South Africans with highly drug-resistant tuberculosis may need to be isolated against their will to prevent "a potentially explosive international health crisis," South African and Canadian ethicists say.

Extreme drug-resistant tuberculosis, or XDR-TB, has killed at least 74 people in the last few months in South Africa, according to a policy paper in Monday's issue of the journal PLoS Medicine. 

"We're not speaking of dropping them off in some sort of colony akin to a leper colony." -Study author Jerome Singh

Tuberculosis is an airborne bacteria spread through coughing or sneezing and can usually be treated. The XDR-strain, however, resists not only front-line drugs but also three of the six classes of second-line drugs.

The more potent medications have more serious side-effects, are more expensive and may need to be taken for as long as two years.

Detentions in hospitals or other health-care facilities would apply to XDR-TB patients who refuse treatment, Jerome Singh and Nesri Padayatchi of the Centre for the AIDS Programme of Research in Durban, South Africa, and Ross Upshur of the University of Toronto's Joint Centre for Bioethics said.

The South African government should also compensate people who are isolated, and they should be prioritized for medical treatment, they wrote.

"We're not saying confine people and leave them there to rot and die. We're saying confine people but ensure that their needs are taken care of," said Singh, a lawyer and ethicist who also works at U of T. 

"We're not speaking of dropping them off in some sort of colony akin to a leper colony."

In September 2006, the World Health Organization announced a deadly new strain of XDR-TB had been detected in Tugela Ferry, a rural town in the South African province of KwaZulu-Natal, and the epicentre of South Africa's HIV/AIDS epidemic.

Ethical, human rights concerns

The strain killed 52 of 53 people infected within an average of 16 days of samples being taken for diagnostic purposes. The country has since seen about 400 cases of XDR-TB.

Medical experts say the strain is particularly dangerous to people with immune systems compromised by HIV. 

Uncertainty among health professionals regarding the ethical, social and human rights implications of fighting the outbreak shows the need to urgently deal with doubts and inaction to prevent an epidemic of XDR-TB in South Africa and beyond, the ethicists wrote.

Health experts in South Africa have discussed the idea, said Ronnie Green-Thompson, an adviser to the South African Department of Health.

"Holding the patient against their will is not ideal but may have to be considered in the interest of the public," Green-Thompson said in a statement issued by the South African Department of Health. "Legal opinion and comment as well as … the opinion of human rights groups is important."

WHO officials have called for XDR-TB to be prioritized on the same scale as bird flu, saying governments should help sub-Saharan Africa governments come up with a strategy to cope with TB and HIV.

South Africa is an important tourist destination that is home to millions of immigrant agricultural workers and a port to other African countries, the researchers noted.

With files from the Canadian Press and Associated Press