1730. Geographic Distribution of Extensively Drug-Resistant Tuberculosis in KwaZulu-Natal Province, South Africa
Session: Poster Abstract Session: Tuberculosis and other Mycobacterial Infections
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
Background:  South Africa has among the highest global burden of tuberculosis (TB) and drug resistance has complicated efforts to combat the epidemic. An outbreak of extensively drug-resistant (XDR) TB was first observed in KwaZulu-Natal Province (KZN), which remains disproportionally impacted with among the highest rates globally. We sought to describe the geographic distribution of XDR TB in KZN.

Methods:  We examined drug-susceptibility test results from the provincial TB laboratory in KZN.  Sputum specimens were collected in government health facilities as part of routine medical care and in accordance with national guidelines. We performed frequency analysis to determine the proportion of XDR TB cases identified by each provincial district and incidence rate per 100,000 population. Results were compared to 2007 published data to evaluate changes over time.

Results: Between Oct 2010 and Nov 2011, 345 XDR TB cases (3.4/100,000) were reported from all 11 districts of KZN. The median age was 34 years (range=4-75). The districts reporting the highest burden of XDR TB were: Ethekwini (n=157, 4.5/100,000), Umzinyathi (n=69, 13.9/100,000), and uMgungundlovu (n=30, 3.0/100,000). Compared to 2007, the overall incidence has increased 10% (Table).

Conclusion: KZN province continues to experience a high and growing burden of XDR TB with widespread distribution throughout the province. The incidence of XDR TB has increased in all districts except for Umzinyathi and uMgungundlovu, although these still remain high.  Greater public health and research efforts are needed to curb transmission and prevent new XDR TB cases, especially in the urban district of Ethekwini.

 

District

Population

No. of XDR cases

Proportion of XDR cases (%)

Incidence

(per 100,000 population)

2007 Incidence* (per 100,000 population)

Ethekwini

3,468,086

157

45.5

4.5

1.9

Umzinyathi

495,737

69

20.0

13.9

34.1

uMgungundlovu

988,837

30

8.7

3.0

4.0

Zululand

902,890

25

7.2

2.8

0.3

Uthungulu

894,260

16

4.6

1.8

1.0

Ugu

709,918

15

4.3

2.1

0.9

uThukela

714,908

10

2.9

1.4

0.8

Umkhanyakude

614,046

8

2.3

1.3

0.3

Amajuba

442,266

7

2.0

1.6

0.3

iLembe

528,198

6

1.7

1.1

1.0

Sisonke

500,082

2

0.6

0.4

2.0

Total

10,259,228

345

 

3.4

3.1

*Moodley et al. PLoS ONE 2011.

Jennifer Lim, MPH1, Thuli Mthiyane, MPH2, Koleka Mlisana, MBChB, MMedPath3,4, Julie Moodley3, Neeshan Ramdin3, Bruce Margot5, James Brust, MD1,6, Nazir Ismail, MBChB, DTM&H3, Roxana Rustomjee, MBChB, MMed, PhD2, Neel Gandhi, MD1 and N. Sarita Shah, MD, MPH1, (1)Albert Einstein College of Medicine, Bronx, NY, (2)Medical Research Council, Durban, South Africa, (3)National Health Laboratory Service, Johannesburg, South Africa, (4)University of KwaZulu-Natal, Durban, South Africa, (5)KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa, (6)Montefiore Medical Center, Bronx, NY

Disclosures:

J. Lim, None

T. Mthiyane, None

K. Mlisana, None

J. Moodley, None

N. Ramdin, None

B. Margot, None

J. Brust, None

N. Ismail, None

R. Rustomjee, None

N. Gandhi, None

N. S. Shah, None

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