Tuberculosis returns with big jump in cases

Almost two centuries after the poet John Keats coughed, turned his pillow crimson and died, specialists have warned that the disease that killed him is on its way back.

The number of cases of tuberculosis, one of the worlds deadliest and hardest to treat diseases, leapt by almost 11 per cent last year to 8,115, the highest total for more than 20 years.

Known as the "white death" because of the deathly pallor of its victims, TB claimed the lives of Chopin, three of the Brontes, Modigliani, Kafka, Stevenson, Lawrence, Chekhov and Orwell.

It had been thought beaten by the introduction of powerful drugs in the mid -20th century and cases fell to an all-time low of about 5,700 a year in the late 1980s. But since then they have been increasing year on year and last year was the largest increase since 1999.

Professor Peter Borriello, director of the Centre for Infections at the Health Protection Agency (HPA), which published the latest figures, said: "The Black Death, smallpox and tuberculosis were the major killers of the past. Tuberculosis is the bogeyman that is returning."

The disease is politically sensitive because the increase over the past decade has been almost wholly confined to the immigrant community.

John Watson, head of the HPA's Respiratory Diseases Department, said the largest rise last year was seen among people not born in the UK, who accounted for 5,310 cases, 72 per cent of the total. Rates among the indigenous population were "low and stable".

Four out of five cases among immigrants involved people who had been in the country for more than two years, who would not have been picked up by screening at the point of entry, he said.

They had either caught the infection after they arrived or their disease was latent when they arrived in the country and it only emerged later. TB infection can lie dormant for decades only flaring into active disease when the patient's immunity is low.

A blood test for detecting the condition in its dormant state is commercially available but it could be five years before trials established it as an effective screening mechanism, specialists said.

John Moore-Gillon, president of the British Lung Foundation, called for more resources to target high-risk groups and recruit more TB nurses. "If we are going to stop TB we have to have action now," he said.

"When I started training I never dreamt I would see the number of cases we are seeing today. Something fairly dramatic is going on."

But he questioned the Home Office strategy of X-raying people applying to enter the UK - a scheme introduced just last year. The programme operates in Bangladesh, Sudan, Tanzania and Thailand for people wishing to come to the UK for more than six months. "We need informed thinking on migration and what X-rays can and cannot achieve," he said.

There are 10 new cases of TB a day in London and more than 600 of the total diagnosed last year were drug resistant. Drug resistant strains can take over a year to treat and cost tens of thousands of pounds. England and Wales are the only countries in the EU to have seen an increase in TB cases over the past 10 years. Germany, France and Spain have seen decreases of up to 35 per cent. In New York, the number of cases has more than halved in the past decade.

Caroline Flint, the Public Health minister, said TB was a global problem that could not be solved by countries in isolation. "We cannot be complacent about this issue. There are no short-term solutions to tackling TB - this will need long-term, concerted action."

Andrew Murrison, a shadow health minister, said: "This is alarming. It suggests that, for all its rhetoric, the Government has failed to get a grip on an important public health issue that is preventable and treatable."