Tuberculosis: the silent epidemic.

Abstract

Tuberculosis (TB) used to be a common cause of death in the UK, accounting for a quarter of all annual deaths in the 19th century. While the poor were most vulnerable to the disease, every stratum of society was affected, as witnessed by the suffering of the Brontë sisters and Keats among others. Improved social conditions and better nutrition helped to reduce the prevalence of TB, and the introduction of the BCG vaccine and successful antibiotic therapy reduced the incidence further. Indeed, in the 1970s some thought that there would be no TB at the millennium. However, following a steady decline in recent decades, there are now an increasing number of TB notifications in England and Wales. While most of the rise is accounted for by notifications in the London area, there has also been a significant rise in notifications in the South East and Trent. Three quarters of notifications relate to males, of whom the vast majority are aged 25–64 years. It is perhaps not surprising, therefore, that TB is ranked the fifth most important communicable disease by professionals and the fifth most important disease requiring further work (Horby et al, 2001).