Public health legislation should be changed

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7033.775c (Published 23 March 1996) Cite this as: BMJ 1996;312:775
  1. G H Stewart,
  2. S Nelson
  1. Consultant in communicable disease control Senior registrar in public health medicine Avon Health, Bristol BS2 8EE

    EDITOR,—We were interested in Meirion R Evans's article about tuberculosis in the United Kingdom.1 A problem recently arose in this district concerning the screening of contacts of a patient with multidrug resistant tuberculosis acquired in a nosocomial outbreak in the Chelsea and Westminster Hospital.2 The contacts identified were sent several invitations to attend the tuberculosis screening clinic, but they failed to attend despite intervention by their general practitioners and the tuberculosis health visitor. As a last resort, the feasibility of applying for an order from a magistrate for compulsory medical examination under section 35 of the Public Health (Control of Disease) Act 1984 was considered. Although this legislation is rarely used, the threat of implementation is occasionally useful.

    To obtain an order under section 35 several criteria need to be fulfilled. These include (para 1(a)) that there is reason to believe that a person (i) is or has been suffering from a notifiable disease or, (ii) though not suffering from such a disease, is carrying an organism that is capable of causing it. Clearly, para 1(a)(ii) may be applied to the contacts of patients with notifiable diseases. Under regulation 4 of the Public Health (Infectious Diseases) Regulations 1988, however, this paragraph is specifically excluded in relation to tuberculosis. Since the aim of contact tracing in tuberculosis is to identify infected people before they become clinically ill, use of section 35 would seem not to be appropriate in this context. Section 20 of the same act, which enables a person to be excluded from work, might be applicable but would not be useful for diagnostic purposes. This would be an expensive option for the local authority, which would be required to compensate for loss of earnings.

    The lack of appropriate legislation is of particular concern in view of the recognised association between tuberculosis and HIV infection. People infected with HIV are at greatly increased risk both of reactivation of latent tuberculosis and of acquiring tuberculosis from contact with infected patients. It has been shown in the United States that the proportion of patients with multidrug resistant tuberculosis is relatively high among patients with HIV infection.3 We hope that the long awaited parliamentary debate after the review of public health legislation4 will adjust the law to meet this threat to the public health.


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