London, tuberculosis capital of Western Europe

Unlike other countries in the region where tuberculosis is dropping, the disease is on the rise in Britain, particularly in London. In 1999, there were about 2,309 cases.

By 2009, London had 3,450 cases of Britain's more than 9,000 cases, according to an article published Friday in the medical journal, Lancet. Since only about 70 percent of active tuberculosis cases are picked up, those numbers are an underestimate.

"We are concerned to see cases of TB at their highest levels since the 1970s," said Dr. Ibrahim Abubakar, head of tuberculosis surveillance at Britain's Health Protection Agency, in a statement. He was not connected to the commentary. "The key to reducing levels of TB is early diagnosis and appropriate treatment," Abubakar said.

While tuberculosis remains rare in the U.K. - about 15 people per 100,000 people are infected - that is still higher than elsewhere in Western Europe. In France, an estimated 10 people per 100,000 have tuberculosis.

Once known as the "white plague" in England because of the loss of skin color in patients, tuberculosis was virtually wiped out after the introduction of drugs and vaccinations in the 1960s. But it has surged in recent years, including drug-resistant strains.

Most tuberculosis cases in Britain are in people born overseas, although not in recent arrivals. About 85 percent of people with tuberculosis have been in Britain for at least two years, meaning the disease is not being imported, but circulating locally.

"The rise in tuberculosis cases has nothing to do with migration and immigrants," said Alimuddin Zumla of University College London, author of the commentary. "This is a fallacy that needs to be corrected," he said, noting the same risks that plagued Victorian England - like poor housing, bad ventilation and overcrowding - are to blame for Britain's current outbreak.

Though tuberculosis mainly affects groups like drug users, refugees, and people with HIV, its prevalence in prisons is problematic. The spread of tuberculosis in prisons has occasionally infected staff and then spilled over into the general population.

Britain is one of the world's biggest foreign aid donors, with considerable investments in projects fighting tuberculosis in poor countries.

"We need to clean up our own back garden first," Zumla said, calling for new strategies and more money to reverse the British epidemic. "Charity begins at home."

More information: http://www.lancet.com

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