A further 400 members of staff at the Countess of Chester Hospital and in nearby community clinics who worked with the doctor are also being tested. Public health officials are also tracing his contacts, including friends and family, to try to establish the primary source of infection.
Parents of at-risk children learnt of the doctor's illness yesterday, when they received letters from Mersey Regional Health Authority offering a tuberculin skin test. By yesterday evening more than 100 had contacted a telephone help line at the hospital. A spokesman said that testing was a precautionary measure and that the chances of infection being passed on were remote.
The doctor, who has not been named, is being treated with antibiotics and is expected to return to work next month. Dr Philip Mannion, a consultant in Communicable Disease Control at Chester Public Health Laboratories, said that chest X-rays and symptoms suggested that he had a recent, acute infection and that it was necessary only to test 481 children who had been seen by the doctor over the past two months.
The doctor had displayed none of the usual symptoms associated with progression of the illness, such as weight loss, a persistent cough and listlessness. On 21 May he suffered a coughing fit after entering a smoky room and brought up some bloody sputum. He immediately stopped work and underwent tests; pulmonary tuberculosis was confirmed on 27 May.
Children are more susceptible to infection with the organism that causes TB, Mycobacterium tuberculosis, because their immune systems are immature. Various, harmless mycobacteria in the environment help build immunity to TB over time.
The tuberculin skin test, known as the Heath test, is usually given twice at six-weekly intervals, and gives doctors some indication of the level of immunity in the body and exposure to new infection. In the unlikely event of a child being infected with TB, the disease is treated with a course of three antibiotics over six months. A patient usually ceases to be infectious within two weeks.
TB is the leading cause of death world-wide from a single infectious agent; three million people die and there are eight million new cases annually. Most cases are in developing countries, but there has been an upsurge in Europe and in the US since the mid-1980s linked to HIV infection, poverty, homelessness and drug misuse. The appearance of strains of bacteria resistant to antibiotics is also causing concern. Preliminary figures from the Department of Health show that there were 5,802 new cases last year, compared with 5,086 in 1987 when the number of new cases was at a record low. Other estimates put the level of new cases at about 7,000.
There have been between 80 and 100 TB cases in the Mersey region over the past five years, often involving immigrant families from Asia or Africa. However, there is some evidence that poor white non-immigrant people are at increased risk. The Chester case follows two recent outbreaks of TB in Liverpool; one involved eight people linked with a social club in the city and the other was in an old people's home.Reuse content