Intended for healthcare professionals


Tuberculosis and social exclusion

BMJ 2006; 333 doi: (Published 06 July 2006) Cite this as: BMJ 2006;333:57
  1. Alistair Story, TB nurse and scientist (,
  2. Rob van Hest, consultant TB physician,
  3. Andrew Hayward, senior lecturer in infectious diseases
  1. Tuberculosis Section, Respiratory Disease Department, Centre for Infections, Health Protection Agency, London NW9 5EQ
  2. Tuberculosis Section, Department of Infectious Disease Control, Rotterdam Public Health Service, Rotterdam, 3011 EN, Netherlands
  3. University College London, Centre for Infectious Disease Epidemiology, London NW3 2PF

    Developed countries need new strategies for controlling tuberculosis

    In developed countries most patients with tuberculosis are not infectious, can readily access health services, and complete treatment successfully with minimal supervision from a health worker. As a result they make only limited demands on services and pose little public health risk. By contrast, many socially excluded patients are at risk of delayed presentation, poor adherence, and loss to follow-up. A recent persistent outbreak in London including over 220 drug resistant cases and disproportionately affecting homeless people, prisoners, and problem drug users clearly illustrates the urgent need to strengthen tuberculosis control among socially excluded groups.1

    Mycobacterium tuberculosis can infect anyone but predominantly affects the poor. Globally, 98% of deaths from tuberculosis are in the poorest countries.2 In rich countries tuberculosis mainly occurs in people born abroad and in socially excluded groups. In London, which accounted for over 40% of all reported cases …

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