Tuberculosis - still a threat
Tuberculosis (TB) may have a place in the popular imagination as a disease of the past - but according to the latest research, itís making a comeback.
Even though the UK still only faces around 7,000 cases a year - down from 50,000 in 1950 - that number is rapidly increasing, and TB has become a major topic again.
In 1993, the World Health Organization took the unprecedented step of declaring TB a global emergency. It estimated that, between 2002 and 2020, 1,000 million people worldwide would be newly infected, over 150 million of them would become sick, and 36 million of them would die, unless action was taken.
But even with UK's nationwide vaccination programme and a low incidence of TB, we are not immune.
In 2000, the British Thoracic Society renewed and updated its guidelines on dealing with TB, after a worrying increase in cases. In August this year, the Department of Health launched a TB awareness campaign - and just last week, the Public Health Laboratory Service (PHLS) hosted a special conference entitled, "Tuberculosis is still a major public health issue in England and Wales".
President of the British Lung Foundation, Dr John Moore-Gillon explains, "There's a rapid rise in TB cases. People are travelling around the world on a scale we've never seen before so, inevitably, we're going to see a rise in TB in the UK.
"And when you add factors such as the rise of HIV, which erodes your body's natural immune system, it makes it easier to understand why the disease is getting more of a hold."
An infectious agent
Tuberculosis is a bacteria, spread like a cold in air droplets, which tends to live in the lungs. If an infected person coughs, sneezes, talks or spits, they will expel TB germs into the air. You only need to inhale a few of them to become infected.
Once in the lungs, the bacteria multiplies, bringing with it a bad cough and pain in the chest. The infected person may cough up blood or sputum. He may also lose his appetite and suffer from chills, fever and night sweating. Untreated, it is fatal, but modern drugs are extremely effective - and with an otherwise fit body, the chances of dying are tiny.
Inhaling TB is not the same as contracting the disease, however. Around a third of the world's population actually have the bacteria in their bodies, but suffer no ill effects and can't spread it to others. The problem arises when the immune system is weakened. HIV-positive patients are at particular risk - but those with diabetes, cancer, leukaemia, kidney disease or a low body weight also have a high risk of developing full-blown TB.
Treatment of the disease is simple and cheap, but notoriously difficult to implement. There is a range of excellent antibiotics that will get rid of the disease, but they take at least six months to be 100 per cent effective.
The problem is that people tend to feel better after two weeks and stop taking the medication. The result is TB bacteria that are resistant to the drugs - and of most concern is a strain of multi-drug-resistant TB that requires a course of chemotherapy to get rid of it.
The real risks
So what is the real risk of someone in the UK catching tuberculosis? The BCG vaccination that most British citizens will have between 10 and 14 years old has helped keep TB rates low in the UK, but the vaccine is only 70 per cent effective, and the chances of catching TB if you live close to someone infected remain high.
TB is a disease that varies widely among ethnic groups, with minority groups accounting for 50 per cent of new cases in the UK.
Dr John Watson, of the PHLS's Communicable Disease Surveillance Centre, says, "Certain sub-groups of the population, particularly those born outside the UK in parts of the world where tuberculosis is more common, are at especially high risk of the disease. These groups, and others such as the homeless, may face a variety of obstacles to being diagnosed and successfully completing treatment."
With people from these groups also far more likely to visit countries with widespread TB, the problem is compounded.
The Department of Health is targeting those most at risk of catching TB - in this case Indians and Africans - and has signed up celebrities, including singer Patti Boulaye, former footballer John Fashanu and leading Bollywood stars, Ashkay Kumar and Sonali Bendre, to drive the message home.
Doctors, particularly in London, are being reminded of the symptoms of TB so it can be diagnosed early - and greater efforts are being put into running programmes to ensure sufferers stick with the full course of treatment.
As for avoiding TB, the best thing you can do is encourage anyone with the symptoms to visit a doctor as soon as possible. Or, if you fear you may have it yourself, pay a visit to your GP today.
British Thoracic Society
Public Health Laboratory Service