Drug-resistant TB on increase in UK

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Source: http://www.inthenews.co.uk/news/health/drug-resistant-tb-on-increase-in-uk-$1221153.htm

Drug-resistant TB on increase in UK
Friday, 02 May 2008 00:01

Drug-resistant tuberculosis (TB) is increasing in the UK, health experts have warned today.

A report in the British Medical Journal (BMJ) says the rise is due to a changing population structure and ongoing migration.

About nine million new cases of TB, an infectious disease caused by bacteria, emerge globally each year, resulting in nearly two million deaths.

It is spread by close, prolonged personal contact to somebody with infectious TB.

While anti-tuberculosis drug resistance is increasing globally, resistance to anti-tuberculosis drugs in the UK remained stable between 1993 and 1998.

But the BMJ report says from 1998 to 2005 the proportion of cases resistant to any first line anti-tuberculosis drug increased from 5.6 per cent to 7.9 per cent.

There was an increasing proportion of isoniazid resistance (6.9 per cent) and small increases in rifampicin resistance (1.2 per cent) and multi-drug resistance (0.9 per cent).

Researchers from the Health Protection Agency, University of East Anglia and the Mycobacterium Reference Unit uncovered the rise after studying data from the National Surveillance System, involving 28,620 confirmed cases of tuberculosis.

They discovered that there was a significant increase in resistance to the drug isoniazid outside of London, which the researchers say is associated with increasing numbers of cases from sub-Saharan Africa and the Indian subcontinent.

In London, the rise in isoniazid resistance is linked to an ongoing outbreak from 1999 that has involved over 300 cases to date.

The report says there has been "inadequate control" of TB transmission in London.

A number of measures are recommended by the researchers to halt the spread of drug-resistant tuberculosis.

"Increased awareness, early case detection, rapid drug susceptibility testing, completion of treatment, continuous surveillance, and a contribution to control of tuberculosis in high incidence countries are needed to halt the observed trends," they conclude.

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Re: Drug-resistant TB on increase in UK

Source: http://www.guardian.co.uk/society/20...edicalresearch


Cases of drug-resistant TB have doubled, study shows

* Ian Sample
* The Guardian,
* Friday May 2 2008

Health officials are blaming a rise in drug-resistant tuberculosis in Britain on immigration and inadequate measures to control outbreaks among prisoners and drug users. Cases of resistant strains of TB nearly doubled between 1998 and 2005, according to a study of 28,620 infections in England, Wales and Northern Ireland by the Health Protection Agency.

Official figures showed that the number of people whose infection was resistant to at least one major drug rose from 170 in 1998 to 336 in 2005. The number of cases of multi-drug resistant TB also rose to 39 from 23 over the same period.

Outside London a big increase in resistance to one drug, isoniazid, was related to immigration, according to the study in the British Medical Journal, with many infected patients arriving from sub-Saharan Africa and the Indian subcontinent.

In London one outbreak of more than 300 cases of drug-resistant TB was traced back to infections which began in prison inmates and drug users in 1999. "The outbreak is still continuing, suggesting that control measures are insufficient," wrote the authors. More than 8,000 TB infections were reported across England, Wales and Northern Ireland last year.

"The observed increases highlight the need for early case detection, rapid testing of susceptibility to drugs, and improved treatment completion," said Michelle Kruijshaar, who led the study.

Although the number of people becoming infected with drug-resistant tuberculosis has risen almost two-fold, they are still a small proportion of those who contract the disease. Over the eight-year period resistance to any drug rose from 5.6% to 7.9%. "The sooner we can do something about it and stop it rising further, the better," said James Lewis of the London School of Hygiene and Tropical Medicine, who wrote an editorial to accompany the study. In it Dr Lewis calls for more stringent controls on TB, more research to improve diagnostic kits for the disease, and new drugs to fight it.

"The problem with drug-resistant tuberculosis is that it is still relatively uncommon but increasing. Individual clinicians will have very little experience in managing cases," said Peter Davies, lead clinician at the National Multi-Drug Resistant Tuberculosis Service.

The figures were released as health officials confirmed five more girls had tested positive for tuberculosis at the Birchfield Independent School for Girls in Aston, Birmingham, bringing the total to eight. A further 13 pupils are taking antibiotics to prevent them from developing the disease and nine more have had chest x-rays after being exposed to the infection.

In March doctors at Gartnavel general hospital in Glasgow confirmed the UK's first case of a virtually untreatable strain of TB. A man in his 30s was treated with a cocktail of antibiotics to treat extreme drug-resistant tuberculosis (XDR-TB).

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Re: Drug-resistant TB on increase in UK

Source: http://www.eurekalert.org/pub_releas...-drt043008.php

Public release date: 1-May-2008

Contact: Rachael Davies
rdavies@bma.org.uk
44-020-738-36529
BMJ-British Medical Journal
Drug-resistant tuberculosis on the increase in the UK
Research: Increasing antituberculosis drug resistance in the UK: Analysis of national surveillance data

A changing population structure and ongoing migration have increased cases of drug resistant tuberculosis, according to a study published on bmj.com today. ( Study is here: http://www.bmj.com/cgi/content/full/...46.573067.25v1 )

The incidence of tuberculosis in England, Wales and Northern Ireland has been on the increase with more than 8000 cases reported in 2006. In addition, resistance to antituberculosis drugs has been increasing globally.

Of mounting concern is the increasing transmission of drug resistant tuberculosis among difficult to treat, marginalised groups in urban areas such as London, and the problems this could create for tuberculosis control.

Dr Michelle Kruijshaar and colleagues present the latest trends in resistance to antituberculosis drugs between 1998 and 2005 using data from the National Surveillance System, involving 28 620 confirmed cases of tuberculosis.

Overall, the researchers found that the proportion of cases resistant to any first line drug had increased from 5.6% to 7.9%. They report an increasing proportion of isoniazid resistance (6.9%) and small increases in rifampicin resistance (1.2%) and multidrug resistance (0.9%).

Importantly, outside London there was a significant increase in resistance to isoniazid. The authors suggest this reflects the increasing number of patients with tuberculosis who are not born in the UK. Analyses showed an increase in the number of cases in people from Sub-Saharan Africa and the Indian subcontinent that could be related.

In London, the rise in isoniazid resistance has been linked to an ongoing outbreak from 1999 that has involved over 300 cases to date. This outbreak has been associated with imprisonment and drug misuse and includes mainly the UK born population. The authors reinforce the importance of recognising symptoms early in this group.

They also note that the proportion of multidrug resistance showed a small increase (from 0.8% to 0.9%)?with the levels seen in the UK similar to those in other Western European countries?and suggest that most multidrug resistance cases occur due to problems with patient management rather than as a result of transmission within the UK.

These findings highlight the importance of early case detection by clinicians, rapid testing of susceptibility to drugs, additional support services to ensure that patients complete treatment, as well as continuous surveillance, and more help with tuberculosis control in countries with high incidence, conclude the authors.

The rising incidence of tuberculosis in the UK, combined with the rising proportion of resistant cases, increases the potential for onward transmission, warn the authors of an accompanying editorial.

James Lewis and Violet Chihota call for a range of strategies to be implemented including strengthening tuberculosis control and improving research into new diagnostics and drugs for multidrug resistant strains.

?Drug resistant tuberculosis in the UK cannot be controlled solely with local strategies ?a global perspective is needed?, they conclude.