Last Friday saw front page headlines about the first documented cases of tuberculosis being transmitted from cats to humans. TB Alert did 15 TV and radio interviews during the day, providing reassurance about the minimal public health risk this is likely to pose, and at the same time highlighting that with 9,000 cases of TB in the UK annually, people need to be aware of the risk TB still carries in the 21st century.
Those 9,000 cases are 50% more than we had 20 years ago, and international comparisons also highlight this country’s poor performance: global TB incidence is falling year on year, while the US, which 20 years ago has three times as many cases as the UK, will next year probably have fewer. So where has this country gone wrong?
The mistake is to see TB simply as an infection that can be cured by a course of antibiotics. While that is true, it misses the point. TB is one of the most complex health issues known to man, with many of the challenges taking place out of sight of the clinician. It starts with the infection which two billion people – one-third of the world’s population – carry in their lungs, and which will only turn into the active disease in about 10% of cases. So although 75% of the UK’s TB is among people born abroad, most of them were infected years before moving to the UK.
That ‘latent’ infection can be treated to reduce the risk of TB disease developing at a later date, but that needs a concerted effort to explain to people the benefits – and the downsides – of being treated for an illness that they have not yet, and may never, contract. During the last year, TB Alert has been advising health services in several parts of the country about how to raise awareness of this form of treatment to people who settled in the UK during the last five or so years. That kind of public health planning has made a big difference to TB control in other developed countries and is likely to form a central theme of England’s first national TB strategy when it is published later this year.
There is also huge stigma around TB, with it seen by some communities as a badge of poverty and shame. That contributes to the delay in many people seeking medical help and the hence the gap between the onset of symptoms and the start of treatment. This is where our work to raise awareness of TB makes such a huge difference, by shortening that delay. The fact that most GPs rarely see tuberculosis and might not “think TB” until they have exhausted other options also contributes to people remaining infectious long after they should be on treatment, and we are successfully addressing this in partnership with the Royal College of GPs.
And then we have the challenge of antibiotic resistance, which manifests itself more viciously in TB than most other diseases. It originates in people not completing their six month course of treatment, which is not surprising given how noxious the drugs are and how quickly the worst symptoms pass. During the next year we will be supporting more community organisations to support patients through their treatment, to help ensure they achieve a full cure.
The US sees every case of TB as a failing of its public health system. That is the mind-set the UK must now adopt and TB Alert is at the forefront of that change, working with health authorities and communities around the country to reverse the impact of TB in this country.