A study just published in the British Medical Journal indicates that the number of cases of multi-drug resistant tuberculosis (MDR-TB) has increased dramatically in recent years in the UK. While we here in the US might not care much, we should. It is only recently that the UK has become a center of immigration; we have accepted immigrants for years and so disease trends are likely now to be similar. Rises in MDR-TB in the UK moreover, mirror rises seen elsewhere even in more insulated countries. The take home lesson: we are bound to be hit, meaning that you should start being concerned now about your future health.

TB, once known as consumption, is a serious lung disease that is fairly contagious in close quarters. The advent of TB drugs at once point had scientists predicting its eradication, but HIV/AIDS changed all that. Because HIV/AIDS weakens the immune system, TB has the tendency to become uncontrollable in those infected with both agents. Additionally, TB medicines are expensive and are often beyond the economic reality of those who need the drugs. Partial treatment of disease, or existence in an invironment where exposure to dilute levels of drug is common, leads to resistance. As TB rates rose in the wake of HIV/AIDS, more and more cases became resistant such that a fair proportion of the worlds TB cases are now resistant to treatment. As we globalize, these strains of MDR-TB have spread, often into the poorest of new communities who have no access to routine medical care and/or who cannot afford the drugs. The UK study shows an increase in overall TB cases both internal to the country and as a result of immigration. Furthermore, they report increases in resistance to all of the first-line medicines used to treat it.

To quote from the Science Daily article reporting the study (emphasis added by me):

These findings highlight the importance of early case detection by clinicians, rapid testing of susceptibility to drugs, additional support services to ensure that patients complete treatment, as well as continuous surveillance, and more help with tuberculosis control in countries with high incidence, conclude the authors.

The rising incidence of tuberculosis in the UK, combined with the rising proportion of resistant cases, increases the potential for onward transmission, warn the authors of an accompanying editorial.

James Lewis and Violet Chihota call for a range of strategies to be implemented including strengthening tuberculosis control and improving research into new diagnostics and drugs for multidrug resistant strains.

“Drug resistant tuberculosis in the UK cannot be controlled solely with local strategies –a global perspective is needed”, they conclude.

TB to a great degree has always been a story about poverty. While diseases may tend to afflict certain populations, however, they do not stay there. Support services for TB patients in most cases is economic support — if the drugs are provided most people will take them for the year or more necessary, but if they can’t afford the drugs, compliance is low. Since MDR-TB is becoming established in places like the UK, more transmission is guaranteed since it is easier to move from first world country to first world country (a lot easier than from the third world to the first). This is a global problem, and requires a global solution.

The best way to stop MDR-TB is to eradicate it from the impoverished communities where it resides. This requires elimination of poverty — not some draconian walling off of people. Eliminating poverty and the conditions it fosters stops the spread of TB. If spread is stopped, and proper treatment is affordable to those with the disease, TB can be stopped. It won’t be stopped if we don’t go to the source. We as a people can no longer afford to ignore the high costs of economic disparity. If we continue to pretend it doesn’t exist, one day we may be the ones waiting in line for our non-effective TB meds.

Science Daily Reference: BMJ-British Medical Journal (2008, May 5). Drug-resistant Tuberculosis On The Increase In The UK. ScienceDaily. Retrieved May 5, 2008, from http://www.sciencedaily.com­ /releases/2008/05/080502081542.htm