Tuberculosis Outbreak in Chatteris

tb_ward08:07 Tuesday 25th March 2014
BBC Radio Cambridgeshire

[P]AUL STAINTON: People in Chatteris say they’ve been kept in the dark over an outbreak of tuberculosis at two vegetable processing plants in the town. Health Protection England has sought to play down fears, after confirming 17 workers have been diagnosed with the deadly illness since 2012. But earlier Chatteris town councillor Florence Newell told us she was absolutely livid about the lack of information.
FLORENCE NEWELL: This has been going on since 2012 in Chatteris, and neither the Town Council nor the District Council were informed. We should have known. If this has been going on since 2012, and they’re people that are working in factories in Chatteris, we should have known.
PAUL STAINTON: Well we stopped routinely immunising children against tuberculosis in 2005, and according to the last recent figures there were 88 cases of TB in Cambridgeshire in 2011. There were a total of 521 across the whole region. But a lot of you are very unhappy this morning and very worried. Cases are on the increase. So are people in Chatteris right to be so concerned? Well Dr Estée Török is a consultant in infectious diseases at Addenbrookes Hospital. Morning.
ESTEE TOROK: Good morning.
PAUL STAINTON: First of all, why is TB on the increase?
ESTEE TOROK: Well, in the United Kingdom we have about nearly 9,000 cases of TB reported every year, and it has been gradually increasing over the last few years. The reason for that really is that most of the people who develop TB have been born abroad. And as you know we have more people who have been born abroad who are living in the United Kingdom than we used to. And so it may well be related to that.
PAUL STAINTON: So it’s immigration that’s exacerbating the problem.
ESTEE TOROK: It may well be. Yes. So a lot of these people may have acquired TB in childhood when they lived at home, and then they’re obviously presenting in adulthood when they’re living and working in the United Kingdom.

PAUL STAINTON: You may not know the answer to this, but are people not screened for diseases when they come here?
ESTEE TOROK: Well again we used to screen for tuberculosis at ports of entry, but because people actually arriving with TB is incredibly rare, it’s been decided that that isn’t really cost-effective to screen people, because most people won’t obviously have symptoms and signs of TB when they arrive. And so if you screen somebody when they arrive, that doesn’t mean that you won’t pick them up when they present later with disease. So what we tend to do is we tend to see if people develop symptoms, and then look for tuberculosis, rather than screening lots and lots of people who are unlikely to have the infection.
PAUL STAINTON: Is it time though with TB on the increase that we thought about bringing back immunisation for everyone?
ESTEE TOROK: Well again the immunisation story is slightly murky in that the current vaccine, the BCG vaccine, is only really effective in preventing severe tuberculosis in young children, so forms of TB, TB meningitis. It’s efficacy in preventing pulmonary TB in adulthood is very variable. So again, it’s something that in a low incidence country like the United Kingdom isn’t considered to be sensible for the general population. There are certain higher risk needs, for example children born into families where an adult has TB, or there’s a high risk of TB, who do get vaccinated, so in certain boroughs of London. But in the country in general it’s not considered a sensible thing to do, just because the risk of TB is so low, and the vaccine, as I said, has poor efficacy.
PAUL STAINTON: Now we’re being told by Health Protection England that you shouldn’t worry about it too much. You can’t catch it from food, and you’ve got to have prolonged access to the disease to catch it from another human. But plenty of people are very worried about it this morning. Should they be?
ESTEE TOROK: Well again the risk of catching TB is incredibly low. So unless you’re living with somebody who has open pulmonary TB, or are in very close personal contact for a prolonged period of time, the risk of acquiring TB is very low. So for the average person, living in Chatteris or working in Chatteris, the risk is not high at all. Obviously if you live with someone who has tuberculosis, then your risk increases.
PAUL STAINTON: And how do we fight it,once you’re got it?
ESTEE TOROK: Well there are, as you know, antibiotics available to treat it. The current treatment for drug-sensitive TB is for the six months of a combination of antibiotics. If the disease is more resistant to antibiotics, then obviously we have to use more antibiotics and for a longer duration of treatment.
PAUL STAINTON: How long will it take me to catch it if I was working with somebody packing swedes every day?
ESTEE TOROK: Well what we tend to say is that if you’re a household contact, so if you live with someone you’re at very high risk. If you have an hour of face to face contact with somebody obviously coughing in your face then you’re at risk. And likewise if you spend eight hours within the same room. So those are the sorts of risks that exist.
PAUL STAINTON: So there’s a risk then, if I’m working with somebody and they’ve got it?
ESTEE TOROK: And you’re in close contact with them for a long period of time, yes. So if you’re in a confined space for a long period of time, you are at risk, or you may be at risk.
PAUL STAINTON: How long would it take me to catch it? Say I was working eight hours today, packing swedes or cauliflowers or whatever with Jeff, and Jeff’s got it, and he’s right next to me, how long before I catch it, on average?
ESTEE TOROK: Well again I think it’s difficult to give you a precise timing. But in terms of screening people for example, there have been studies that have shown that if you’re on an aeroplane with somebody who has open pulmonary tuberculosis, if you’re sitting within seven rows of them and you’ve been on that flight for eight hours, you are at increased risk. So the public health doctors basically ..
PAUL STAINTON: So it could be a day?
ESTEE TOROK: It could be a day, or it could be several weeks. But the public health doctors basically use those sorts of figures to decide who to screen, so who has been in prolonged contact with a patient for long enough to warrant screening.
PAUL STAINTON: Right. What about children at school? If their mum and dad have got it, the kids might have it, mightn’t they?
ESTEE TOROK: Indeed. If the mother or father have tuberculosis and they obviously live with the child, the child is at risk. And it’s only obviously if the child then develops it, and is in close contact with lots of other children for a long time. I think Public Health England are obviously conducting investigations and are screening all the people who they deem to be at risk.
PAUL STAINTON: How will we know if we’ve got it?
ESTEE TOROK: Well there are two ways to find out really. First of all there are some tests that you can do, blood tests and chest X-rays to see whether you have ever been exposed. And those can be positive in people who are what we call latently infected. But if you actually have the disease, the most common presentation is with a chronic cough and weight loss and fevers and those sorts of things.
PAUL STAINTON: OK. Estee, fascinating to talk to you this morning. Thank you for coming in. Estée Török a consultant in infectious diseases at Addenbrookes Hospital.