Tuberculosis in Ealing

•

What is TB

Tuberculosis, or TB, is a disease caused by a germ (M

ycobacterium tuberculosis

). • TB usually affects the lungs, but can affect other parts of the body, such as the lymph nodes (glands), the bones and (rarely) the brain. • Infection with the TB germ may not develop into TB disease.

Symptoms

• Fever • Night sweats • Persistent cough • Losing weight • Losing appetite • Blood in your sputum (phlegm or spit) at any time

Treatment

• Standard treatment for TB: – 4 drugs for 2 months – 2 drugs for 4 months • Non standard treatment normally represents – either resistance to the bacteria or – reaction to the medication

Prevention and control of TB

1. Treatment of TB patients 2. Contact tracing (screening people who have been in contact with a known TB patient) 3. Providing treatment for people with TB infection but not disease 4. Education and Health Promotion 5. BCG vaccination

Epidemiology

Number of people notified with TB in Ealing

Local Authority

Brent

Ealing

Hammersmith & Fulham Harrow Hillingdon Hounslow Kensington & Chelsea Westminster

Sector Total Notifications 2005 (rate/100,000)

287 (107.18)

242 (79.34)

90 (51.66) 133 (63.11) 143 (57.74) 169 (79.38) 48 (27.53) 98 (44.14)

1210 (66.68) Notifications 2006 (rate/100,000)

238 (88.88)

237 (77.70)

81 (46.50) 124 (58.84) 126 (50.88) 140 (65.76) 53 (30.40) 85 (38.29)

1084 (59.74) Notifications 2007 (rate/100,000)

274 (102.33)

246 (80.65)

69 (39.61) 121 (57.42) 127 (51.28) 139 (65.29) 32 (18.35) 88 (39.64)

1096 (60.40) Percentage change betw. 2006-2007

+15.13

+3.80

-14.81

-2.42

+0.79

-0.71

-39.62

+3.53

+1.11

100 90 80 70 60 50 40 30 20 10 0

Ethnicity NW London (=Ealing)

2002 2003 2004 2005 2006

Age and Gender

TB Notifications by Age and Sex (2007)

180 160 60 40 20 0 140 120 100 80 0-9 10-19 20-29 30-39 40-49 50-59

Age Group

60-69 70-79 80-89 90+ male female

Year of Entry

Year of Entry for Non UK-born TB cases by PCT (2007)

300 250 200 150 100 50 0 Brent Ealing Hammersmith and Fulham Harrow

PCT

Hillingdon Hounslow Kensington and Chelsea Westminster Not stated Within 5 Years 6-10 Years 10+

Year 2002 2003 2004 2005 2006

Drug resistance in Ealing

Isoniazid resistance (UK rate) Rifampicin Resistance (UK rate) 1.3% (6.9%) 1.4% (6.9%) 2.6% (6.8%) 4.0% (7.0%) 4.4% (7.0%) 0.0% (1.2%) 1.4% ( 1.8%) 0.0% (1.5%) 0.0% (1.4%) 0.0% (??%) MDR TB (UK rate) 0.0% (1.0%) 2.1% (1.3%) 1.5% (1.1%) 1.1% (1.0%) 1.6% (1.1%)

Barriers to seeking treatment

• Culture • Fear / Shame • Stigma • Knowledge • Service (GP, EHT)

Delay between first contact with a health professional and referral to a TB clinic* Chest Clinic

Chelsea & West.

Charing Cross

Ealing

Hammersmith Hillingdon Northwick Park St. Mary’s West Middlesex Willesden

Total no. referred less than 2 weeks (%)

12 (75) 13 (45)

8 (21)

4 (80) 0 (0) 64 (80) 27 (66) 18 (56) 18 (75) 164 (61)

no. referred between 2 - 4 weeks (%)

3 (19) 3 (10)

6 (16)

1 (20) 2 (50) 3 (4) 4 (10) 4 (13) 2 (8) 28 (10)

no. referred over 4 weeks (%)

1 (6) 13 (45)

24 (63)

0 (0) 2 (50) 13 (16) 10 (24) 10 (31) 4 (17) 77 (29) * NWL HPU (2007) Patient delay audit report

Reasons

• Waiting for results from their investigations. (What the investigations were was not specified) • TB not being suspected or being misdiagnosed by the GP.

Delay between referral to TB clinic and first appointment at the TB clinic Chest Clinic

Chelsea & West.

Charing Cross

Ealing

Hammersmith Hillingdon Northwick Park St. Mary’s West Middlesex Willesden

Total

* NWL HPU (2007) Patient delay audit report

no. seen less than 2 weeks (%)

12 (71) 24 (73)

33 (70)

3 (60) 20 (91) 92 (97) 33 (85) 17 (53) 21 (60) 255 (78)

no. seen between 2 - 4 weeks (%)

2 (12) 4 (12)

6 (13)

1 (20) 2 (9) 1 (1) 2 (5) 5 (16) 11 (31) 34 (11)

no. seen over 4 weeks (%)

3 (18) 5 (15)

8 (17)

1 (20) 0 (0) 2 (2) 4 (10) 10 (31) 3 (9) 36 (11)

Reasons

• Waiting for investigation results • Patient not being able to attend an earlier appointment

Other work

• Close working relationship with NW London Sector • Performance management from SHA London • Good communication with other TB clinics across London • Find and Treat team • Working with Crisis and other homeless / drug and alcohol agencies

Action taken

• Health promotion activities in the Somalian community (Community advocate worker) • School assemblies • Mobile X-ray Unit screening in Ealing (SHA London) • Annual activities on World TB day (23 March yearly) – (TB team) • ‘Advertising’ – TB alert (PCT) • Streamlining the TB Service (TB Service, PCT) • Increase of staff in 2008 (PCT) • LAA targets (PCT)

Staffing

• 1 TB Associate Specialist – doctor (three sessions per week) • 5 WTE TB Specialist Nurses • 1 Administrator support worker (full time) • 1 Somalian Outreach Worker