Cases of drug-resistant TB have doubled, study shows
Friday May 2 2008
Health officials are blaming a rise in drug-resistant tuberculosis in Britain on immigration and inadequate measures to control outbreaks among prisoners and drug users. Cases of resistant strains of TB nearly doubled between 1998 and 2005, according to a study of 28,620 infections in England, Wales and Northern Ireland by the Health Protection Agency.
Official figures showed that the number of people whose infection was resistant to at least one major drug rose from 170 in 1998 to 336 in 2005. The number of cases of multi-drug resistant TB also rose to 39 from 23 over the same period.
Outside London a big increase in resistance to one drug, isoniazid, was related to immigration, according to the study in the British Medical Journal, with many infected patients arriving from sub-Saharan Africa and the Indian subcontinent.
In London one outbreak of more than 300 cases of drug-resistant TB was traced back to infections which began in prison inmates and drug users in 1999. “The outbreak is still continuing, suggesting that control measures are insufficient,” wrote the authors. More than 8,000 TB infections were reported across England, Wales and Northern Ireland last year.
“The observed increases highlight the need for early case detection, rapid testing of susceptibility to drugs, and improved treatment completion,” said Michelle Kruijshaar, who led the study.
Although the number of people becoming infected with drug-resistant tuberculosis has risen almost two-fold, they are still a small proportion of those who contract the disease. Over the eight-year period resistance to any drug rose from 5.6% to 7.9%. “The sooner we can do something about it and stop it rising further, the better,” said James Lewis of the London School of Hygiene and Tropical Medicine, who wrote an editorial to accompany the study. In it Dr Lewis calls for more stringent controls on TB, more research to improve diagnostic kits for the disease, and new drugs to fight it.
“The problem with drug-resistant tuberculosis is that it is still relatively uncommon but increasing. Individual clinicians will have very little experience in managing cases,” said Peter Davies, lead clinician at the National Multi-Drug Resistant Tuberculosis Service.
The figures were released as health officials confirmed five more girls had tested positive for tuberculosis at the Birchfield Independent School for Girls in Aston, Birmingham, bringing the total to eight. A further 13 pupils are taking antibiotics to prevent them from developing the disease and nine more have had chest x-rays after being exposed to the infection.
In March doctors at Gartnavel general hospital in Glasgow confirmed the UK's first case of a virtually untreatable strain of TB. A man in his 30s was treated with a cocktail of antibiotics to treat extreme drug-resistant tuberculosis (XDR-TB).