Photograph: Barts Hospital/Getty Images: An X-ray of a human chest showing pulmonary tuberculosis; Tuberculosis, the "white plague", is returning to London, which risks the sort of serious outbreaks that occurred in New York and California in the 1990s, an article in the Lancet medical journal warns today.
Nowhere else in Europe have TB rates continued to rise, says Dr Alimuddin Zumla of the department of infection of University College London medical school. "The incidence in the UK has gradually increased over the past 15 years," he writes. Last year more than 9,000 cases were reported in the UK, with nearly 40% in London. "This pattern is striking when compared with the general decline in other European countries," he says.
TB, known as the white plague in Victorian Britain because of the pallor of the patients, who were often confined to sanatoriums and usually died, was thought to have been conquered by the early 1980s. Antibiotic drugs, improved health services and the BCG vaccination brought it firmly under control.
In recent years, however, it has undergone a resurgence, worsened by the prevalence of HIV, which damages the body's defensive immune system. Currently 1.7 million people die of TB every year around the world. Because of the difficulties in complying with a six-month regime of antibiotic treatment, strains of TB bacteria have become resistant to the commonly used drugs.
In London too, says Zumla, drug-resistant TB has been on the increase over the past decade. Last year, 172 TB cases were resistant to isoniazid, the standard antibiotic treatment. A further 58 cases were resistant to more than one drug.
TB thrives in areas of deprivation. The increase in numbers has been largely in people who were not born in the UK, but in 2009, most of them (85%) had lived in the country for at least two years. Many are living in conditions familiar in Dickens's time. "Poor housing, inadequate ventilation and overcrowding – conditions prevalent in Victorian Britain – are causes of the higher tuberculosis incidence rates in certain London boroughs," writes Zumla.
The disease spreads in the close conditions that thrive in shelters for the homeless. It is also in prisons.
Zumla calls for immediate and long-term political and financial commitment from the government "if the tide is to be turned against the return of the white plague in London, and if tuberculosis is to be controlled".
Events in the United States provide a warning, writes Zumla. "The ominous situation in London is reminiscent of the unexpected outbreaks of multidrug-resistant tuberculosis in New York and California prisons in the early 1990s, which arose as a result of complacency of the respective states' surveillance and control programmes. A large financial investment, with political and legal support, was required to re-establish control."
http://www.guardian.co.uk/world/2010/dec/17/tuberculosis-thriving-victorian-london
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