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Tuberculosis is back and growing fast

May 21 2009
Diana Taubman, radiographer, is coming to a street near you! Diana Taubman, radiographer, is coming to a street near you!
London is the only Western European capital in which the rates of TB are increasing Tuberculosis or TB has long been thought of as a disease people used to contract in the past, but recent data has revealed it is on the increase in the UK. According to figures from the UK charity TB Alert, London is the only Western European capital in which the rates of TB are increasing. Though some of the new cases are among the immigrant community, the groups most at risk in London are those living on the streets or in hostels, HIV sufferers, drug users and ex-prisoners. Research has shown that about one in five TB cases in London are vulnerably housed, drug users or ex-prisoners. Other statistics support this. In 1994 and 1996, Crisis found that between one and two per cent of the sample homeless population had the disease - a rate 200 times higher than the national average. The charity claims these that findings demonstrate TB transmission is occurring in the capital and that, contrary to popular opinion, the biggest challenge is home-grown TB. TB is an infectious airborne disease which is almost always curable, provided it is caught in time and is not resistant to the drugs commonly used to treat it. It is spread by people who have infectious TB of the lungs, often called 'open' TB. Sufferers expel millions of organisms into the air around them by coughing, sneezing or simply talking. In poorly ventilated rooms, these organisms can remain suspended in the air - and potentially infectious to others - for hours. While easily treatable, patients have to take multiple drugs for six months or longer in order to prevent the disease from recurring and, most importantly, to stop the disease from becoming drug-resistant and potentially incurable. Alarmingly, the Health Protection Agency reports that levels of drug resistant TB are highest among UK-born cases. Foreign-born cases are less likely to have infectious forms of the disease and tend to get diagnosed quickly and take treatment. The single most important way to control TB is to find cases early, ideally before they have infected other people, and support them to complete a full course of treatment. In most cases this is not a problem because patients seek medical help early in the course of the disease and take their medication. Tackling TB among homeless people, people who are in and out of prison and drug or alcohol users is much more difficult because patients delay seeking medical help, can infect many others and often do not complete treatment. Some lifestyles mask the classic symptoms of TB (cough, fever, night sweats and weight loss), so sufferers are often totally unaware that they have the disease. Find & Treat is a new initiative to tackle TB among homeless people, prisoners and drug and alcohol users. The Find & Treat team of specialist TB nurses, social and outreach staff works alongside TB clinics and the Mobile X-ray Unit across London to raise awareness of TB and ensure that vulnerable cases are rapidly identified and can access the support services they need to complete treatment. Phil Windish, an outreach worker with Find & Treat, said: "We need to get away from the stereotype of the problem being linked to immigration. The biggest problem is our own home-grown group." There are several reasons why people who do not have access to permanent accommodation or regularly use drugs are more at risk from TB. First, they are more likely to have weakened immune systems, which can make it easier to catch the disease. (Crack cocaine smokers may be particularly vulnerable, because the natural defences in the lungs are damaged.) People in these categories are also more likely to have shared accommodation, more often than not with people sleeping in relatively close proximity to each other. "Places where there is a confined air space - hostels, prisons and crack houses, for example - are very likely to be transmission zones,"Mr Windish said. "Unfortunately, many of the symptoms are common enough in people living on the street without the disease - coughing, sometimes coughing blood, sweating, rapid weight loss - so it is difficult to self-diagnose. The only way to be sure you have it - or be sure you do not - is to be screened. You may have already encountered the Mobile X-Ray Unit, which has been running for three years. But the uptake has been slow, and over the last few months Mr Windish and his team have embarked on a programme to encourage more people to get screened. He describes it as a social responsibility: "If you have other non-communicable [those which are hard to contract] diseases, it is fair enough not going to be tested. But with TB, you can spread it around a lot and potentially kill someone, so it is your responsibility to others to get checked. Every time there is a screening opportunity, you should go. The onus is more about responsibility to those around you." The MXU has a timetable of where and when it will be, which will appear in the back of The Pavement in The List from now on. The X-ray - which is taken using a modern digital machine that gives off only minute amounts of radiation - takes a few seconds, and the results are given out immediately. The radiographer will then go through the x-ray, looking for signs of TB. More often than not, there will be no problem. "Most people come out feeling happy because they get the all clear,"says Mr Windish. "If a free, quick, easy service is presented you should take advantage of it,"says Mr Windish. "It takes one minute, is safe and painless, and you will be looked after if anything is found - plugged into services really quickly."If the person has an abnormal X-ray, a nurse or worker will give advice and provide an escort to the nearest TB clinic. Once a case has been diagnosed, there is another major problem Mr Windish and his team are trying to eradicate. Many people who start the six-month course of treatment fail to complete it. This may not sound too serious, but can be deadly. If a course is left unfinished, or stopped and started again, the disease can become resistant to the drug. As a result, there are now strains of TB that are resistant to the usual form of treatment, and require a different set of medicine. Again, it is the vulnerably housed who are most likely to fall into this risk category. London has already seen more than 330 cases of drug-resistant TB linked together in one outbreak - the largest known outbreak in Western Europe. "Unfortunately, people are often given a carrier bag of medication and if you are living in a shop front, the chances are you are not going to take it,"says Mr Windish. "This is worse than taking nothing at all, because it creates multi-drug resistance." Mr Windish believes the best solution to this is directly-observed therapy, where a nurse or worker sits with the patient while they take the medicine. This is a non-intrusive way of ensuring the patient takes the medicine regularly, and can offer both a carrot and stick approach to get the job done. However, Mr Windish admits that supervising treatment properly is very time-consuming and resources across London are strained "We need more outreach nurses and care workers who can offer this package to make it effective."Mr Windish also uses 'peer educators', people who have gone through the experience and can honestly explain why it is so vital. Besides the hassle of taking a half-year course of drugs, Mr Windish acknowledges that for some the medicine has side-effects. "Some people feel sick, so it is totally understandable that they do not want to take them."But it is vital people do. "For themselves and the rest of us,"says Mr Windish. "We share that same air‚Äö?Ñ??. What to expect from a screening Should the MXU van come to a hostel of day centre near you, or you hear of someone walking down to get screened, you might like to go, but feel awkward or anxious about walking in. Don't. The staff are welcoming, will explain everything, and it's a simple thing to have carried out. Here's what will happen: 1 You'll walk up the steps and into van, and usually be seen within a few minutes. 2 The staff will explain what's going to happen, why they need the x-ray, and what's needed to take an x-ray. You'll then be asked to stand in the booth (pictured in the centre pages). 3 You dont have to get undressed. 4 A low dose of radiation will then be used to take an x-ray, which will then be digitally enhanced. The radiation is about the same as received on a flight to France, or the equivalent to two days walking on the street. 5 Being digital there will be a two seconds wait for the image to come up before the technician. The radiographer will look at it, and explain what they see. If there is any abnormality you'll be seen by a clinical worker, and support will be provided to get you to the next step.