So how surprising would the same people find it to discover that, in 2003, Health Protection Agency (HPA) figures show that reported incidences of TB in the London Borough of Brent, at 117 per 100,000 of population, were almost twice as high as Brazil (at 64 per 100,000) and also greater than China?
Probably both surprising and shocking. But not to Dr Sam Walters, who runs what is generally considered to be the UK's largest paediatric TB clinic. Based at St Mary's Hospital Paddington, part of the Imperial College NHS Healthcare Trust, the clinic now treats around 50 children a year who are infected with TB, and another 30 who have full blown symptoms of the disease.
Dr Walters, one of the country's leading infectious diseases paediatricians, is worried about the way things are going. "This used to be a pretty rare disease, but now we run a clinic here every Wednesday morning, and the numbers require it to be every week. As well as the children we treat, we screen another 150 each year for the disease."
Clinical nurse specialist Anne Marie Hatton, who works closely with Sam Walters to provide joined up care for adults and children with TB at St Mary's, says there are several ways that children will come into the service. "Many paediatric cases come to us because their parents have been diagnosed; they will first be seen in our TB walk in clinic. The most common symptoms are persistent coughing, fevers, night sweats and weight loss, usually spanning several weeks. The worry is it can be weeks or even months before a child gets to the clinic."
So what is the prognosis if you are found to be infected with TB? "The good news is that, with treatment, kids can quite quickly become much better.
We do get difficult cases referred from across the country and we are happy to see children from anywhere. Once diagnosed, it would be very unusual for this to be fatal in children, and it is many years since we had a TB death in a child," says Walters.
"The hardest thing about TB for parents is that they sometimes find themselves having to give a protracted course of drugs to their child, who screams and kicks or spits out medicine because they don't like the taste," he says.
Around the world, TB is on the march again. This disease of the respiratory system is now the biggest killer of women, according to new research from the World Health Organisation. Figures show that 8.8 million people worldwide are infected with the disease and it is estimated that two million deaths resulted from TB in 2002 alone.
The HPA has reported that there has been a small decrease in UK Tuberculosis (TB) cases in 2007, compared to 2006. These provisional UK figures were released for World TB Day, but experts warn the number is still too high.
Ibrahim Abubakar, Head of the Tuberculosis Section at the Health Protection Agency's Centre for Infections, says: "This year's report 'Tuberculosis in the UK' shows that in 2006 both the number of TB cases and the rate were very similar to 2005. It is too early to judge, however, whether this is a sign of a slow down in the long term increase which we've seen over the last two decades.
"Although levels of TB among the general population continue to be low, in some areas of the UK , such as the inner cities, it is clear that rates of TB remain high. The majority of TB cases in the UK occurred in young adults aged 15-44 years with the London region accounting for the largest proportion of cases (40%) and the highest rate (44.8 per 100,000)," he says.
The St Mary's team run teaching sessions to get the prevention and treatment message across to communities in London that can be hard to reach. "The epidemiology is that this disease is more prevalent in kids from sub-Saharan Africa, especially Ethiopia and Somalia. There is still a huge stigma attached to TB amongst these communities, added to which sometimes we are trying to help kids whose families have a temporary residential status which might inhibit them from coming forward with a health problem," says Walters.
As tough a challenge as this might be, Walters says there are darker storm clouds gathering on the horizon. MDR TB has been in the news a lot recently. This is a highly resistant strain driven by poorly followed treatment or misprescribed drugs, two issues which make the original problem much worse.
He points to the countries of the former Soviet Union as being in 'meltdown' with newer, drug resistant strains of TB where standard medication simply won't work because of bungled healthcare treatment. "In terms of public health, imperfect healthcare for TB is worse than no healthcare," he emphasises.
So what is his advice for parents who might be worried their child has been exposed? "If you know your child has been exposed to TB, see your GP or contact your nearest TB clinic. This disease is curable if you treat it seriously. "
And treating it seriously is just what he and colleagues like Ann Marie Hatton are doing at St Mary's.
Notes
TB is a disease caused by a germ usually spread in the air. It is caught from another person who has TB of the lungs when that person coughs or sneezes. TB usually affects the lungs, but can affect other parts of the body. Infection with the TB germ may not develop into TB disease. Only some people with TB in the lungs are infectious to other people and even then, you need close and prolonged contact with them to be at risk of being infected. TB disease develops slowly in the body, and it usually takes several months for symptoms to appear. Any of the following symptoms may suggest TB:
- Fever and night sweats
- Persistent cough
- Losing weight
- Blood in your sputum (phlegm or spit) at any time
Imperial College Healthcare
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