London - the tuberculosis capital of Europe
17 December 2010
Professor Alimuddin Zumla
UCL Division of Infection & Immunity
UCL Global Health
Download 'The Challenge of TB: UCL's contribution'
The UK is the only country in Western Europe with rising rates of tuberculosis (TB), and cases in London have increased more than 50% since 1999. Nationwide, there are now more than 9,000 cases diagnosed per year. The problem is becoming particularly acute in London, where 40% of all UK TB cases are diagnosed.
In a comment piece published today in The Lancet, Global TB expert Professor Alimuddin Zumla (UCL Infection & Immunity) calls for recommendations from a recent UK TB review to be implemented urgently to keep this re-emerging problem under control.
The death toll from TB in the UK began to fall in London at the start of the 20th century as living standards (better housing, nutrition and economic status) improved and subsequent TB control was achieved by the introduction in the early 1960s of anti-TB drugs, improved health services and BCG vaccination. By the early 1980s, TB was considered to be conquered in the UK and National Health Service (NHS) TB services were scaled down considerably.
Alarmingly, TB has returned to London with a vengeance with an increase in the number of TB cases by nearly 50% since 1999, from 2,309 cases in 1999 to 3,450 cases in 2009 accounting for nearly 40% of all TB cases in the UK. The situation in the capital is reminiscent of the multi-drug resistant TB outbreaks in prisons in the USA in the 1990s, that required a large financial investment to be brought under control.
Professor Zumla said: "Poor housing, inadequate ventilation and overcrowding, conditions that were prevalent in Victorian Britain a century ago, are causes of the higher TB incidence rates in certain London boroughs. In all European countries TB is mainly concentrated in high risk groups such as migrants, refugees, homeless, drug users, prisoners and HIV-infected groups."
Referring to the recent London TB Service Review Assessment, Professor Zumla said: "This review, if implemented by the UK NHS, would allow standardisation of TB clinical policy and practice and improve responsiveness of London's TB services needs. This will require a serious political and financial investment if the tide is to be turned against the current return of the 'White plague' to London."
Professor Zumla established the UCL London TB Link Project in 2006 which has brought to major visibility to the growing problem of TB in London's homeless population. This also led to establishment of the Mobile X-ray unit by University College Hospitals NHS Foundation Trust to provide access to care for this disadvantaged population.
Image: Professor Ali Zumla