London TB rates similar to China

Tuberculosis, a 19th century disease that modern medicine and sanitation virtually eradicated, has made such a dramatic comeback that parts of the UK are experiencing levels of the disease higher than those in China and parts of India and Africa.

The UK cannot escape the TB epidemic that is ravaging some of the poorest countries in the world, said experts yesterday, and it will have to get better at recognising and treating it. Doctors are failing to spot TB; some cases are misdiagnosed as asthma, which leaves those with the disease untreated and spreading infection.

The highest rates in the UK are in parts of London with high levels of immigration, such as Brent, Newham, Ealing and Hackney. The TB burden in those boroughs is not dissimilar to Russia, China, and Brazil - countries that have some of the highest rates in the world.

"London is a snapshot of the global epidemic. What we are witnessing here and in other European capitals reminds us of the 'globalisation' of disease - so long as there is TB in the world, no one can feel completely safe," said Chris Dye of the World Health Organisation yesterday.

Two million people die of TB around the world each year, and the HIV/Aids epidemic is driving rates up by undermining people's immune systems and making them vulnerable to other infections.

Dr Dye was speaking at a briefing for MPs on the world TB epidemic at the House of Commons, organised by the Stop TB Partnership - a coalition of concerned groups that includes the WHO and the Department of International Development.

Tuberculosis rates have risen by 80% in London over 10 years, to reach 40 cases per 100,000. Last year there were 7,300 cases in the whole of the UK, of which more than 3,000 were in London.

Foreign travel and moving populations make it impossible for any country to isolate itself from global diseases. What the UK was experiencing, said Peter Davies, a consultant chest physician in Liverpool, was the return - at a lower level - of the tidal wave of TB that built up in the industrial revolution, as people crammed into cities living in poor housing where contagion easily spread.

"The tidal wave carried off one in four, including the three Brontë sisters," said Dr Davies. "Then it declined, because of better living conditions and natural selection; but the tidal wave moved on. "Africa and Asia have not had the improvement in living conditions we have." Around 60% of the UK's TB cases are people who were foreign-born and acquired it before they arrived. A study in 1995 showed that, among the homeless, levels of TB were 200 times higher than in the general population.

Kenneth Citron, a retired consultant from the Royal Brompton hospital in London and a former government adviser, said that, in his opinion, hostels for the homeless could incubate an epidemic.

"I think this present government has done a great job getting the homeless off the streets into the hostels, but that may have aggravated things. In these hostels there is an excellent chance for TB to spread." All those staying in hostels should be screened for TB, he said.

Dr Davies said he felt that a major advertising campaign to the medical profession by the pharmaceutical industry with the slogan, "Cough? Think of asthma", may have been inadvertently responsible for doctors failing to diagnose TB.

A paper presented to a meeting of the British Thoracic Society yesterday showed that more than half the 121 cases of TB that arrived at an accident and emergency department in Newham were not recognised as TB, in spite of symptoms such as coughing up blood.

Ian McCartney MP told the House of Commons gathering that it took him, a white middle-class man, nine months to convince doctors that he was really ill and not suffering from stress. After treatment for TB, he spent further years trying to get medical help for the painful after-effects caused by scar tissue, and will now be on medication for life.