Massive increase in TB in London to be revealed

Tuberculosis, known as the white plague in Victorian England, is returning to London at an alarming rate, according to a set of studies and reports due to be released this weekend. London now is the only major European city where the rate is actually rising, according to one report.

TB was once thought to be a factor of Charles Dickens’s times, and was virtually banished through most of the last century. Last year, however, some 9,000 cases were reported in the UK, 40 per cent in the capital.

These represent a 50 per cent increase in reported cases in London over the past decade – up from 2,309 in 1999 to 3,450 last year. This, say authors of the reports to be released in the coming days, is certainly an underestimate – because they have evidence that only 70 per cent of all Tuberculosis cases are being picked up and treated.

At least 250 of the cases, according to one of the experts, have proved resistant to the usual antibiotic treatments. Another worry is that the disease is now in Britain’s jails. In 2000 TB swept through New York jails and spread among jail staff. It was when a white jailer died that the authorities released $80 million to tackle the outbreak.

This led experts in infectious diseases on both sides of the Atlantic to warn the British government that the same sort of outbreak might be imminent in Britain – particularly as a rise in TB cases was being reported across eastern and central European.

However, the assumption that TB is being spread by recently arrived immigrants in London is erroneous, according to one frontline medical practitioner in the East End I spoke to. “Most of the cases occur in people who have been here at least three years,” he said.

This suggests that what’s behind the rise in TB cases is poverty, insanitary conditions and overcrowded housing, particularly in London’s East End.

TB is likely to strike most in so-called ‘high risk’ groups in the capital – the homeless and vagrants, drug users and HIV-positive groups. Some may carry the illness and not realise they have it all, and pass it on unwittingly.

Though the government declined to fund any special measures, in 2000 the King’s Fund gave a grant of £250,000 for a study on the resurgence of TB in the capital. One of the studies was carried out by Professor Griffiths, an expert in community hygiene and medicine who has continued to practice as a GP in Hackney.
 
One of the measures undertaken in the research was to brief 30 out of a group of 61 GPs in the East End with a one-day course on how to identify TB. The 30 doctors who received the training showed a dramatic increase of ‘pick up rate’ in identifying early symptoms of the disease compared with the 31 doctors who had not been given the tutorials.
 
One of the problems, a health worker explained to The First Post, is that it so difficult to identify the early symptoms – tiredness, a fever and some sweating at night. The last stages of coughing up sputum, often with blood, immortalised in the accounts of the early 19th century death of the poet John Keats, come much further down the line.

Today TB can still prove deadly. Treatment with antibiotics takes about six months.

Doctors and frontline health workers are very sensitive about talking openly about the return of the white plague as they are concerned about resources for the future in the present climate of government spending cuts across the board. However, I understand a number of experts are preparing to approach the Health Secretary Andrew Lansley about the matter once the reports are published this weekend.

But one experienced doctor I spoke to said, “We need an urgent and radical rethink about how we go about this.” A health worker who has a practice in Bow said, “The problem is the shortage of primary health care delivery – and so many GPs serve as a referral agency and little more.”

One relatively inexpensive innovation is to have one or two paramedics or doctors acting as link personnel to help identify TB cases. They could liaise with GPs and the highly successful mobile clinic services operating in the poorest boroughs. ·