The United Kingdom is experiencing its most serious outbreak of tuberculosis (TB) for 20 years, with a total of 33 cases now confirmed in Leicester. The outbreak is centred at a secondary school—the Crown Hills Community College—in Evington, Leicester.
Four teachers tested positive for tuberculosis at the end of the first week of April; tuberculosis had been diagnosed in 19 pupils and teachers earlier in the week. Tuberculosis had been diagnosed in three other pupils and three relatives during the previous eight months. Leicestershire Health Authority screened all close contacts of those who had initially been diagnosed. They then screened all teachers and the 700 students in the year groups having contact with those who had TB. The authority now plans to screen close contacts of all diagnosed as having TB and the remaining pupils at the school.
Dr Philip Monk, consultant in public health with the health authority, said: “We are dealing with a very virulent form of TB. At this stage, I feel that we are in control of the situation in the school. The problem is that this is probably indicative of a wider community outbreak and that will be much more difficult for us to get on top of.”
The incidence of tuberculosis has increased in England and Wales over the past few years, with a current annual rate of 5000 to 6000 cases. For the year 2000, the Public Health Laboratory Service has had a 10.6% increase in notifications over 1999. Dr John Watson, consultant epidemiologist with the laboratory service, said: “The rise that has been observed over the last 10 years, and particularly over the last year, is a cause for concern as TB is a disease that had declined 10-fold over the past 40 years.”
Surveillance data indicate that at least part of the increase is attributable to people originating from countries with a high incidence of the disease. The reason for the outbreak in Leicester is unclear, although it is thought that the fact that most of the children at the school are from the south Asian community could be important. There is a high incidence of tuberculosis in south Asia, so children or their relatives could have been at risk of contracting the disease during visits to the region.
Most of the pupils at the school had been vaccinated against the disease, so the recent suspension of routine vaccination for 18 months, which was caused by a shortage of vaccine, is thought unlikely to have had a significant impact on the outbreak. However, the Department of Health has said that a vaccination programme for teenagers will be resumed. Specialists from the Communicable Disease Surveillance Centre and the Public Health Laboratory Service met clinicians and health service managers from Leicester on 10 April to draw up contingency plans and to try to gain further insight into how the outbreak started.