolerate the daily three drug treatment course due to hunger which eventually may result in the emergence of multi-drug resistant tuberculosis (MDR-TB).
Despite the escalating problem, many provinces fail to meet their commitments due to a lack of financial and human resources needed to diagnose and manage cases. Such failed programmes contribute to thousands of adults and children dying needlessly of a curable and preventable disease. This is only the tip of the iceberg as affirmed by the chief of the National TB programme of the Department of Health, Dr Lindiwe Mvusi.
It is evident that South Africa’s efforts to stop the cycle of infection and combat TB is being complicated by the above, while various other modes of transmission of tubercle bacilli from non-pulmonary sources also play a role, which although relatively minor is often neglected. These include infection from cutaneous TB, in the laboratory setting, by needle stick, transmission by bronchoscopic examination, in the autopsy room, following vaccination by Bacillus Calmette-Guerin (BCG) in severely immunocompromised patients including those receiving corticosteroid therapy, congenital TB, and other rare routes of transmission.
For the purpose of this study the investigators are concerned about occupational exposures, particularly in health care facilities. Epidemiological studies have shown that health care workers are at risk of contracting TB.
We believe that the potential use of the PCR method is far-reaching. The greatest application of this technology is in the area of infection control. A reliable method to detect MTB spreading in the environment would be useful to control infection risk from pulmonary and non-pulmonary sources. Once the method is set-up health care facilities and other workplaces may be able to evaluate their environmental control measures and monitor the air quality within these institutions. Defining those at highest risk and devising a means of protection against MTB infection should be a priority for hospital infection control personnel and other public health professionals. Controlling exposure in the workplace would be in compliance with the Hazardous Biological Agents Regulation (Act no. 85 of 1993).
Ms. Z. Kirsten