Tuberculosis is "London's shame," according to a new report from the city's government which says the infection in some parts of the UK capital has reached levels significantly higher than countries including Rwanda, Iraq, and Eritrea.
The disease is a "barometer of health inequality," said Dr. Onkar Sahota, Chair of the London Assembly's Health Committee which commissioned the report. "It is astounding that that tuberculosis (TB) is such a prevalent disease in London."
The infection disproportionately affects poor and marginalized groups such as refugees, homeless people, and people living in crowded substandard accommodation.
Around seven people develop symptoms of TB in London each day, said the committee, whose study found that many people, including medical professionals, lacked basic information and awareness of what TB is, its symptoms, and how it is spread.
Drug-resistant strains have developed which can take two years to treat, with some of these resistant strains already having mutated into types that are virtually untreatable.
One TB specialist doctor told the assembly that London had "the largest outbreak of drug-resistant TB ever documented in Western Europe… and plenty of evidence that current efforts to contain transmission, even occurring at household level, are insufficient."
There were more than 2,500 new cases of TB in London last year, accounting for around 40 percent of all cases in the UK. Cases of multi-drug resistant (MDR) TB — which can cost up to $760,000 to treat per patient — rose from 28 cases in England in 2000 to 68 in 2013.
One third of London boroughs have rates exceeding the World Health Organization's "high incidence" threshold of 40 cases per 100,000 populations. Some have rates higher than that of countries including Rwanda, Niger, Eritrea, and Guatemala — the borough of Newham has the highest rate at 107 cases per 100,000 people, compared to the World Health Organization (WHO) figure of 92 cases per 100,000 people in Eritrea or 45 per 100,000 people in Iraq.
The rate for the UK as a whole is 13 per 100,000 — still more than four times that of the United States, where the rate is three per 100,000 people.
TB should be a disease of the past, say health officials, but the UK has failed to get rid of it.
High poverty rates, transient populations, and poor housing conditions in London could all be to blame for the persistently high rates in the city, said an assembly spokesperson, adding that other big cities such as Paris and New York had carried out focused, sustained action to combat TB, such as active case finding, better vaccination, and screening programs.
There is a vaccination against TB recommended for all newborn babies in London, but eight of the capital's 24 boroughs do not offer it. "It is unacceptable that children are put at risk of developing a potentially life threatening illness on the basis of which borough they are born in," said the report.
The number of people defined as "working poor" — members of households whose income falls below the poverty threshold but in which at least one adult has a job — has surged 70 percent in London over the last 10 years.
The UK is now also of the most unequal countries outside the developing world in terms of income, which has a direct impact on health inequality.
"It's pretty damning that a rich country like the UK still sees so many suffering from Victorian-era illnesses. But that is the state we're in," said Duncan Exley, director of the Equality Trust. "While a small number have wealth beyond the dreams of avarice, many more are struggling to achieve a basic degree of security in their jobs and their homes. This has a huge impact on mental and physical health, and is a key reason behind the massive gulf in the health of the rich and poor."
One in five of the Londoners surveyed by the assembly said they did not know what the symptoms of TB were, when presented with a list. More than half of respondents incorrectly thought TB was transmitted through spitting, and 17 per cent of thought TB could be transmitted through unprotected sex — again untrue.
The survey revealed high levels of stigma surrounding the disease, with almost half of respondents believing people with TB should stay away from other people while being treated, which the report said was unnecessary and impractical.
TB is a disease caused by the bacterium Mycobacterium Tuberculosis, which is released into the air when someone with infectious TB coughs or sneezes. At one time it was one of the world's biggest killers, responsible for one in four deaths in Europe and America at the end of the 19th century.
The majority of people exposed to the bacteria will either fight it off of carry it within their bodies without getting sick or becoming infectious. This is known as latent TB infection, and its thought around 2 billion people worldwide have it.
Between 10 and 30 percent of people infected with latent TB will go on to develop the active disease at some point in their lives, usually when their immune system has been weakened.
People whose immune system is already compromised by chronic poor health due to lifestyle factors are at higher risk, as are people living in overcrowded and poorly ventilated living conditions which make it easier for TB to spread in the air.
The bacteria can affect any part of their body, but most commonly affects the lungs — known as pulmonary TB, which is the only form that can be passed on to other people.
The most common symptoms of pulmonary TB are persistent coughing, sometimes with blood, weight loss, tiredness, night sweats, fever, and loss of appetite.
A typical case is treated with a six month course of antibiotics, but drug resistant strains have developed which can take up to two years to treat and can cost more than $150,000 per patient.
Patients with drug resistant strains are prescribed an average of 19 pills a day, which can have "severe, life-altering side effects," including nerve damage, kidney and liver impairment, and loss of sight or hearing.
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