TB Infection Control
Turning off the spigot: reducing drug-resistant tuberculosis transmission in resource-limited settings
This is a ‘State of the Art’ article in the current IJTLD that can be accessed for free. In it we make the strong case that the most important TB infection control intervention is rapid diagnosis and effective treatment. We also make the case for community-based treatment and traditional engineering and design interventions to reduce transmission. Because we have not yet published our data on the remarkably fast reduction in transmission, even MDR transmission, due to treatment, we could not focus as much on that in this review as the findings warrant. However, even the older data strongly supports the notion that patients who are smear and culture positive on effective treatment are not likely to be infectious – almost immediately after starting effective treatment!
We will publish this data as soon as we are sure that it is iron tight. The key word is ‘effective’. In our facility in South Africa, where all patients are on MDR treatment, only XDR patients appear to transmit to any extent. They are not ‘effectively’ treated. It is unclear at this time whether XDR treatment can be effective in stopping transmission. This is unlikely to be so clear in my opinion. Every MDR patient is susceptible to both a FQ and injectable (beyond SM), but XDR may not be susceptible to any drugs, or not enough to stop transmission. Studies on the impact of treatment on XDR TB have yet to be done.
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