UK risks time bomb of untreatable TB as number of drug-resistant cases rises rapidly
Doctors warn virulent strain of lung disease could get out of control
Medical experts warned last night that there could be a surge in cases of tuberculosis resistant to current drug treatments unless the Government takes urgent action.
Europe has seen a rapid increase in multi-drug-resistant – or MDR – tuberculosis, which cannot be treated with the two antibiotic treatments normally given to sufferers. In the past eight years scientists have seen an increase in another strain, known as XDR tuberculosis, which is resistant to even more TB drugs. A report published in The Lancet today warns that this more virulent variety could lead to the emergence of "untreatable tuberculosis".
In Britain the vast majority of TB cases are treatable. But cases of MDR jumped from 28 to 81 between 2000 and 2011, while some 24 cases of XDR tuberculosis have come to light in the past two years. Professor Alimuddin Zumla, from University College London and one of the authors of The Lancet report, warned that with growing immigration from eastern Europe these numbers could rise rapidly: "TB is a time bomb. If you don't curtail it now it will be out of control."
Professor Zumla cautioned that with the numbers of "home grown" resistant cases among the British-born population – particularly in London – also rising, the UK could find itself in the grip of a health emergency.
Tuberculosis was once one of the world's biggest killers and was known as the "white plague" when it ravaged Britain in Victorian times. By the 1970s it had almost been eradicated, but in the last 30 years there has been a major re-emergence of the disease, which is airborne and spread through close contact with others.
TB rates in Britain have increased rapidly and now stand at around 9,000 cases – the highest level since the 1970s. Between 2001 and 2010 more than 4,800 people died of TB in the UK. The Health Protection Agency has forecast that if the rise in TB continues at its current rate then by 2015 Britain will have more new cases each year than in the whole of the US.
Dr Paul Cosford, director for health protection at the newly formed Public Health England, said: "It's quite a striking figure that in the whole of the States there might be fewer cases of TB each year than in the whole of the UK, given the difference in population numbers. It's a bit of a wake-up call." He added: "The multi-drug resistance is a worry because this gets into an area where we're losing the ability to treat TB because of the lack of antibiotics."
A government task force is being set up to tackle the problem, and its first meeting will be next month. Dr Cosford said: "As a preventable and treatable condition which still causes much suffering, TB will be a major priority for Public Health England."
There is growing alarm at the rise of drug-resistant TB globally, with the World Health Organization estimating that there around 600,000 cases were diagnosed in 2011.
But experts say there are likely to be four times as many undiagnosed cases. It is now the world's second biggest infectious killer, and despite a recent decline in the number of TB-related mortalities, it was still blamed for an estimated 1.4 million deaths worldwide in 2011.
The highest levels of drug-resistant TB have emerged in the former Soviet Union. In countries such as Ukraine, Belarus and Kazakhstan more than 30 per cent of new TB patients have the MDR strain. Across the globe, it is estimated that there are around 40,000 people suffering from XDR TB.
The Lancet report, published to coincide with World TB Day, warns: "The widespread emergence of XDR tuberculosis could lead to virtually untreatable tuberculosis. With the ease of international travel and increased rates of MDR in eastern Europe, central Asia and elsewhere, the threat and range of untreatable tuberculosis is very real."
Professor Mario Raviglione, director of the World Health Organization's TB department, said with drug-resistant strains spreading to 84 countries there is a pressing need for better treatments. Current tests to diagnose and the cocktail of drugs used to treat the disease are increasingly ineffective in the face of MDR and XDR tuberculosis, he added. "They are also quite toxic, so some of them can cause problems with the liver."
"Some others can cause problems with the brain – you get convulsions and psychologically strange behaviour. That's why we badly need research and badly need new tuberculosis drugs."
Case study: 'It's been a long and hard eight months for me. It's a massive relief to finally have the all clear'
After six years travelling the world Simon Richardson, 28, from Burgh Castle, Norfolk returned to Britain last year and tried to join the Army, only to find he had drug-resistant TB. Now back to full health, he joined the Army last week.
"I started to get pains in the left side of my chest but didn't think anything of it until it wouldn't go away – and started to get worse … It's been a long and hard eight months for me – the side-effects of the drugs were pretty bad – but it's a massive relief to finally have the all clear."
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