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TB's comeback

December 17, 2010

Tuberculosis, which was thought to have been conquered by the early 1980s, has made a resurgence in the UK, especially in London, where Victorian living conditions are common among some groups.

x-ray of lungs
Tuberculosis was once thought defeated in the UK, but London is now the TB capital of western EuropeImage: picture-alliance/dpa

The rates of tuberculosis are rising in Britain, according to an article published Friday in the British medical journal The Lancet, while the disease's occurrences in other western European countries are dropping.

The problem is becoming particularly acute in London, where 40 percent of all of the UK's TB cases have been reported. Four in ten cases are reported in the capital, with the number of cases rising by nearly 50 percent since 1999.

"It's prevailing today in certain sections of the community that replicate conditions in Victorian London," TB expert Alimuddin Zumla of University College London told Deutsche Welle. "Most of the TB occurs in areas where there's deprivation and poverty, and that's where all the homeless are. So we've set up an endemic cycle of transmission."

In all European countries, tuberculosis is largely concentrated in high-risk groups, such as migrants, refugees, homeless people, drug users, prisoners and HIV-infected people. It is caused by a bacterial infection, usually of the lungs.

clinic in South Africa
Some TB strains in South Africa are resistant to all known TB drugsImage: The Global Fund/Juda Mgwenya

The increase in the number of TB cases in the UK has largely been among immigrant groups, although most were not new migrants. Among the cases of those born overseas, 85 percent had lived in the UK for two or more years and about half had lived in the country for five or more years.

The death toll from TB, which used to referred to as the "white plague" due to the pallor of those who had it, began to fall in London at the beginning of the 20th century thanks to improved living standards. In the early 1960s, anti-TB drugs, better health services and BCG vaccinations continued to cut the number of cases.

The disease was thought to have been conquered by the early 1980s, but had something of a resurgence with the coming of HIV, which weakens the body's immune system. In London, as recently as 2000, everyone thought the disease had been conquered, according to Zumla. But now among high-risk populations, TB rates are equivalent to those in Africa.

Drug resistant strains

Another alarming fact is that drug-resistant forms of the disease are beginning to be seen. Complying with the six-month regime of antibiotic treatment has meant that strains of TB have become resistant to drug treatments.

"People start feeling better after two months and stop taking their tablets and drug resistance occurs," Zumla said.

Indian doctor's clinic with x-rays
In India, new treatment methods have helped cut the number of casesImage: picture-alliance/ dpa

The situation is very serious in South Africa, where strains have developed which are resistant to all known TB drugs. In London, TB is showing up that is still treatable, but resistant to the most commonly used drugs.

Zumla said the situation in London is reminiscent of multi-drug resistant TB outbreaks in prisons in the US in the 1990s. They required a large financial investment to be brought under control.

He has called for a reconsideration of the delivery of TB services by Britain's National Health Service, standardized treatment and care methods and improvements in access to TB services. He said because many with TB do not have permanent residences, it is difficult to get them to special clinics for treatment and ensure that they comply with drug regimens.

In New York, he said, a community-based model where health care workers take services to those affected has proven effective and should be adopted in the UK.

Britain, one of the world's major foreign-aid providers, is active in funding anti-TB programs overseas, but Zumla says the country needs to look in its own backyard.

"We seem to neglect our own people here," he said.

Author: Kyle James
Editor: Rob Turner