TB in Leicester: out of control, or just one of those things?
BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7295.1133 (Published 12 May 2001) Cite this as: BMJ 2001;322:1133
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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.
Competing interests: No competing interests
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.
Competing interests: No competing interests