Experts predict big rise in TB cases and slam Government’s failing TB Action Plan

Nine out of ten TB specialists believe the number of TB cases in the UK is set to rise over the next five years, and there is a failure to implement the Government’s much fan-fared TB Action Plan, according to results of a new survey by the British Thoracic Society, published today. (1)

The TB experts’ prediction is supported by new figures, published today by the Health Protection Agency, which show yet further increase in the number of TB cases in this country, which have risen year on year for the last decade.

Professor John Macfarlane, Chairman of the British Thoracic Society said,

“This Victorian disease is on the march. Doctors up and down the country are warning us TB is in danger of staging a serious comeback.”

The results of the BTS’s survey among TB leads show worrying gaps in the implementation of the Government’s TB Action Plan since its publication in 2004 (2), including: lack of TB resources and trained staff and failures to meet referral times:

• 77% of TB leads reported no change in provision of resources to implement the recommendations of the Government’s TB Action Plan; almost 10% witnessed a decline in resources and 15% predict further decreases in resources
• Despite it being a central aim of the TB Action Plan that "suspected cases of pulmonary TB are seen by a TB team within two weeks of first presentation to healthcare", over a fifth (21%) of TB leads stated this is not the case
• Despite the recommendation in the TB Action Plan that there should be “local TB clinical networks at population levels, with a designated local TB co-ordinator mandated to work across organisational boundaries (3), 46% of respondents reported that they still do not have a local multi-disciplinary TB network in their area
• Almost half of TB leads (43%) do not have access to a designated microbiologist who deals with TB.

TB specialist nurses seems to be worst affected. NICE guidelines state that TB specialist nurses are essential for the management of patients, yet almost a third (30%) of respondents to the survey claimed TB specialist nurse positions remain under threat or review. This is supported by further research from Britain's national TB charity, TB Alert, which shows five out of 11 high incidence areas in the UK do not meet the recommended 1:50 TB nurse to patient ratio. (4)

Paul Sommerfeld, Chair of TB Alert, said,

"TB numbers are still rising despite optimistic predictions in the 2004 TB Action Plan of a dropwithin three years. It is deeply troubling that at the same time resources for TB services are drying up. It should be clear that the London guideline of one specialist TB nurse per 40 TB cases must applyto all high-incidence TB areas. It is unacceptable that barely a third ofsuch areas meet this standard."

Professor John Macfarlane, Chairman of the British Thoracic Society said,

“Since the publication of the Action Plan in 2004, the number of TB cases in the UK has risen year after year. It’s clear the Government is going to fail to meet its success criteria (5) if targets set out in the TB Action Plan are not urgently prioritised and PCTs and Trusts are not given the leadership and resources they need to achieve this and see TB start to decline.”

Dr Keith Prowse, Chairman of the British Lung Foundation, said: "TB is an important public health issue but according to this survey the Government's TB Action Plan is all plan and no action.  We urgently need the resources to deliver the specialist doctors, nurses and multi-disciplinary teams which were promised in the Plan.  TB is a preventable and treatable condition and the key to tackling it in the UK is in early diagnosis and treatment by specialists."

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For more information about the British Thoracic Society’s survey or to set up interviews, please contact Anna Gardner or Ben Caspersz on 0207 815 3900 or email Anna.Gardner@munroforster.com

Notes to editors

• The British Thoracic Society is the UK’s professional body of respiratory specialists (www.brit-thoracic.org.uk)
• TB Alert is an awareness raising and campaigning group on all aspects of TB worldwide (www.tbalert.org)
• The British Lung Foundation is a charity set up in 1985 to provide information on lung conditions and all aspects of lung health, support for those living with a lung condition through the national Breathe Easy network, as well as funding of research in to lung disease (www.lunguk.org)

(1) On-line survey by the British Thoracic Society among 54 of a total 184 TB leads across the UK (any healthcare professional in charge of managing TB cases in their area, including TB nurses, consultants and other specialists), March 7th-14th 2007

(2) ‘Stopping tuberculosis in England’ An action plan from the Chief Medical Officer, Oct 2004

(3) ‘Stopping Tuberculosis in England’, 2004, page 13

(4) Research from TB Alert: TB Nurse to Patient Ratios in UK High Incidence Areas 40/100,000+, January 2007. High risk areas include: Bradford, Birmingham, Derby, Leicester, Luton, NC London, NE London, NW London, Sandwell, SE London, Slough. The 1:50 ratio is recommended by NICE

(5) “If Tuberculosis is being controlled successfully we expect to see within the next three years: a progressive decline (of at least 2 per cent per year) in rates of TB in population groups born in England [and] a reduction in the incidence of disease among people who entered the country and became resident here within the previous five years.” ‘Stopping Tuberculosis in England’, 2004

GLOBAL CAMPAIGN TO ELIMINATE TB BY 2050 CAN ONLY SUCCEED WITH NEW TECHNOLOGIES SAY HEALTH EXPERTS

A TB-free world by 2050 is achievable but only with a new TB vaccine and new drugs and diagnostics, said a group of health experts in London today.

At a meeting at the Royal Society of Medicine, New Tools for a TB-free World: Enhancing the British Contribution to the Development and Introduction of New TB Drugs, Diagnostics and Vaccines, scientists, policymakers and industry said there was a unique opportunity to rid the world of TB and called on the UK Government to provide leadership and full funding for new tools for TB at the G8 this July.

The meeting, organised by UK charity TB Alert in association with the Royal Society of Medicine, follows the launch of the Global Plan to Stop TB 2006-2015: Actions for Life, by the Stop TB Partnership, in January this year. At the launch, Chancellor Gordon Brown called for the G8 to formally make TB a priority, and urged G8 member countries to pledge immediate new funding.

Secretary of State for International Development Hilary Benn pledged an additional £47.1 million for procurement of TB drugs in India at the beginning of the year.

Scientists at today’s meeting in London signed a Communiqué calling on the UK Government to commit increased resources to development of new tools; pursue innovative ways of financing commercial scientific development, and urged the G8 at their meeting in July in St. Petersburg, to strongly endorse the Global Plan to Stop TB 2006–2015, including its targets for new tools.

These are the development of a new vaccine by 2015; new drugs with the possibility of reducing treatment time from six to two months shortly after 2015, and a more accurate point of care diagnostic test for active TB by 2010. 

The current TB BCG vaccine, developed more than 80 years ago, has only limited effect, diagnostics for the global campaign are more than a century old and there has been no new TB drug for 40 years.

The Global Plan identifies the total costs of R&D of new tools as £4.8 billion with a funding gap over the next ten years of £3.25 billion.

Speakers from the main public-private partnerships working on TB research and development also called for greater public investment to match the substantial philanthropic funding now in place for TB, and innovative funding mechanisms that will accelerate the research and development of TB drugs, diagnostics and vaccines.

”Fundamental advances in the last few years have transformed the field of TB vaccines. We now have six promising vaccine candidates in clinical and pre-clinical trials, and within the next ten years we can have a vaccine that, in combination with new drugs, could achieve global control of TB,” said Dr Jerald Sadoff, President and CEO, Aeras Global TB Vaccine Foundation.  “But this will only happen with strong public investment to ensure the rapid development and distribution of new TB vaccines.”

“In just five years, we have created the largest pipeline of new TB drugs in history, with two in clinical trials and nine more in development,” said Dr Maria Freire, President and CEO, Global Alliance for TB Drug Development. “But TB is a global problem and it requires a global solution, which means that governments must step up to the plate and help provide the funding that will let us achieve one of the greatest global health victories ever.”

“FIND is making great strides in the development of simple, rapid and affordable diagnostics for poverty-related diseases in developing countries,” said Dr Vinand Nantulya, Senior Policy Director of the Foundation for Innovative New Diagnostics.  “Funding now will make the difference between public health success or failure.”

“Without new tools it will be impossible to eliminate TB by the middle of this century and an immense challenge to control TB in Africa and Eastern Europe,” said Dr Christopher Dye, Chief Epidemiologist, Stop TB Department, World Health Organisation. 

“Britain has a good tradition of contribution to research on TB. We have the opportunity to bring about major advances. We very much hope that the government, foundations and companies will provide the necessary resources,” said Paul Sommerfeld, Chair of TB Alert.

Note to editors

1. For further information please contact Becky Owens Tel: 07779 260454.

2. TB Alert as Britain’s national tuberculosis charity is concerned with TB both overseas and in the UK. Abroad, it supports TB projects with a focus on community involvement in Bangladesh, India, Malawi, Zambia and Zimbabwe. In Britain it provides information services on TB and is engaged in advocacy to increase action on TB by government, companies, and other agencies.

Commenting on the publication of the National Institute of Public Health and Clinical Excellence’s (NICE) guidelines on the clinical diagnosis and management of tuberculosis, and measures for its prevention and control today:

Dr John Moore-Gillon, Chair of the British Thoracic Society’s (BTS) Joint Tuberculosis Committee said:“We are delighted that NICE has produced these new guidelines for Tuberculosis (TB), which build on the work of the British Thoracic Society in this area in the past 25 years.  There has been a worrying resurgence of TB in the last decade so these guidelines are vital if we stand a chance of eradicating this disease once and for all.

“There are many challenges in controlling TB in Britain, and indeed, across the world.  Setting high standards and ensuring the resources to meet these standards are available are aims, which must go hand in hand.”

Paul Sommerfeld, Chair of TB Alert said: "TB Alert welcomes the fact that NICE has given the issue of TB serious consideration. It is a major health issue both globally and in the UK. We hope the NHS will allocate the resources required to bring TB numbers in this country down - by applying the NICE guidelines as well as recommendations arising from the Department of Health's own working groups on implementation of the National Action Plan for Stopping Tuberculosis in England."

Dame Helena Shovelton, Chief Executive of the British Lung Foundation said: “The British Lung Foundation welcomes the new NICE guidelines for TB.  Setting standards and having adequate resources in place will help to fight this serious respiratory disease both in the UK and globally. With nearly 8.8 million new cases of TB worldwide every year, it is crucial that the NHS provides the guidelines of best practice to fight this disease in the UK.”

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For more information or to set up interviews please call Anna Gardner, James Hollaway or Ed Gyde on 0207 815 3900 or email anna.gardner@munroforster.com

Notes to editors:

• The BTS is the UK’s professional body of respiratory specialists (www.brit-thoracic.org.uk)
• TB Alert is the UK’s national TB charity founded in 1998. It has become a main reference point for health professionals, other NGOs, media and government on TB issues, with several of Britain’s leading TB experts on the Board of Trustees and volunteer committees
• For more information regarding TB Alert, contact Tina Harrison on 0845 456 0995 or visit www.tbalert.org
• For further information about the British Lung Foundation, please visit www.lunguk.org/
• For more information about NICE, visit their website www.nice.org.uk

National charity TB Alert provides information on TB vaccination following end to BCG schools programme.

National charity TB Alert has produced a leaflet for the public giving guidance on BCG (Bacille Calmette-Guerin) vaccination.  This follows the suspension of routine vaccination of children against TB last year. Until Summer 2005 the TB vaccine BCG was given to children at secondary school.

TB Alert, along with many schools and frontline healthcare staff, has been inundated with calls regarding BCG since the programme ended, mostly from parents who are unclear about what they need to do about vaccinating their children.  

“Many parents feel they need more information about the change in policy and are usually quite perplexed when they first contact us.” said Tina Harrison, TB Alert’s Awareness Officer.

“On average the BCG calls I’m receiving last for over 20 minutes and I know that many healthcare staff have had the same experience. We hope the leaflet will help allay parents’ concerns and reduce the additional burden placed on healthcare and education staff regarding this issue.”

The BCG schools programme has been replaced with targeted vaccination aimed at babies, children and adults at higher risk of TB.

There are good epidemiological reasons as well as issues around thelimitations of the BCG vaccine that have led to the change of policy. The risk of catching TB for most people is still very small and the best way to stop the spread of the disease is to cure people who have it. BCG does not protect everyone and is thought to be effective only for around 15 years.

Parents, however, are understandably anxious, especially as they hear that TB is a continuing global and British problem, and rates in Britain are rising.

The Department of Health recommends BCG for:

• All babies under 12 months either born or living in areas where there is a high number of cases, or who have a parent or grandparent who were born in a country where there is a high number of cases. A midwife or health visitor should automatically arrange a BCG if a child falls into this category and parents should contact them if they have any questionns.

• Older children who have not had BCG and either come from a country where there is a high number of cases or have a parent or grandparent who were born in or come from such a country. A health visitor, practice nurse or GP should seek advice from the local Immunisation Coordinator if parents feel their child is at increased risk and they have not been vaccinated.

Other groups who may be at increased risk of TB are:

• Close contacts of people diagnosed with TB in the lungs. In this category, people will be identified and contacted by local public health services.

• Occupational groups such as those working in health care, with the elderly, in hostels for the homeless and refugees, laboratory staff, prison and veterinary staff. In this group, people are advised to contact their occupational health or personnel department regarding BCG.

• Individuals going to live or work with local populations for more than one month in a country that has a high number of TB cases. In this group, those under 35 years of age (research suggests BCG has little impact in people over 35) and not previously vaccinated may need BCG and may need to access it privately for travel.

The leaflet, ‘Tuberculosis and the BCG Vaccination’ follows national policy. As a non-government organisation, TB Alert also provides independent information, including who to approach for advice regarding BCG and guidance on where to get BCG for travel purposes.

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Note to Editors

1. ‘Tuberculosis and the BCG Vaccination’, is available from TB Alert, at a cost of £12.50 per hundred copies, plus postage.  A PowerPoint presentation, intended to help healthcare and education professionals explain the BCG policy change in the context of TB today to a wider audience, is also available free of charge from TB Alert.

2. About TB Alert

TB Alert is the UK’s national TB charity founded in 1998. It has become a main reference point for health professionals, other NGOs, media and government on TB issues, with several of Britain’s leading TB experts on the Board of Trustees and volunteer committees.

TB Alert’s aims are to:

• Increase awareness of TB both as a global threat and as resurgent in the UK, advocating for greater priority to be given by government to the disease.
• Support TB control programmes, mainly in countries that are highly endemic, to increase access to treatment especially for poor and marginalised groups.
• Complement the work of the NHS in the UK, for example providing information on TB for the public and parents; raising awareness of TB among non-TB specialist staff, and providing resources such as treatment diaries to help patients remember to take their medication (not taking medication correctly can lead to TB becoming resistant to drugs).

Commenting on the Chief Medical Officer’s announcement that the Government will be abolishing the comprehensive BCG vaccination programme for TB for all school children aged 14 today…

Dr John Moore-Gillon, Chair of the British Thoracic Society Joint TB Committee and President of the British Lung Foundation, said:

“We understand the rationale behind the Government’s decision to stop the universal BCG vaccination programme.  It is appropriate to concentrate resources where they are most needed: shifting the focus to areas where TB is particularly prevalent such as in London and other major inner cities, and to population groups at particularly high risk of TB. However, a selective vaccination programme will need to be properly resourced so that those in high risk groups and areas continue to be protected from the disease. It is vital that every single penny of the funds freed up from abolition of universal BCG vaccination is diverted directly into other aspects of TB control, and we would be very concerned if it just became lost in the general public health budget”

Paul Sommerfeld, Chair of TB Alert, said:

“The government decision reflects the position for areas at low risk of TB. It will be extremely important, however, to maintain BCG programmes in areas of Britain with high rates of TB and, even more so, to support BCG programmes in high-burden countries worldwide. TB can never be fully controlled in the UK unless it is controlled worldwide.  As the G8 leaders meet in Gleneagles today we hope they will remember the two million avoidable deaths that occur worldwide every year because of TB.”   

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 For further information or to set up interviews, please call Lauren Goddard or Alessandra Norman on 020 7815 3900 or email lauren.goddard@munroforster.com

 Notes to Editors

 The British Thoracic Society is the UK’s professional body of respiratory specialists (www.brit-thoracic.org.uk)

 The British Lung Foundation is a charity set up in 1985 to provide information on lung conditions and all aspects of lung health, support for those living with a lung condition through the national Breathe Easy network, as well as funding of research into lung disease (www.lunguk.org)

 TB Alert is a charity working to raise awareness of TB, and to support work against the disease worldwide (www.tbalert.org)