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Mine Health and Safety Act, 1996 (Act No. 29 of 1996)

Notices, Guidance Notes, Compilation Guidelines

Guidance Note for the Management of Latent Tuberculosis Infection in the South African Mining Industry

Part A: The Guidance Note

7. Background

 

7.1. The WHO define LTB infection as “a state of persistent immune response to stimulation by Mycobacterium tuberculosis antigens without evidence of clinically manifested active TB”.

 

7.2. A third of the world population is estimated to be infected with TB according to the WHO, a significant majority without signs or symptoms thereof, yet at risk of developing active TB and becoming infectious. The lifetime risk of progression to active disease, is noted to be dependent on the immunological status of the host and occurs within the first five years after initial infection.

 

7.3. Those at highest risk of progressing to active TB disease are people who are immuno-compromised (e.g. HIV infection), on dialysis, preparing for organ or hematologic transplant, PTB household contacts (particularly children younger than five years of age) and those who have silicosis from exposure to silica dust.

 

7.4. South Africa is noted to have one of the highest burdens of LTBIs in high-risk groups such as young children, adolescents, household TB contacts, PLHIV, gold mine workers and healthcare workers.

 

7.5. South African mines have elevated levels of TB, HIV and silicosis, and silicosis is an independent risk factor for TB. Gold mine workers with silicosis have a three-fold higher incidence of TB compared to non-silicotic workers, and in some instances patients with silicosis and a positive TST have an estimated 30-fold higher odds of developing TB than the general population.

 

7.6. A dose-response has been demonstrated between cumulative silica dust exposure and the risk of TB, even in the absence of silicosis. It has also been shown that HIV and silicosis increase the risk of TB multiplicatively.

 

7.7. Prevention of TB disease by treatment of latent infections is incorporated in the National Strategic Plan for HIV, TB and sexually transmitted infections (STIs) 2023- 2028 of South Africa and a critical component of the WHO End TB Strategy.

 

7.8. To address the scourge of TB disease in the South African mining industry, the DMRE issues guidance notes to guide implementation by the mines. As a minimum this guidance note should be read in conjunction with, but is not limited to, the following documents:
7.8.1. Guidance Note for a Management and Control Programme for Tuberculosis in the South African Mining Industry (DMR 16/3/2/3-A8).
7.8.2. Guidance Note for Implementation of TB Preventative Therapy among People Living with HIV and silicosis.
7.8.3. Prevailing guidelines or guidance notes from the NDOH on managing LTBI.