Britain's TB Hits 10-Year High

October 22, 2002
By Maxine Frith, Health Correspondent, Evening Standard

A new alert has been raised over the tuberculosis crisis gripping London.

A senior government adviser today calls for the return of the sanatorium in which carriers are isolated in a bid to control the spread of the disease.

Rates of TB in some London boroughs are now at Third World proportions and cases of its more dangerous drug-resistant form are increasing, the head of Britain's TB unit warned. Professor Francis Drobniewski said the disease is also spreading from poverty-stricken areas to more middle-class ones.

He put this down to a small minority of patients who are refusing treatment and going on to infect other members of the public. Rates of the disease are at a 10-year high. Last year there were 6,838 cases in England and Wales and more than 3,000 of those were in London.

At a conference organised by the British Medical Association to discuss London's TB crisis on Thursday, Professor Drobniewski will make the controversial proposal that patients who persistently refuse treatment should be forcibly detained in secure units.

He will also call for the return of sanatoriums to treat other vulnerable sufferers - such as the homeless - in isolation. He will suggest a system of small units with private grounds where patients could receive treatment for up to six months without coming into contact with healthy people.

The image of the TB sanatorium is associated with the Forties and Fifties when more than 50,000 people a year suffered the disease.

Professor Drobniewski is a director of the Public Health Laboratory Service's specialist unit on TB and a consultant at King's College Hospital in Camberwell. He told the Evening Standard: "Tuberculosis is now a major cause for concern in London.

"Half of all the country's cases are in the capital and at the moment we simply do not have the resources or the systems in place to address the issue properly.

"Doctors and the public need to realise that this is not a disease of the past, or limited to those in poverty, I am now seeing rising numbers of affluent, middle class people who have TB.

"These are people who normally should not get it, but because of its prevalence in the community, they are being infected. They are catching it from people they sit next to in a cafÈ, or on a Tube train or in the course of their work."

He added: "Fifty years ago, your granny would have diagnosed someone on the street with TB because it was known about. Now, we have a problem that doctors and the public are not aware of it. A GP may think about TB if they see someone from Africa who is coughing, but if a white banker comes in it does not spring to mind.

"So these people are not being picked up and diagnosis, and therefore treatment, is being delayed."

Cases of the disease in hotspot boroughs such as Newham are now running at 200 per 100,000 of the population - higher than the rates in India. Nearly 400 people died from TB in 1998, the last year for which figures are available. Experts are worried that with rising cases of the drugresistant form, the death rate is inevitably going to rise.

While most patients can be treated with a six-month course of drugs, there are increasing concerns about people who are not sticking to the treatment.

Drug addicts and the homeless are particularly at risk from TB, but Professor Drobniewski said these are the people who can be hardest to treat.

He said: "They may start on the treatment but then they feel better and do not finish the course. This is encouraging the spread of drug-resistant TB and also means that those people are still infected, and passing on the infection to other people.

"We need to balance the rights of the individual against the interests of the public's health, and I would always err on the side of the individual.

"But some people have chaotic lives and they may benefit from choosing to go into a sanatorium where they will get food, shelter and treatment.

"For the small minority of people who refuse all treatment options, it may be that we need to have a way of detaining them in a similar way to the Mental Health Act.

"We would not force treatment on them, but they could be detained in secure units to prevent them from infecting other people."

New York introduced a similar detention system to control a TB epidemic in the 1980s. People who did not take their medicine are now detained at a hospital on Roosevelt Island, in the middle of the East River. Goldwater Hospital has treated tuberculosis since the 1930s, but the secure unit was set up in 1993, when a TB epidemic threaten to spill out of a circle of homeless and drug addicts and ravage the wider population.

In the Nineties, new drug-resistant strains of the disease meant that almost 15 per cent of all cases of TB in the United States were in New York. Many of those infected were also suffering from Aids or suffered from mental illnesses that made them difficult to treat voluntarily.

New laws meant that anyone who refused to accept treatment on the island could be forced to do so and, if necessary, be put in total isolation. The plan proved successful beyond the expectations of the authorities, with the unit discharging its last patient in 2001 after once numbering nearly.

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