A leading TB consultant has warned an "inexorable rise" in tuberculosis will continue unless more specialist nurses are put in place. London is now a TB "hotspot" with nearly half of all UK cases occurring in the capital -- around 3,000 each year -- double the total of 15 years ago. TB cases have jumped by nearly 20% in England and Wales over the last two years, but London in particular is under threat from the bacterial disease, which is more commonly found in developing countries.

Immigration, overcrowding and the spread of HIV infection have all contributed to the resurgence of TB in the UK. TB is a contagious airborne bacterial disease of the respiratory system which causes severe lung symptoms, but can often be present without causing any symptoms until the patient becomes run down or the immune system is damaged. The disease can usually be treated by a six-month course of drugs, but in many developing nations it can prove to be fatal due to a lack of medical care, a failure to complete treatment, and a combination of other diseases.

An audit of high incidence TB areas in 43 districts across England and Wales carried out last year by the British Thoracic Society (BTS) found that nearly 90% of them had insufficient staff to cope with such a high prevalence rate. Dr Vas Novelli, head consultant on infectious diseases at Great Ormond Street hospital, London, which is running a new monthly TB clinic in response to the steep rise in cases, called on the government to pump more cash into improving TB services.

Two of the main problems, he said, are that certain strains of TB are becoming resistant to many drugs, and that the number of specialists falls far short of current recommendations. "Whilst screening for TB in high-risk groups has always been a priority, TB is not always picked up immediately, and we are now facing multi-drug resistant strains of TB in the capital".

Dr Novelli said: "The current numbers of TB clinical nurse specialists also fall dramatically short of (BTS) Joint Tuberculosis Committee recommendations that there should be one nurse for every 40 TB patients. "Unless the numbers of TB nurses are increased we will continue to see an inexorable rise in TB cases in London." Areas worst-hit by TB such as Newham and Tower Hamlets should be a top priority for recruiting more specialist nurses in order to better screen and keep track of TB patients and ensure they are taking their medication, he said. A Department of Health spokeswoman said it was "well aware" that a small number of areas of the country were seeing TB cases rising.

"Primary care trusts are responsible for delivering TB services appropriate for their population and a huge amount of action is already under way across the country", she said. The spokeswoman added: "The chief medical officer identified the need for more intense action and that is why we have been preparing a TB action plan for England, which will be published in the autumn."

Main findings :

The BTS reported a rise in TB cases in England and Wales from 5,798 in 1992 to 6,891 in 2002.
No other EU country has suffered an increase in TB over the past 10 years.

London accounted for 43% of all cases reported; West Midlands (15.6%), East Midlands (12.2%), and Yorkshire and Humberside (10.6%), according to figures from the Health Development Agency.

Plans to introduce a compulsory HIV test for immigrants applying to come to Britain have been dropped by ministers, amid growing concern that it would fuel illegal immigration and drive the disease underground. The cabinet set up a review of the issue of imported infections earlier this year to investigate whether potential immigrants could be screened for the virus as part of the visa process. It came about because of increasing concerns about how much 'health tourism' is costing the NHS, and the growing rates of HIV among people who have acquired the disease abroad.

But there has been mounting controversy about the idea of making would-be migrants have a mandatory Aids test before they come into Britain. Some ministers have argued that it is inherently racist as it would mostly target Africans from countries with the highest rates of the disease.

Ministers signalled to MPs last week that the plan has now been shelved, although there is not expected to be any official announcement over it. They had become concerned that the compulsory tests would have the effect of pushing up the rate of illegal immigration among groups who knew they might be harbouring the infection and would not get the all-clear from a compulsory test.

The Home Office had become increasingly worried that a mandatory HIV test would also carry the risk of pushing up rates of illegal immigration, because people who failed to be given a negative result on a test would find another pathway into Britain. They had also been warned by immigration experts of the dangers that it would create demand for forged health certificates in countries such as Botswana or Zimbabwe. Health experts had also warned that the plan could push the disease underground, because immigrants and asylum-seekers would worry about being detained or arrested if they went for tests at an NHS clinic. There are an estimated 17,000 people in Britain who have the infection but have not yet been diagnosed with it.

The decision not to go ahead with the plan is likely to provoke a backlash among groups who have argued that Britain needs to be protected from imported infections by compulsory health tests in the country of origin.

The group MigrationWatch UK, said it was dismayed by the decision to drop the plans. Its director, Sir Andrew Green, said: "The Government should explain why 46 other countries including Australia, Canada and the US require HIV testing before immigration, but ministers have now decided, apparently in secret, to do nothing.! "

Neil Gerrard, chair of the all-party parliamentary group on Aids, said he was pleased that the proposals had been dropped. "There have been recommendations from all kinds of bodies, including the World Health Organisation, to say that this kind of approach wouldn't work."

"The evidence that there are lots of people coming into Britain in order to access treatment for their Aids is actually quite sketchy. What we do know is that a lot of people who do come in with HIV have been living here for some time, and are being diagnosed at quite a late stage. What we need is to be persuading them to come for tests at an earlier stage."
 

The HIV virus which causes Aids and is devastating sub-Saharan Africa is now "the fastest growing serious health condition in England", the chief medical officer said yesterday.

Most people infected here have been gay men, he said in his annual report. "However, the risk is ever present of the disease breaking through and infecting significant numbers of people in the heterosexual population in our country." The CMO's report points to the alarming year-on-year rise in the numbers of people becoming infected and the failure of clinics to cope with the need to test those at risk. People who do not know they are HIV positive will fuel the epidemic by infecting new sexual partners.

Between 1996 and 1997, new infections rose by just 42, from 2,479 to 2,521. But since 2000, the numbers have increased by a little under 1,000 a year. The last year for which there are complete figures is 2002, when 5,615 people became infected. The estimate for 2003 is more than 7,000 -- the highest ever. The fastest growth is in people infected through heterosexual sex in Africa, but infections from heterosexual sex outside of Africa are also rising.

At the end of 2002, an estimated 43,500 people in England were carrying the HIV virus, but a third of them did not know it, the report said. The CMO, Sir Liam Donaldson, highlighted HIV as a major concern because of inadequate testing for the virus, which means that people ignorant of their HIV status may infect others and that some people with the virus may die because their condition is not identified in time.

Opportunities to test those at highest risk are not being taken, the report said. About 59% of men who have sex with men and visit a genito-urinary medicine clinic leave with their HIV status undiagnosed. Every pregnant woman should be offered a test, because treatment can prevent transmission of the infection to the baby. But in London a quarter of HIV-positive pregnant women are not tested, and 13% are not tested in the rest of England. This lack of testing "has serious implications for the HIV/Aids epidemic in England. Urgent improvements need to be made," said the report.

People are having to wait up to six weeks to have a sexually transmitted infection diagnosed, health campaigners said at the launch of a report by the Health Protection Agency on the soaring rate of other infections. Early results of a pilot study by the HPA into waiting times at GUM clinics are worrying, said the CMO's report. More than a quarter -- 28% -- of emergencies were not seen within 48 hours and 8% waited longer than two weeks. Only 18% of people making routine appointments were seen within 48 hours and 41% were waiting for over two weeks. "This report and the figures released on sexually transmitted infections underline the appalling state of the UK's sexual health," said Nick Partridge, chief executive of the Terrence Higgins Trust. He called for more investment in services.
 

The government policy of dispersing asylum seekers away from London and the south-east may increase HIV transmission, medical experts warned last night. They also said it may interrupt therapy and compromise care. Nineteen clinics said asylum seekers had been moved against medical advice. The warnings result from a survey of English sexual health clinics by specialists in genito-urinary medicine in London, and reported in the British Medical Journal.
It is not known how many of the more than 100,000 dispersed people have HIV, but many come from areas with Aids epidemics.
Doctors said dispersal was done at short notice or with no prior arrangement, and often without the transfer of full medical details. Only three of 56 centres had experienced the appropriate transfer of care. The survey, led by consultants in Camden primary care trust, said transferring HIV patients could lead to increasing resistance to drugs, the spread of the disease and avoidable illness and death. They said the National Asylum Support Service should seek specialist advice before moving someone. Asylum seekers may only receive 48 hours' notice of a move. If they refuse they face immediate loss of income, housing and legal support. Last week the chief medical officer, Sir Liam Donaldson, warned of the fast-growing threat from HIV in the UK.