The Royal Society of Medicine in the UK held a conference for World TB Day entitled ‘TB at the Crossroads – Our Choice?’ This annual TB meeting aimed at discussing recent progress towards elimination of TB. It also discussed recent progress in diagnosis and treatment of TB, ways of managing outbreaks, and reducing transmission. It provided an opportunity for those of us working in the TB sphere to reflect on the path towards the elimination of TB. The event was attended by a number of healthcare professionals and civil society organisations, like TBEC. Other conference objectives included: understanding the strategy to end TB, assessing TB transmission by analysing relapse versus reinfection, analysing the impact of screening and the WGS prevention method, understanding natural resistance and the ways in which this can be harnessed.
In the morning, Dr Al Story (Associated Professor, Find and Treat Clinical Lead, University College Hospitals) discussed homeless and other high-risk groups. He noted that TB is a social disease that presents problems that transcend the conventional medical approach. Any approach to TB demands that we consider the impact of individual social and economic factors on the individual as well as the mechanisms by which the tubercle bacilli damage the human body. He pointed out that the groups affected the most in the UK include migrants, homeless people, prisoners, and drug addicts. It has been found that there is strong collinearity between hepatitis C and TB infection among homeless people driven by opiate and cocaine use. It is therefore vital to tackle access to housing, addiction, destitution, mental health and criminal justice. Al is the lead for the Find and Treat project, a set of vans which move across London to check for TB among homeless groups. He was involved in our Study Visit last year, which you can read more about here.
Dr John Watson (Consultant in Respiratory Medicine, Leeds Teaching Hospitals NHS Trusts) discussed a clinical perspective on delayed diagnosis and consequences for transmission. He pointed out some of the challenges that are faced in diagnosing patients. One key barrier to tackling TB in the UK is related to the fact that many migrants may not be eligible for treatment under the National Health System, or have concerns about reaching out to institutions. Dr Watson further mentioned the healthcare delays that can occur related to reaching the right department, etc. There is a need to increase training and raise awareness among radiologists to do proper investigation and improve communication between departments. Delayed diagnosis affects TB patients, increases morbidity and mortality, and contributes to increased transmission.
Professor Kevin Fennelly (Senior Research Clinician, National Institutes of Health, National Heart, Lung, and Blood Institute, Division of Intramural Research) discussed some of the factors that affect transmission. His group has shown that cough aerosol cultures were the best predictors of transmission in household contacts in Uganda. His aim is to review the known clinical and epidemiological, environmental and microbiological factors affecting transmission. He briefly discussed factors known to affect transmission, discussed evolving methods of assessing infectiousness and how they help prevent transmission and how emerging knowledge of infectious and transmission can inform development of better animal models for TB.
We were very grateful for the opportunity to attend the event and extend our thanks to the Royal Society of Medicine. This was a great opportunity for health professionals in the UK to assess the approach and build on current successes.
You can find the day’s agenda on the Royal Society of Medicine website.
Blog written by Caroline Anena, TBEC Coordinator
- Story A, Aldridge RW, et al. Active case finding for pulmonary tuberculosis using mobile digital chest radiography: an observational study. Int J Tuber Lung Dis. 2012 Nov;16 (11):1461-7.
- Loutet MG, Sinclair C. et al. delay from symptom onset to treatment start among tuberculosis patients in England, 2012-2015.Epidemol infect 2018;146:1511-151
- Fennelly KP, Jones-Lopez EC. Quality and quantity of inhaled dosed predicts immunopathology in tuberculosis (2015;6:511)