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Calls for urgent action as TB soars

An expert is calling on the Government to stop the relentless climb of TB.

London is now a TB "hotspot" with nearly half of all UK cases occurring in the capital - around 3,000 each year - double the total of 15 years ago.

TB cases have jumped by nearly 20% in England and Wales over the last two years, but London in particular is under threat from the bacterial disease, which is more commonly found in developing countries.

Immigration, overcrowding and the spread of HIV infection have all contributed to the resurgence of TB in the UK.

Multi-drug resistance

Dr Vas Novelli, head consultant on infectious diseases at Great Ormond Street Hospital, London, which is running a new monthly TB clinic in response to the steep rise in cases, called on the Government to pump more cash into improving TB services.

Two of the main problems, he said, are that certain strains of TB emerging are becoming resistant to many drugs, and secondly, that the number of TB specialists falls far short of current recommendations.

Dr Novelli said: "Whilst screening for TB in high-risk groups has always been a priority, TB is not always picked up immediately, and we are now facing multi-drug resistant strains of TB in the capital.

"The current numbers of TB clinical nurse specialists also fall dramatically short of British Thoracic Society (BTS) Joint Tuberculosis Committee recommendations that there should be one nurse for every 40 TB patients.

"Unless the numbers of TB nurses are increased we will continue to see an inexorable rise in TB cases in London."

Areas worst-hit by TB such as Newham and Tower Hamlets should be a top priority for recruiting more specialist nurses in order to better screen and keep track of TB patients and ensure they are taking their medication.

Insufficient staff

A national roll-out of DOT-S programmes (Directly Observed Therapy - Short Course) would also be key.

An audit carried out by the BTS of high incidence TB areas in 43 districts across England and Wales last year found that nearly 90% of them had insufficient staff to cope with such high levels of the disease as were being experienced.

But calls for the Government to take action on TB have been met by a wall of silence from the Department of Health, according to the BTS, the British Lung Foundation and TB Alert.

The groups are warning that lives are being put at risk by the government's failure to publish the long-promised TB Action Plan, which was expected to outline better prevention, diagnosis and treatment of TB.

Professor Peter Ormerod, member of the BTS Joint TB Committee said: "It is amazing that on one hand the Government makes grandiose statements about building a modern, hi-tech NHS, but when it comes to deciding how we are going to manage a Victorian disease like TB we appear to be still living in the dark ages.

"It seems to me that when it comes to TB, John Reid is all talk and no action."

The BTS reported a rise in TB cases in England and Wales from 5,798 in 1992 to 6,891 in 2002, in figures released in March of this year. No other EU country has suffered an increase in TB over the past 10 years.

Figures from the Health Protection Agency showed London accounted for 43% of all cases reported - followed by the West Midlands (15.6%), East Midlands (12.2%), and Yorkshire and Humberside (10.6%).

Action plan

The 15-44 year-old age group accounted for 56% of all cases while the highest rate of 28.8 cases per 100,000 was found in people aged 25-29.

TB is a contagious airborne bacterial disease of the respiratory system which causes severe lung symptoms but can often be present without causing any symptoms until the patient becomes run-down or the immune system is damaged.

The disease can usually be treated by a six-month course of drugs but in many developing nations it can prove to be fatal due to a lack of medical care and a combination of other diseases.

Sir John Crofton, President of TB Alert, said: "Despite the seriousness of the situation, there is an apparent lack of urgency on the Government's part to take action on TB.

"It is now two-and-a-half years since the Chief Medical Officer for England identified TB as an area where intensified action is needed, but there has been no movement since then."

A Department of Health spokeswoman said: "We are aware that there are a small number of areas of the country where numbers of TB cases are rising.

"Primary Care Trusts are responsible for delivering TB services appropriate for their population and a huge amount of action is already under way across the country.

"The Chief Medical Officer identified the need for more intense action and that is why we have been preparing a TB Action Plan for England which will be published in the Autumn.

"In the meantime there is no reason why the ongoing diagnosis, treatment, care and control of TB should be in any way compromised."