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- Euorpe's cities are facing epidemics of potentially untreatable
tuberculosis, leading experts warned yesterday.
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- At the same time, age-old perceptions of the disease
are being challenged by new DNA techniques in studies in Copenhagen and
Glasgow.
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- 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.
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- 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."
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- 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.
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- Professor Enarson said research in Copenhagen had demonstrated
spread of the disease from a small quarter of the city to the community
at large
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- "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."
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- 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.
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- "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.
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- 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.
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- But next month will see the launch of an enhanced Scottish
surveillance programme gathering far more detail than available at present.
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- Dr Christie said this would enable resources to be targeted
to needy areas.
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- "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."
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- 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.
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- 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.
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- 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.
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- "I don't think we are setting a good example,"
he said.
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- "London has got this problem for same reason as
New York - the breakdown of services to poor people," Professor Enarson
said.
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- 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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