Reducing risk of TB transmission

Around nine million new cases of tuberculosis (TB) and nearly two million deaths from TB are estimated to occur around the world each year. It is the leading cause of death among curable infectious diseases and was declared a global emergency, in 1993, by the World Health Organization.1 In many parts of the world, the lethal combination of TB and HIV is fuelling the TB epidemic and figures released to coincide with World TB Day, in March 2009, showed that one in four TB deaths are HIV-related. In 2007, there were an estimated 1.37 million new cases of TB among HIV-infected people and 456,000 deaths worldwide. Of particular concern is the fact that the rates of drug-resistant TB are increasing in areas with a high prevalence of HIV.2 However, concerns over the spread of the disease are not confined to developing countries and London has been described as Europe’s “TB capital”. According to a report by the All Party Parliamentary Group on Global TB, the British Thoracic Society, TB Alert, and the Royal College of Nursing, local NHS services to tackle TB in England are improving, but, worryingly, nearly 1 in 5 (18%) TB “hot spot” areas and 6 in 10 (60%) areas overall, still do not have a strategy in place to tackle the disease. The study also revealed that nearly 4 in 10 (39%) Primary Care Trusts in England have no current plan (pathway) to deal with a TB outbreak. The report was launched as the provisional number of TB cases in England reached 7,998 cases (2008) – an increase of 2% on the previous year (there were 7,837 cases in 2007). Separate data, released at the British Thoracic Society Winter Meeting, also showed that Manchester has shown a three-fold increase in TB cases since 1996. Other cities and areas with higher rates of TB include: London, Leeds, Leicester and West Midlands. The study analysed the results of a survey, conducted between August and September 2009, among 112 Primary Care Trusts (PCTs) in England, and revealed some positive progress in the delivery of NHS TB services compared with a similar survey in 2007:

 • 6 in 10 (60%) PCTs reported increased funding to tackle TB over the last three years. • Over 9 in 10 (93%) have a senior designated “lead” to tackle TB – nearly double the amount reported in 2007.
• 8 in 10 (80%) are now part of TB multi-disciplinary clinical network.
 • Nearly three quarters (74%) have run awareness raising activities of TB in their local area.
• 7 in 10 (70%) have a system in place for screening TB in “new entrants” to their area.

The survey also showed some worrying deficiencies in local NHS planning and delivery of TB services, however:
• 6 in 10 (60%) have no current strategy to tackle TB.
• Only half (57%) carry out routine active screening for “high risk populations”.
• No PCT consulted people with TB or “at risk” communities in developing their strategy.
 • Only 4 in 10 include provision of long term isolation facilities for TB patients in their strategy.
 • There is seemingly no uniform standard in how PCTs screen “new entrants” to their local area.
• Only 7% have targeted GPs in their TB awareness raising initiatives.