Education And Debate

Is tuberculosis taken seriously in the United Kingdom?

BMJ 1995; 311 doi: (Published 02 December 1995) Cite this as: BMJ 1995;311:1483
  1. Meirion R Evans, consultant in communicable disease controla
  1. aDepartment of Public Health Medicine, South Glamorgan Health Authority, Abton House, Cardiff CF4 3QX
  • Accepted 8 September 1995

Tuberculosis has been the subject of much concern in recent years. Notifications have increased, inadequacies in surveillance revealed, and policies for BCG immunisation and screening of immigrants questioned. Until recently the disease was given low priority in the United Kingdom. There is no overall strategic framework for tackling tuberculosis, and fears have been expressed about the future of local tuberculosis control programmes in the new market economy of the NHS. An action plan for tuberculosis within the context of a national programme is urgently required. Only then will a major impact on the incidence of the disease be seen.

Until the late 1980s, tuberculosis had been in steady decline in the United Kingdom for over 40 years. However, between 1982 and 1993 there were an estimated extra 8000 cases,1 and around 6000 cases of tuberculosis are now notified annually in England and Wales.2 The rise has reopened debate about the effectiveness and adequacy of control measures and highlighted the lack of an overall strategy for tackling tuberculosis in the United Kingdom.

Tuberculosis strategy in the United States

In 1989 a strategic plan for the elimination of tuberculosis was published in the United States.3 This declared a goal of eliminating tuberculosis (defined as an incidence of less than one case per million population) by the year 2010, with an interim target of 3.5 cases per 100000 population by the year 2000. The plan identified several problems, including deficiencies in identifying and reporting tuberculosis cases and contacts, failures in prevention and in compliance with treatment, and inadequate evaluation of prevention and control programmes in the community. It recommends three priority areas for action:

  • Identifying and screening high risk population groups

  • Making adequate and appropriate treatment and prophylaxis more widely available

  • Developing other approaches to disease prevention and more rapid and effective tests for identifying infective …

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