Families told not to panic as TB total reaches 29

By Maurice Weaver

http://www.telegraph.co.uk/et?ac=003787952918705&rtmo=fxVNVoos&atmo=rrrrrrrq&pg=/et/01/4/6/ntb06.html

Re-emergence of a killer that was nearly wiped out

THREE teachers and two pupils were confirmed to have tuberculosis yesterday, bringing the Leicester outbreak total to 29. Health officials are to send letters to families of all 40,000 pupils in the city explaining the situation and urging them not to panic.

Dr. Philip Monk, Leicestershire health authority's consultant in communicable diseases, said: "We are not living in a plague city."

Geoffrey Rawnsley, chairman of governors at Crown Hills Community College, where the outbreak was first detected, called for an inquiry into the shortage of the drug BCG, which led to a decision to shelve vaccination. He said: "There has to be a question over the discontinuing of automatic vaccination. What we are seeing now may be a consequence."

Crown Hills College has 1,200 pupils, 93 per cent of Asian background. Dr. Monk dismissed any correlation between that and the outbreak. He said: "We do not know the origins of this outbreak but it takes two or three months to develop, so what we are seeing occurred some time ago."

Leicester has traditionally had an infection rate four times the national average and there has been speculation that this is connected to Asian families visiting relatives overseas. However, as D.r Monk pointed out: "White children go abroad for their holidays too."

TB, once widespread in Victorian Britain but virtually eradicated with the advent of antibiotics, remains commonplace in India, Pakistan and Bangladesh. There are fears that it is re-establishing itself in Britain. The 29 confirmed cases comprise 22 pupils at Crown Hills College, three relatives and four teachers. Sixty children are also receiving precautionary treatment with antibiotics after tests found they may be in the early stages of the disease.

Dr. Monk said: "It is very clear that it is being spread by minor exposure. It is particularly virulent, and there will undoubtedly be more cases, but the students who have TB have been identified at an early stage and do not pose an infectious risk."

The college is not being shut, but it will shortly close for the Easter holiday. In the meantime, health officials will screen the families of those infected and the rest of the staff and pupils. Tests on more than 5,000 pupils at other schools in the east Leicester area will begin after Easter.

-- Swissrose (cellier3@mindspring.com), April 06, 2001

Answers

I have no independent knowledge of this particular situation in the U.K., but I must say several aspects seem quite odd to me (I have extensive experience investigating TB outbreaks and treating TB disease in former jobs).

It may be that there is indeed a more virulent strain of the organism at play, but in general TB spreads only after prolonged contact between an infectious person and a susceptible person (there are exceptions but they are rare--some clinical types of TB spread more easily, such as laryngeal TB in a chorus singer).

Also, TB has a quite complicated "life cycle." The media often get the details wrong, in particular they confuse TB active disease (infectious, serious illness) with TB latent infection (positive skin test, not infectious unless it becomes active). Something like 70% or 80% of the world's population is latently infected, mostly in less developed countries. In fact, I myself am latently infected (positive skin test) after exposure to a known case of active TB in my youth. Latent infection is often but not always treated with one medication for usually 6 months. Active disease requires multiple medications for 6 months or more.

I don't want to speculate without more information, but I must say the details in the news report above seems at odds with most TB situations in my experience. From experience, I would begin by assuming the news reports got it wrong. But I don't know.

-- Andre Weltman, M.D. (aweltman@state.pa.us), April 06, 2001.

Andre- Thank you for putting this in perspective and providing correct info. This is helpful. Swissrose.

-- Swissrose (cellier3@mindspring.com), April 07, 2001.

Sunday 8 April 2001

TB victim under 'house arrest' for three years By Jonathan Petre And Lorraine Fraser

A MAN has been confined to his own home for more than three years because he is suffering from a drug-resistant form of tuberculosis, a rare version of the disease that last week infected 33 people in Leicestershire. In what is thought to be the only case of its kind, the unnamed man has been put under a form of "house arrest" by the local council to protect the public. He has not left his house or garden in Leeds, west Yorkshire since the autumn of 1997.

Health officials have isolated him to prevent the disease from spreading and have so far spent more than £70,000 on treating him. Until his illness was diagnosed he was a manual worker earning about £15,000 a year. Leeds City Council has undertaken to pay his wages for as long as he remains at home.

The case, first disclosed in The Telegraph more than two years ago, is the first in which a local authority has agreed to pay the salary of someone with a condition that could last years. Dr Martin Schweiger, the Public Health Consultant for Leeds, said last week: "It is a major life change for this man and we are grateful that he has agreed to stay at home.

"He needs to stay away from work to prevent infection of other staff and customers and even people whom he may infect on the way to work." About 30 to 40 people in Britain suffer from multi-drug-resistant TB every year but most respond to a level of antibiotic treatment that makes them non-infectious. They are usually treated in hospital isolation units.

The man in question has not responded to drugs and has been kept in his house under Section 20 of the Public Health Control of Disease Act 1984. He has difficulty walking and breathing. The Department of Health said: "We know of no other cases such as this. Obviously we cannot comment on individual cases but it is very unusual for anyone to be in isolation for this length of time."

Hundreds of children are to be screened for TB this week after the outbreak at a school in Leicestershire - the worst in Britain in recent years. According to Dr John Moore-Gillon, a TB expert and spokesman for the British Thoracic Society, the outbreak was caused by the lack of resources for TB surveillance.

Dr Moore-Gillon said that simply relying on vaccination was insufficient; most of the 26 children who had caught TB at Crown Hills College, Leicester, had been vaccinated but the BCG injection was only 70 per cent effective. He said: "BCG is an important protection but it is not a complete protection, You have got to devote resources to identifying cases quickly and to supporting people through their treatment."

Dr Moore-Gillon said that Leicester was not an isolated example. "There are 40 districts around the country where the rates of TB are high and there there is a strong case for having an additional specialist in TB to support the people who are there."

Four teachers at the Leicester school and three adult family contacts have contracted TB. Most of the affected pupils are aged 11 to 14. Health officials have decided to screen 550 older pupils at the college on Wednesday after a teenager of 16 was confirmed as having the disease.

It is still not known how the outbreak started, although inquiries are focusing on two pupils who became infectious before their illness was discovered. All the new cases are believed to be at a non- infectious stage that can be treated swiftly with antibiotics. Doctors stress that they are no risk to others.

Parents in Leicester have been sent letters warning of the problem and the Department of Health has praised health officers' handling of the problem. Liam Fox, the shadow health minister, said the "low priority" that the government gave public health had made the outbreak a "disaster waiting to happen".

http://www.telegraph.co.uk/et? ac=000118613908976&rtmo=kC31xxLp&atmo=rrrrrrrq&pg=/et/01/4/8/ntb08.htm l

-- Martin Thompson (mthom1927@aol.com), April 08, 2001.

There you go. Although it is still difficult to interpret fully the second press report, it notes that most of the "cases" are actually skin-test conversions rather than "active disease."

-- Andre Weltman (aweltman@state.pa.us), April 09, 2001.