Tuberculosis in Ealing

What is TB• Tuberculosis, or TB, is a disease caused by a germ

(Mycobacterium 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 patients2. Contact tracing (screening people who have been in

contact with a known TB patient)3. Providing treatment for people with TB infection but

not disease4. Education and Health Promotion5. BCG vaccination

Epidemiology

Number of people notified with TB in Ealing

Local AuthorityNotifications 2005 (rate/100,000)

Notifications 2006 (rate/100,000)

Notifications2007(rate/100,000)

Percentage change betw. 2006-2007

Brent 287 (107.18) 238 (88.88) 274 (102.33) +15.13

Ealing 242 (79.34) 237 (77.70) 246 (80.65) +3.80

Hammersmith & Fulham

90 (51.66) 81 (46.50) 69 (39.61) -14.81

Harrow 133 (63.11) 124 (58.84) 121 (57.42) -2.42

Hillingdon 143 (57.74) 126 (50.88) 127 (51.28) +0.79

Hounslow 169 (79.38) 140 (65.76) 139 (65.29) -0.71

Kensington & Chelsea

48 (27.53) 53 (30.40) 32 (18.35) -39.62

Westminster 98 (44.14) 85 (38.29) 88 (39.64) +3.53

Sector Total 1210 (66.68) 1084 (59.74) 1096 (60.40) +1.11

Ethnicity NW London (=Ealing)

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Age and GenderTB Notifications by Age and Sex (2007)

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

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Harrow Hillingdon Hounslow Kensingtonand Chelsea

Westminster

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Within 5 Years

6-10 Years

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Drug resistance in Ealing

YearIsoniazid resistance

(UK rate)

Rifampicin Resistance

(UK rate)MDR TB

(UK rate)

2002 1.3% (6.9%) 0.0% (1.2%) 0.0% (1.0%)

2003 1.4% (6.9%) 1.4% (1.8%) 2.1% (1.3%)

2004 2.6% (6.8%) 0.0% (1.5%) 1.5% (1.1%)

2005 4.0% (7.0%) 0.0% (1.4%) 1.1% (1.0%)

2006 4.4% (7.0%) 0.0% (??%) 1.6% (1.1%)

Barriers to seeking treatment

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

Chest Clinicno. referred less than 2 weeks (%)

no. referred between 2 - 4 weeks (%)

no. referred over 4 weeks (%)

Chelsea & West. 12 (75) 3 (19) 1 (6)

Charing Cross 13 (45) 3 (10) 13 (45)

Ealing 8 (21) 6 (16) 24 (63)

Hammersmith 4 (80) 1 (20) 0 (0)

Hillingdon  0 (0) 2 (50) 2 (50)

Northwick Park 64 (80) 3 (4) 13 (16)

St. Mary’s 27 (66) 4 (10) 10 (24)

West Middlesex 18 (56) 4 (13) 10 (31)

Willesden 18 (75) 2 (8) 4 (17)

Total 164 (61) 28 (10) 77 (29)

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

* 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 no. seen less than 2 weeks (%)

no. seen between 2 - 4 weeks (%)

no. seen over 4 weeks (%)

Chelsea & West. 12 (71) 2 (12) 3 (18)

Charing Cross 24 (73) 4 (12) 5 (15)

Ealing 33 (70) 6 (13) 8 (17)

Hammersmith 3 (60) 1 (20) 1 (20)

Hillingdon 20 (91) 2 (9) 0 (0)

Northwick Park 92 (97) 1 (1) 2 (2)

St. Mary’s 33 (85) 2 (5) 4 (10)

West Middlesex 17 (53) 5 (16) 10 (31)

Willesden 21 (60) 11 (31) 3 (9)

Total 255 (78) 34 (11) 36 (11)

* NWL HPU (2007) Patient delay audit report

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