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EDITORIALS: John M Watson and Fiona Moss TB in Leicester: out of control, or just one of those things? BMJ 2001; 322: 1133-1134 [Full text]

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Leicester TB outbreak

Peter Davies   (16 May 2001)

Look for the elderly carrier

B C Rao   (16 May 2001)

Leicester TB outbreak 16 May 2001
Peter Davies, Consultant Chest Physician Cardiothoracic Centre, Liverpool Send response to journal: Re: Leicester TB outbreak	Sir Leader 12/5/01 p1133. TB in Leicester: out of control or just one of those things? There is one other possible contributing factor not mentioned in your leader on the Leicester school TB outbreak. Unlike most authorities treating tuberculosis and latent tuberculosis infection (subclinical infection) and in contravention of current guidelines 1., Leicester has never pursued a policy of giving comprehensive preventive therapy. The grounds for failing to do this have been published but are somewhat tenuous.2. As your leader states any protection given by BCG in these school children would be waning. If a substantial proportion of children at the school had latent tuberculosis infection a small amount of added infection received through school contact with an infectious case could have tipped a number of students into having active disease. It is possible that the failure to use preventive therapy in Leicester has been a contributing factor to the biggest outbreak of tuberculosis in at least the last 25 years. P.D.O. Davies, Director Tuberculosis Research Unit, Cardiothoracic Centre, Thomas Drive, Liverpool, L14 3PE References 1 Joint Tuberculosis Committee of the British Thoracic Society. Peter Ormerod, Craig Skinner, Johhn Moore-Gillon, Peter Davies, Mary Connolly, Virginia Gleissberg,John Watson, Anton Pozniak, Ruth Gelletlie, Ann Cockroft, Francis Drobniewski,Jane Leese. Control and prevention of tuberculosis in the United Kingdom: Code of practice 2000. Thorax 2000;55:887-901 2.Cookson JB, Cookson AGI. Does a positive Heaf reaction in Asian schoolchildren predict later breakdown of tuberculosis? Thorax 1992;47:776-777.
Look for the elderly carrier 16 May 2001
B C Rao, Genral practitioner Apoorva diagnostic and day care centre, Indiranagar,Bangalore, India Send response to journal: Re: Look for the elderly carrier	The sudden onset of so many cases in a small area makes me suspect the presence of contact/contacts close by. I am sure the two epidemiologists must have thought of this and investigated close contacts like the parents and teachers. But what about grand parents who may have come visiting and those parents who have moved into the area recently? We , unfortunately have more than our share of problems with this disease and when ever faced with a new case the first persons to look for is an elderly carrier in the home who has covert undiagnosed tuberculosis. Occasionally we succeed. It may be a good idea to contact trace the elderly in the area especially those who have moved recently.