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Drug resistant TB on the increase

The number of drug resistant cases of TB continues to rise with 431 reports in 2011, up from 342 in 2010 – an increase of 26 per cent. Overall, 8,963 new cases of TB were reported to the Health protection Agency (HPA) in 2011, up from 8,410 cases in 2010. Although this represents an increase in new cases, it is within the range reported to the HPA in recent years.

The data has been published in the HPA’s annual TB report yesterday (Thursday) and is also being presented at a meeting of the International Union against Tuberculosis and Lung Disease, which is being co-hosted by HPA at Imperial College London this week (4-6 July).

Drug resistant TB, when a patient fails to respond to one of the four main antibiotics used to treat the infection, accounted for 8.4 per cent of laboratory confirmed TB cases in 2011 (431 out of 5,127*).

Professor Ibrahim Abubakar, head of TB surveillance at the HPA said: “Although we are disappointed that there has been an increase in new TB diagnoses in the past year, we are pleased that TB cases overall have been stabilising since 2005 with around 8,500-9,000 new diagnoses each year. However, the increase in drug resistant cases remains a concern and a challenge to our efforts to control TB in the UK.”

Patients usually acquire drug resistant disease either as a result of spread of a drug resistant strain from another person or as a result of inappropriate or incomplete treatment. Treatment outcome data was available for 97 per cent of cases (8,171 patients) in 2010 and revealed that 84 per cent of patients completed their treatment, up from 78 per cent in 2001.

Professor Abubakar, continued: “Failing to complete treatment is one of the key causes of drug resistance. Although we are seeing increases in both drug resistant and multi-drug resistant TB (MDR TB), it’s very encouraging that the proportion of people who are completing their treatment is increasing.

“TB continues to disproportionately affect those in hard to reach and vulnerable groups, particularly migrants. In order to reduce TB cases in the future, it’s very important that health commissioners, especially in parts of the country with the highest rates of TB, prioritise the delivery of appropriate clinical and public health TB services.

“In addition, the HPA is recommending that local commissioners ensure they coordinate their TB control activities so that completion of treatment can be ensured wherever the patient is located. The message that not completing the full course of treatment can encourage drug resistance is an important one in light of today’s figures.”

Notes to editors:

1. *Of the 8,963 cases of TB reported to the HPA in 2011, 5,127 samples were laboratory (culture) confirmed and 431 of these had evidence of antibiotic resistance.

2. For a copy of HPA’s annual TB report, as well as further information about TB, visit http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Tuberculosis/   

3. TB usually causes disease in the lungs (pulmonary), but can also affect other parts of the body (extra-pulmonary). Only the pulmonary form of TB disease is infectious. Transmission occurs through coughing of infectious droplets, and usually requires prolonged close contact with an infectious case. TB disease develops slowly in the body, and it usually takes several months for symptoms to appear. Any of the following symptoms may suggest TB:

  • Fever and night sweats
  • Persistent cough
  • Losing weight
  • Blood in your sputum (phlegm or spit) at any time

TB can also be latent, this is when an individual has been exposed to TB and therefore may develop the infection later in life. This type of TB can be seen on an x-ray, so there are different types of test available to screen for latent TB.

4. The first four key first line drugs in the treatment of TB:

  • Isoniazad
  • Rifampicin
  • Ethambutol
  • Pyrazinamide

First line drug resistance is when a patient with TB does not respond when treated with one of the above antibiotics. Multi Drug resistant TB (MDR TB) is when a patient does not respond when treated with the first two of the above antibiotics. Extensively drug resistant TB (XDR TB) is MDR plus resistance to two other groups of antibiotics: one or more of the fluoroquinolones (e.g. moxifloxacin), and to one or more of the injectable second-line drugs (e.g. amikacin, capreomycin or kanamycin).

MDR TB accounted for 1.6 per cent of all new cases in 2011. Cases of MDR TB have nearly trebled in the last 12 years from 28 cases in 2000, to 81 in 2011.

Since 1995, the HPA has recorded 24 cases XDR TB.

5. London is hosting an important scientific meeting of the International Union Against Tuberculosis and Lung Disease European Region from 4-6 July, to discuss the approaches to the control of tuberculosis and other respiratory diseases. For more information about this conference please visit www.hpa-events.org.uk/TheUnion

6. The mission of the International Union Against Tuberculosis and Lung Disease (The Union) brings together innovation, expertise, solutions and support to address health challenges in low- and middle-income populations. With nearly 10,000 members and subscribers from 150 countries, The Union has its headquarters in Paris and offices serving the Africa, Asia Pacific, Europe, Latin America, Middle East, North America and South-East Asia regions. Its scientific departments focus on tuberculosis and HIV, lung health and non-communicable diseases, tobacco control and research. For more information about the Union, visit: http://www.theunion.org/  

7. On 22 May 2012 the HPA welcomed the decision by the Home Office to replace existing airport based screening for TB infection with a pre-entry screening programme. Currently, the Department of Health has a policy of chest X-ray screening of migrants at Heathrow and Gatwick airports as part of immigration control. This applies to individuals who are staying in the UK for six months and are from a country with a high incidence of TB. The new measures, announced by the Home Office mean migrants wanting to enter the UK for more than six months, who are from over 67 countries with a high risk of TB, will need to be screened before they are granted a visa for the UK. The UK Border Agency will build on existing pre-screening undertaken by international partners including the USA, Canada and Australia.

8. The Health Protection Agency is an independent UK organisation that was set up by the government in 2003 to protect the public from threats to their health from infectious diseases and environmental hazards. In April 2013 the Health Protection Agency will become part of a new organisation called Public Health England, an executive agency of the Department of Health. To find out more, visit our website: www.hpa.org.uk or follow us on Twitter @HPAuk.

9. For more information please contact the national HPA press office at Colindale on 0208 327 7901 or email colindale-pressoffice@hpa.org.uk. Out of hours the duty press officer can be contacted on 0208 200 4400.

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