TB in Haiti
By Carol A. Kemper, MD, FACP , Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases; Santa Clara Valley Medical Center. This report originally appeared in the April 2010 issue of Infectious Disease Alert. Dr. Kemper conducts research for GSK Pharmaceuticals, Abbott Laboratories, and Merck.
Source: ProMED-mail post, Feb. 5, 2010; Available at: www.promedmail.org.
Haiti is one of the poorer countries in the world, with the highest per-capita rate of tuberculosis (TB) in Latin America and the Caribbean. According to the WHO 2009 Global TB Control Report, 29,333 new cases of tuberculosis were diagnosed in Haiti in 2007 (approximate incidence, 300 cases/100,000 population). Of these, 53% were sputum smear positive, and 1.8% were multidrug resistant. An estimated 6814 people died from TB in Haiti in 2007 alone.
Since 1998, the Ministry of Health stepped up TB control efforts in the country, increasing detection efforts and initiating a directly observed therapy (DOT) program. Attempts at DOT have varied from region to region, but it was used for as many as 91% of cases in 2006, although that number declined somewhat to 70% in 2007. The situation is compounded by the high rate of HIV and TB co-infection, which occurs in as many as 30% of TB cases in some areas.
The recent earthquake not only demolished buildings and infrastructure in Haiti, but also has devastated TB control efforts. The only TB hospital/sanitorium in the country, which housed several hundred of the sickest patients, was critically damaged, and The New York Times reports that patients have fled and are now living in tent cities, where TB transmission seems likely. "Hundreds" still report daily to pick up their medications, but the efforts of trained personnel have been diverted, or they have died as a result of the quake. The obvious concern is the potential for increasing drug resistance and widespread infection.