Sharp increase in tuberculosis

The tuberculosis bacterium is becoming resistant to drugs

The number of adults and children with the respiratory disease tuberculosis (TB) in the UK has hit a 15-year high, according to the latest figures.

Research by the British Thoracic Society (BTS), published in the journal Thorax, shows that TB cases have risen by nearly a fifth between 1987 and 1998.

London has more cases of the disease than any other large European city, with more than 4,000 diagnoses a year in the capital.

The BTS is warning that more specialist health staff are urgently needed to tackle the upsurge in the disease.

TB is not a disease confined to the history books

Professor Peter Ormerod, British Thoracic Society

TB nurses and health visitors play a vital role ensuring that patients with TB take their prescribed drugs, and tracing family and friends who may be at risk of infection.

However, the BTS has found that only 14% of the UK's TB hotspot districts had adequate numbers of specialist staff in 1998.

A recent study has also shown that England and Wales have half as many lung physicians per 100,000 people as the rest of Europe.

The BTS has issued a revised code of practice designed to combat the disease. It suggests:

• all immigrants and longstay visitors to the UK from Asia, Africa and South America should be screened for TB. In 1998, 56% of reported TB cases were in people not born in the UK
• the procedure should be performed at the port of entry or by local health authorities
• screening should consist of a health interview, with testing and treatment where necessary
• all TB cases must be notified to a designated Communicable Disease Control officer
• BCG vaccination should be offered to certain higher risk groups

Professor Peter Ormerod, Chairman of the British Thoracic Society Joint TB committee, said TB infection rates in the UK were still relatively low.

But he added: "TB is not a disease confined to the history books - and there is no room for complacency.

"If we want to maintain full control of the disease we must be vigilant and fully implement these recommendations.

"Local TB services and staff must be strengthened as a matter of urgency."

Costing millions

The BTS study has been echoed in a new report published by the British Lung Foundation (BLF).

The study, Lung Report II, warns that complacency towards TB is costing the NHS millions of pounds every year.

Lung disease

Lung disease affects about eight million people in the UK

Lung disease is the third biggest killer - responsible for 10.8% of all deaths

More people (17.8%) consult their GP for respiratory problems than for any other disease area

6.5% of all hospital admissions are due to respiratory illness

It is estimated that treating a patient with multi-drug resistant TB (MDR-TB) costs the NHS an average of more than £60,000 per person.

This strain of the disease is usually caused by unmonitored patients failing to take their treatment correctly and developing resistance to effective anti-TB drugs.

Dr John Moore-Gillon, BLF spokesman, said: "In the 1970s we thought we were close to wiping out TB but now there are more than 6,000 new cases each year, with London having more cases than any other large European city.

"And, as it was in Victorian times, it is still those with the poorest living conditions who are worst affected by this disease."

He added: "But the real tragedy is that the development of new drugs over the past 50 years could have led to the eradication of the disease.

"World-wide complacency about TB has led to an increasing burden on resources in Britain and elsewhere and to a truly desperate situation in many parts of the world."

The BLF is calling for more investment, both in specialist TB staff and research into combating drug resistant strains of the disease.

At present, only 2% of government funding for all medical research is given to lung disease.

In England alone, respiratory disease accounts for up to 20% of all admissions to NHS hospitals.