TB rates in London higher than Rwanda and Iran

Rates of Tuberculosis (TB) in London are among the highest in Western Europe, with some boroughs having levels higher than Rwanda, Iraq and Guatemala, according to a new report from the London Assembly health committee.

It highlights that 2500 cases of TB were reported in the capital in 2014, accounting for 40% of all UK cases. A third of boroughs, including Newham, Brent and Ealing, exceeded the World Health Organization’s ‘high incidence’ threshold, with some boroughs recording incidence as high as 113 cases per 100,000 people.

The London Assembly’s report, Tackling TB in London, was published yesterday (27 October) to coincide with the launch of a ‘find and treat’ mobile x-ray clinic at University College London Hospitals, which aims to screen 10,000 high risk patients a year, including prisoners and homeless people.

The report also included research on public awareness, which highlighted a number of incorrect assertions about how to identify the disease or how it is spread. TB is caused by the bacterium Mycobacterium tuberculosis, and is spread by extended close contact with infectious people, commonly family members.

Among its recommendations is that the charity sector and Public Health England (PHE) develop a London-wide programme to better educate the public about the symptoms of the condition and how it spreads.

Responding to the report, PHE told OT that the capital has seen a reduction in the number of TB cases for the third year in a row, as well as drug resistant cases, highlighting the work going on to tackle the disease.

However, a spokesperson for PHE said: “TB rates in London still remain among the highest in Western Europe and to achieve further decreases and reduce inequalities associated with the disease, we will ensure that TB control remains our priority.”

While uncommon, the disease can result in eye complications, including uveitis.

The PHE spokesperson added: “TB of the eye and its adnexa is quite rare and if it happens would be dealt with by a TB specialist with ophthalmology input. NICE guidelines are the national treatment recommendations for all forms of TB.”

Commenting on the report, clinical adviser for the College of Optometrists, Daniel Hardiman-McCartney, said: “Uveitis as a complication of TB is difficult to distinguish from uveitis from a range of other sources, but it does need to be picked up and treated as early as possible, particularly as we are now dealing with more strains that are antibiotic resistant.”

Mr Hardiman-McCartney told OT: “Although London is experiencing increased incidence of TB, even in those areas particularly affected it is unlikely that TB will account for more than one in 10 cases of uveitis. The likelihood is that most uveitis cases will present at hospital eye services via GPs or other routes, but optometrists are trained to detect disease and would refer someone they thought might have uveitis, whatever the cause.”

In January this year, a TB control board was established by PHE and NHS England to reduce the annual number of TB cases in London, including screening programmes for latent forms of the disease and contact with hard-to-reach groups.

Image credit: Janice Haney Carr and Dr Ray Butler; Public Health England