TB control can be roughly divided into two camps - those that only diagnose and treat active TB and those that diagnose and treat both active and latent TB. For instance, the UK
Action Plan incorporates the following aims
- reduce the risk of people being newly infected with TB
- provide high quality treatment and care for all people with TB
- maintain low levels of drug resistance, particularly MDR-TB.
Indeed, the UK
toolkit primarily concerns itself with the threat to the public once the infection becomes active. Nothing much was said about reducing the pool of infection, latent TB. Compare this policy with that of the
USA
An estimated 9.6--14.9 million persons residing in the United States have LTBI (39). This pool of persons with latent infection is continually supplemented by immigration from areas of the world with a high incidence of TB and by ongoing person-to-person transmission among certain populations at high risk. For TB disease to be prevented among persons with LTBI, those at highest risk must be identified and receive curative treatment (4). Progress toward the elimination of TB in the United States requires the development of new cost-effective strategies for targeted testing and treatment of persons with LTBI
Consider two similar cities, NYC and London. Whilst the TB rate in
NYC is 9.1 per 100,000 people they say they can do better
“New York City has long been a model for the rest of the world in TB control,” he said. “But there is more to be done, and we can’t do it alone. We must continue to work with our partners to prevent the spread of disease and to ensure that TB patients receive proper care.”
On the other hand
Lancet has cited London as being at the centre of the resurgence of the "white plague"
In the UK there were over 14.6 cases of TB reported per 100,000 population in 2009; it is the only European country in which incidence rates continue to rise. In London TB has returned ‘in force’ with 3450 cases diagnosed in 2009 (almost 40% of all UK cases), compared to 2309 in 1999. This is likely to be an underestimate as sputum microscopy and culture only detects up to 70% of active cases. Drug-resistant TB is also becoming a problem in the capital, with 172 isoniazid-resistant cases and a further 58 multi-drug resistant cases reported in 2009.
