TB: The Fight Against The White Plague

The number of cases in the capital has been rising since the mid-1980s. Of all the cases diagnosed in England and Wales, over 40 per cent are in the capital.

In Epping Forest, the numbers of recorded cases have not risen above ten in the past four years and currently stand at just five cases.

In Waltham Forest, however, the rate is one in 2,000, which is a doubling of its rate since the early 1990s.

In Redbridge, a total of 74 cases were recorded in 2001, and by 2003 that number had risen by more than a third to 114.

Other parts of London, Newham for example, suffer far greater rates of infection.

The London Assembly Health Committee and the Department of Health have issued recommendations to reverse this worrying trend.

What is TB?

Tuberculosis (TB) is a curable infectious disease caused by the tubercle bacillus, known as mycobacterium tuberculosis, which grow slowly in the body after exposure and can remain dormant for years.

TB affects the lungs and can be fatal if left untreated.

The bacteria spread through the air when sufferers cough, sneeze or talk, propelling the TB germs into the air.

Yet, according to Esther Trenchard-Mabere, assistant director of public health at Waltham Forest Primary Care Trust, there is no need to fear contracting TB through casual contact.

She said: "To get TB you would need to have had sustained physical contact with someone who had TB. Spitting does not spread TB, and people coughing on the Tube does not spread TB.

"If you are generally in good health, you are highly unlikely to become ill."

Who is vulnerable?

Anyone can catch TB, but only about 30 per cent of healthy people who are exposed to the bacteria will develop it, Those at the highest risk include those with close contacts with an infected patient and those who move from a country where TB is more prevalent.

HIV/AIDS patients often suffer from TB, and others with weakened immune systems are more susceptible, such as young children, diabetics and the elderly.

Other factors that can increase someone's chance of contracting TB include chronic poor heath.

Screening and treatment TB has long been associated with poverty.

Families were ripped apart by the disease, even up until the 1950s, when doctors sent infected children off to open-air schools for years of fresh air they believed would help alleviate the symptoms.

The schools did little to alleviate the TB and left children round the UK emotionally scared owing to their family separation.

Patients today can rely on effective testing and antibiotic treatment (usually a six-month course) to kill the bacteria.

A simple skin test is all that is required, possibly followed up with a chest x-ray.

Symptoms include coughing for more than three weeks, sometimes with blood, shortness of breath, loss of appetite and/or weight loss, fever and night sweats, swollen glands and extreme fatigue.

North east London TB network manager William Roberts said: "If people suspect they may have TB, they should make an appointment to see their doctor as soon as possible."

Those who would like to take action to prevent possible contracting TB can ask their practitioners about BCG vaccinations.

In most cases, TB is easily treatable through a six-month course of antibiotics.

Six per cent of the TB bacteria from patients with TB are resistant to one or more drug, but only one per cent have proved to be multi-drug resistant.

So while drug resistant strains of TB are on the rise in London, most cases of TB are easy to treat.

The spread of TB: In England, the disease was all but defeated in the 1960s and 1970s, thanks to improved nutrition, better housing, milk pasteurisation, early detection methods, antibiotics and BCG immunization.

It finally looked as though England was about to rid itself of the deadly bacteria.

Increasing international travel to and from more exotic locations, such as Africa, Asia, Latin America and Eastern Europe, however, has led to TB's re-emergence.

Nearly two million people die of TB each year worldwide, nearly a third of the world's population is infected, and it is the biggest killer of women worldwide, according to the World Health Organisation.

Last month the Department of Health published an action plan from the Chief Medical Officer entitled Stopping Tuberculosis in England. In addition to its recommendations, the report pointed to several worrying facts, most notably that 6,638 people were newly diagnosed with TB in England in 2002, that around seven out of every ten people with TB come from an ethnic minority group and that nearly two thirds of TB patients were born abroad.

Untreated TB sufferers, on average, infect ten to15 people every year, according to the report.

In November 2003, the London Assembly's Health Committee issued its own report, Tuberculosis in London, which stated that TB growth rates were greatest and rising fastest in the north east and north west NHS sectors of London.

In the last ten years there has been a fourfold increase in TB in Hillingdon, Enfield and Greenwich, according to the assembly's report. And the rates have doubled in Barking, Easling, Hackney, Islington and Lewisham.

Tackling the problem Government and health agencies are boosting training, testing and treatment efforts for TB, as well as research into better treatments.

A recent TB action plan by the Government recommended a number of measures, such as better screening for high-risk groups, as well as vaccinations for babies in those groups.

One major problem, however, is sufferers' unwillingness and/or inability to get tested.

The poorer, higher-risk groups are less likely to have access to primary care, and others simply fear the stigma.

In researching this article, a colleague shared the experience her family had with her brother's bout with TB, but she demanded anonymity for both her brother and herself for fear of being associated with the "dirty" disease, despite the fact that more than 50 years had passed.

The brother was pulled from his home and sent to an open-air school.

"My brother stayed there for six years because the doctors didn't want him returning to the damp housing conditions that they feared would exacerbate the problem. He's never got over it. I can remember them dragging him away from my mum," she explained.

Sufferers today are just as unwilling to be identified. One patient, despite being offered anonymity, refused to discuss his experience with TB, noting only that he had no idea how he contracted it. "There is still a lot of stigma surrounding TB and this prevents people with symptoms from coming forward," explained Redbridge Primary Care Trust nurse consultant Gladys Xavier."

Agencies are working hard to reverse this trend.

"Hospital trusts and PCTs within north east London, working in collaboration with the NE London TB Network, are committed to tackling the issue of increasing rates of TB in NE London," explained TB network manager William Roberts.

Despite the low rate of infection in Epping Forest, the Essex HPA has been working to raise awareness of the disease.

Dr Sally Millership said: "Essex HPA ensures all staff working in Epping Forest receive training sessions to ensure they are aware of the symptoms and how to care for patients diagnosed with TB."

If you suspect you have been exposed to TB, or have any of the symptoms discussed above, contact your doctor immediately for a TB test.

For more information about TB, contact NHS Direct on 0845 4647, which is available 24 hours a day.