By Hoosen Coovadia
We shouldn’t be surprised by recent news that 12% of hospital staff at the largest, government-funded tuberculosis hospitals in KwaZulu-Natal are themselves infected with tuberculosis. The public in South Africa will remember media reports of the tragic consequences of the acquisition of TB by health staff working in health-facility environments where the twin scourges of TB and HIV are ever present. These hazards have to be minimised so that the optimum healthcare can be provided to patients and prevention of TB for staff maximised.
Continuous contact with tuberculosis patients places hospital staff working on the front lines of the TB epidemic at heightened risk of becoming infected. The problem is growing more complex and fragile, underfunded healthcare systems are ill-prepared to manage the problem. A strike by nurses in Swaziland in March was a case in point. The strike was called after the tragic death of Bongani Mavimbela, a nurse at the National TB Hospital who died after contracting TB at work, her colleagues contend. Their rightful demand for workplace safety was placed in balance against the needs of sick patients — a complex and tragic juxtaposition.
The nurses, doctors and hospital staff who dedicate themselves to assisting people with TB deserve to be protected, both now and in the future. Only a healthy work environment will provide an atmosphere for them to deliver compassionate care. Along with the basics of improved ventilation and sufficient supplies of face masks for staff, better and more cost-effective tools to prevent TB are essential. There is currently no effective tuberculosis vaccine that can prevent pulmonary tuberculosis, and the drugs we have are quickly becoming obsolete when faced with drug-resistant TB.
The single most effective weapon in the battle to eliminate TB is a vaccine that could prevent adolescents and adults from developing the disease. Tuberculosis vaccine research is gaining momentum, and much of this work is happening right here in South Africa at the University of Cape Town and other leading research institutions, where clinical trials of promising TB vaccine candidates are under way.
At a well-attended TB conference held in Durban in June, TB advocates elevated the development of new TB vaccines on their agenda. This is a turning point for the TB prevention community and provides an open door for greater participation and collaboration across southern Africa by everyone who recognises that the battle against TB in our hospitals and in our communities will not be won without new vaccines.
The future for TB vaccines is bright, as the South African government and mining communities have signaled the prioritisation of vaccine research and development, recognising that this is a crucial goal for the health and wellbeing of the workforce.
This momentum must be maintained and accelerated, and corporate and government leaders should be reminded of their commitments and urged to follow through on pledges to develop and implement a coordinated plan to develop long-term solutions to the TB epidemic.
Hoosen Coovadia is the director of MatCH (Maternal, Adolescent and Child Health) at the University of the Witwatersrand and Emeritus Professor of Paediatrics and Child Health and Emeritus Victor Daitz Professor of HIV/Aids research at the University of KwaZulu-Natal.
The future for vaccines is always bright. They are always the promise of tomorrow and receive all the funding..
And meanwhile people die today.
@hoosen:
Thank you for highlighting this scourge.
We are years away from a vaccine. So that is not a solition for SA.
We need to make greater strides in HIV prevention and treatment. Citizens must learn to protect themselves and say no to risky sexual behaviour. Much easier said than done.
We must divert resources from trying to save the patients with HIV dementia and stage 4 disease to prevention. These patients are burden to themselves and to society in general. They deserve a peaceful painless end, rather than futile attempts to prolong a life without any quality.
DOH must protect the health care workers as well. At our hospital, we have protocols, but cannot apply practically. No n95 masks, no gene x pert, no isolation facilities. Its all paper talk, that results in workers seeking oppurtunities that are NOT life threatening. These doctors and nurses are unsung heroes who risk their lives/ health daily, rather than perform simple sensationalised skin grafts.
The truth about the efficacy of the TB drugs we buy and give our patients must also be revealed. Cheaper drugs, less quality, greater side effects and harm. Ripapoor rather than Rifafour.
TB and poverty go hand in hand. Until we uplift our people, the scourge will continue. This is an indictment on the ANC who have made no meaningful changes to the majority of their supporters other than wastefully spend. The money used for WC2010 would have turned the public hospitals around, but we love a…
I hadn’t even read about this, so for me, it’s news and I admire anyone continuing to work under these sad, but probably not easily avoided conditions.
Malnutrition, unhealthy living conditions, HIV. Not as spectacular as vaccine research but solvable parameters that could turn the tide on TB.
No quick fix for one of mankind’s oldest diseases.
Taken from newscientist.com: “… a drug combination that could for the first time dramatically shorten treatment and tackle both ordinary and multi-drug-resistant strains of TB.
Called PaMZ, the pill is a combination of the standard TB drug pyrazinamide with the antibiotic moxifloxacin – not previously used against TB – and PA-824, a drug whose potential against TB was reported by New Scientist in 2001.
PaMZ could wipe out several resistant strains of Mycobacterium tuberculosis – the cause of most cases of TB – which have been spreading through South Africa, India and the countries that made up the former Soviet Union. What’s more, it could work in a sixth of the time of existing treatments, at a tenth of the cost – as well as slashing by a third the number of pills required.”