News Roundup [abridged Versions Appear In The Paper Journal]

UK government acts to curb rise in tuberculosis

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7471.877-a (Published 14 October 2004) Cite this as: BMJ 2004;329:877
  1. Rebecca Coombes
  1. London

The government has launched an action plan to curb a 25% rise in cases of tuberculosis in England over the past decade. A series of measures will target groups at high risk, such as homeless people, prisoners, drug misusers, and recent arrivals from countries with high prevalence.

The chief medical officer, Liam Donaldson, announced a batch of measures including new tuberculosis clinical networks, along the lines of cancer networks; named case managers for every tuberculosis patient; and higher vaccination coverage of babies in high risk groups.

Modern techniques to tackle the disease will be focused on, to bring about quicker and more effective screening, such as DNA bacterial fingerprinting to track tuberculosis spread in communities.

The government is also set to spend more than £400 000 ($720 000; €580 000) on vans containing digital x ray machines, which give an instant means of getting a radiograph and use less radiation.

But Professor Donaldson also said there was a need to “get back to basics” to eliminate tuberculosis, which has been on the rise in England since 1987 and now claims 350 lives a year. He said public health efforts were not consistent across the country and that too many health professionals thought tuberculosis had disappeared in Britain.

This had caused delays in diagnosis and a lack of focus on those most at risk of the disease. Two in five tuberculosis cases occur in London, most of the rest in inner cities, including in the Midlands, Yorkshire, and Humberside.

A total of 6638 people were diagnosed as having tuberculosis in England in 2002, about 70% of whom come from an ethnic minority group and nearly two thirds were born abroad. People from the Indian subcontinent and sub-Saharan Africa have high rates.

Professor Donaldson said that one easy solution to eliminating tuberculosis from England did not exist. Increased use of the bacillus Calmette-Guerin (BCG) vaccination was not a “panacea,” he cautioned.

“Its effectiveness has been disputed. Some say it's very effective, others say it doesn't protect against anything but severest forms of the disease, such as meningitis.”

Increasing proportions of “complex” patients, made rejection of or failure to finish treatment quite likely, Professor Donaldson said. These patients can cost the NHS up to £500 000 each to treat, he said.

“So it's not simply a case of lining people up and curing them. Some people have very chaotic lifestyles and achieving compliance can be difficult,” he said.

The chief medical officer said that the means to force people to have treatment under existing laws are limited. “You can remove someone to hospital, but you can't compel them to have treatment,” he added. Left untreated a person with infectious tuberculosis of the lungs infects 10 to 15 people a year.

But John Moore-Gillon, of the British Thoracic Society, who welcomed the plan, was disappointed about the absence of any funding to implement it. He said the United States had had to spend $1bn to achieve a turnaround in cases after a resurgence of tuberculosis in the 1980s.

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