An all consuming disease tuberculosis
But while Mycobacterium tuberculosis is the main infectious cause of death worldwide, killing 2 million each year, most of these deaths are preventable. And though an estimated one-third of the world's population has been exposed to the bacteria, the vast majority have remained healthy.
'To become ill with TB, something has to go wrong,' says Tim Baker, assistant director of public health at Newham Primary Care Trust and a former TB nurse. 'Either you breathe in so much that your immune system can't protect you or you breathe it in and your immune system works okay but later something goes wrong.'
Newham was the first London borough to be hit hard by the rise in TB though Tim is keen to stress that, contrary to reports, its rate has never been neck-and-neck with Romania or India. The source, he says, was a data error, since repeated, and confusion over ratios per head of population and the actual number of cases.
He adds: 'It's not valid to take the worst rate of the worst hit area and compare it to an entire country.' That said, alarm bells had long been ringing by 2000, when Newham's notification rate hit 100 for every 100,000 residents.
Once rife in the UK and in major cities in the USA, TB has declined fairly steadily since monitoring began in the 1840s. 'The fall wasn't anything to do with treatment,' says Tim, 'it was to do with living conditions. In the UK in the late 1980s, it gradually reached zero. In Newham, it doubled again. We have high rates of HIV but that doesn't explain even a tenth of the increase.'
The most likely causes, he says, are high levels of travel among both established and arriving communities, combined with extremes of deprivation that force already vulnerable people into overcrowded, substandard accommodation.
In the run up to 2000, Newham's population grew by 50 per cent. 'A large influx followed every international disaster in the 1990s,' he says. 'There were Somalis, Afghans, eastern Europeans, Congo, east Africa - you name it, they eventually found their way to Newham. A proportion had been exposed, as have a third of the world's population. When people arrive they're okay but, within one to five years, they start to develop it.
'So are they being exposed to TB [here] or are they arriving having been exposed and then something is happening to their immune systems? It's mix and match - they arrived, we put them on vouchers set below supplementary benefit levels, which in theory were subsistence levels, so really it was a test of "how well can your body cope with the stresses we're putting you under?" on top of the stress factors that reduce immunity anyway.'
This article continues at www.publichealthnews.com
by Lisa Thompson
Un toate consumatoare de boala tuberculoza - An all consuming disease tuberculosis - articole medicale engleza - startsanatate