Largest recorded outbreak of TB in a British school

By Josie Jones
8 May 2001

Health officials have begun a tuberculosis-screening programme in the city of Leicester, England where a six-year-old girl has died of the disease.

Screening revealed a further 10 cases, bringing to 62 the number of people diagnosed with TB. Most have connections to the Crown Hill Community College in the Evington area of Leicester.

The latest victims are in addition to three cases at Loughborough College, Wyvern Primary and Hamilton College. The first of the three cases was a 16-year-old boy at Loughborough College, who was identified with TB in December, followed by a nine-year old girl at Wyvern Primary, who was diagnosed in February this year and a 16-year old girl at Hamilton College later that same month.

Until recently, TB was thought to be a thing of the past in Britain. In the last two decades, however, there have been significant increases in the number of cases identified.

In 1993, the World Health Organisation (WHO) declared tuberculosis to be a global emergency. Worldwide, WHO estimates that tuberculosis causes eight million new infections and three million deaths annually. This is mostly in developing counties, but the report notes there are continued upward trends in Europe and the United States.

In England and Wales 5,920 cases were notified in 1993, compared with 5,798 in 1992. The WHO reports a further increase in 1999, with 6,144 cases recorded. The World Health Organisation has estimated that TB infections are spreading worldwide at the rate of one person every second, and the ailment now kills more young people than any other disease. Moreover, there are an increasing number of TB cases that are proving to be resistant to drug treatment.

Many people infected with TB bacteria do not develop the disease, and it can lie dormant for years before striking when the body's immune system is weakened. This is why the disease particularly affects children and the elderly, as well as those suffering from drug or alcohol addiction, or those who are HIV positive. In Europe and America it is prevalent in inner-city areas where poor housing, inadequate diet and other symptoms of poverty prevail.

The population of Leicester contains more than 28.5 percent coming from ethnic minorities. More than 90 percent of pupils at Crown Hill are Asian, and some press articles have speculated that the latest outbreak is a result of frequent travel to and from the Indian subcontinent, where the disease is more prevalent. In addition, the city has lower than average wage rates and was recently awarded £4.8 million from the government's Children's Fund as a result of the city's high incidence of child poverty.

In most cases, TB is cured after a six-month course of treatment. Multi-drug-resistant TB is caused by strains of bacteria that are unaffected by at least one of the two most common anti-TB drugs. This form of the disease takes between 18 and 24 months to treat with medicines that are about twice as expensive as regular TB drugs.

Earlier this year it was reported that the TB immunisation programme in schools was suspended by the Department of Health in 1999 because of a vaccine shortage. Leicestershire Area Health Authority claimed that this was not a factor in the current outbreak, as most students at Crown Hills had been immunised against TB before the programme stopped.

TB is spread through coughing, spitting and sneezing, all of which are symptoms of the disease. In the crowded conditions of schools and colleges, immunising “most students” is clearly inadequate.

The Leicestershire region has only half the number of specialist nurses recommended by national guidelines. British Thoracic Society (BTS) guidelines recommend one specialist nurse for every 50 notifications of the disease. Leicestershire, which received 200 notifications last year, employs the equivalent of just over two full-time specialist nurses, instead of the recommended four.

A BTS survey last year showed that only 14 percent of TB hotspots in the UK have adequate levels of specialist staffing. One of the causes of multi-drug resistant strains of the disease is the failure of patients to complete a full course of medication to kill off TB bacteria, and specialist nurses play a crucial role in ensuring this is done.

The 62 cases confirmed so far make this the biggest recorded outbreak in any school in the UK. A further 99 pupils at the school are said to have shown signs of the disease and are now receiving antibiotics. The last similar outbreak was 1978.

The local Health Authority is now to screen around 500 pupils at Crown Hill Community College, plus 1,200 at Hamilton College and 400 at Wyvern Primary.