Europe Fears Drug-Resistant
TB Epidemic
By Chris Holme

Euorpe's cities are facing epidemics of potentially untreatable tuberculosis, leading experts warned yesterday.
At the same time, age-old perceptions of the disease are being challenged by new DNA techniques in studies in Copenhagen and Glasgow.
Although eminently curable, TB kills 60,000 Europeans a year, a figure certain to rise with the enlargement of the European Union and the opening up of former Eastern bloc countries with very high rates of drug resistant tuberculosis.
Professor Donald Enarson, scientific director of the Paris-based International Union Against Tuberculosis and Lung Disease, said: "If you look carefully at every large city like Copenhagen, London, Paris or Barcelona you will find this core of tuberculosis."
He said these were concentrated in pockets among marginalised groups like the homeless, those with mental health problems and people born overseas. Small districts within large cities had rates matching those in Africa with an explosion of TB-related AIDS.
Professor Enarson said research in Copenhagen had demonstrated spread of the disease from a small quarter of the city to the community at large
"Over the last four years rates have started to rise in Denmark. This is the first evidence of incidence of the disease rising in a stable well-to-do community. We had assumed that good socio-economic status prevented this type of spread."
Similar DNA studies among homeless people in Glasgow have also led to a rethink. Experts have now tracked 38 cases linked to the same source, which previously would have been classed as reactivation of infection acquired decades earlier.
"Hitherto, we would have assumed these to be reactivated cases. DNA fingerprinting is proving otherwise," said Dr Peter Christie, consultant epidemiologist at the Scottish Centre for Infection and Environmental Health.
By the end of November there had been 435 TB cases in Scotland, reflecting a gradual decline since 1990. Glasgow's rate remains almost twice the Scottish average and there are specific initiatives aimed at high risk groups like homeless people.
But next month will see the launch of an enhanced Scottish surveillance programme gathering far more detail than available at present.
Dr Christie said this would enable resources to be targeted to needy areas.
"With tuberculosis you can never take your eye off the ball. New York is the classic example of what happens when you do by removing the public health infrastructure. TB is something which will take advantage of any opportunity."
Experts last year warned London was heading for a similar epidemic as faced by New York a decade ago. But, as The Herald revealed this week, there has been little or no concerted response from the Government to threat of a disease which is the ultimate in social exclusion.
Not one London borough with high TB incidence has the minimum required numbers of TB nurses or support staff. Newham, with the highest rates, has had to ditch essential screening of new arrivals because of lack of resources.
The Department for International Development is assisting Third World countries to adopt directly observed therapy in treating the disease. Professor John Grange, of Imperial College and a trustee of the charity TB Alert, said England was largely unable to deliver the same treatment to its own citizens because of shortage of nurses.
"I don't think we are setting a good example," he said.
"London has got this problem for same reason as New York - the breakdown of services to poor people," Professor Enarson said.
He said the European Commission had made progress in many area of TB control but more resources were needed to assist former Eastern bloc countries, where recorded cases rose by 7% during 1997 alone. - Dec 17


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