There were 2,500 cases of tuberculosis in London last year, that’s more than any other western European city. 9% of those cases were resistant to the first line of antibiotics used to fight the infection. And the Health Committee of the London Assembly warns that drug resistance is set to rise.
In its report Tackling TB in London the Health Committee highlights how the risk from TB is increased by the lack of knowledge and the social stigma attached to the disease and it calls on the Mayor to do more to raise awareness.
It also suggests a more unified and consistent approach to treating the infection across the capital. Currently, treatment and prevention is handled at a local level and the approach varies between the 30 clinics. The committee warns that this can lead to a fragmented approach. This is underlined by the fact that only 24 of the 32 boroughs offer universal vaccination against TB to babies.
Cases of TB have risen by 50% in the last 15 years. A third of boroughs have what is classified by the World Health Organisation as a high incidence – that is more than 40 cases per 100,000 people. But in some areas of Newham, Brent, Hounslow, Harrow and Ealing it is over 150, a higher level than many developing world counties such as Rwanda or Iraq.
At borough level, Newham has the highest incidence in London and England, followed by Brent. London accounts for 40% of all TB cases in England.
TB is caused by bacteria and spread through coughing and sneezing. It most commonly affects the lungs, causing serious illness, and is potentially fatal.
It is treated by a 6-month course of antibiotics that costs around £5,000. Last year £30 million was spent tackling TB in London. Drug resistant strains of the infection require complex treatments often involving hospital care and costs are typically 10 times higher or more.
TB is closely linked to social deprivation with those who are homeless, living in overcrowded conditions, misusing drugs and alcohol, or with weakened immune systems particularly vulnerable.
Many people who are exposed to the tuberculosis bacterium will fight it off or may carry it in their bodies without getting sick. This is known as latent TB.
More than 80% of the cases in London are seen in people born outside the UK, though only a small proportion in those who have recently arrived. The most common countries of origin for non-UK born cases are India, Pakistan and Somalia.
Sufferers may have contracted TB in countries with high incidence and carried the infection in latent form only for it to become active while living in London. Chronic illness or poor housing and nutrition may have acted as a trigger in these cases.
The rate for non-UK born cases has fallen in recent years but those for UK residents have remained unchanged.
The Health Committee reports says that far from being a disease of London’s past TB continues to present a significant public health challenge.