When my 13-year-daughter arrived home from school in tears and told me that she would have to go to hospital to have a chest x-ray to check for TB I was - understandably - devastated. Tuberculosis is something that you associate with Victorian times, or developing countries, not 21st-century Britain. I had, of course, read in the papers that it's on the increase in the UK but somehow you never think that it is going to affect you.
My daughter's school, as is the case throughout the country, routinely offers Bacillus Calmette-Guerin (BCG) vaccinations in year 8 to protect against TB. About a week before the jab, she, like everyone else, had a Heaf test, a simple skin test before the BCG to check for immunity. Generally, children don't have any reaction and go on to have their BCGs, but in my daughter's case her skin prick was red and raised which meant that she had already had some contact with TB. She was the only one in her class to have such a reaction and she was distraught, especially when other children cottoned on to the fact that she wasn't having the BCG and yelled out, "Don't go near her, she's got TB!"
I did my best to calm my daughter down and, once she was in bed, gleaned all I could from the information leaflets the school had sent out before the BCG, which - luckily - I had kept. I discovered that since the early 1990s the number of cases of TB in the UK has risen to around 7,000 a year. Contrary to popular opinion, TB isn't a walk-by disease that you just catch in passing but an infection that is generally spread only after quite long and close contact, such as living in the same house as someone with the disease. Of course, that threw up the question of who, when and where, but I drew a blank. I took comfort in the fact that my daughter certainly doesn't look like she could have TB, she's healthy and strong and has had none of the symptoms such as a cough, weight loss or night sweats. But I still worried about what lay ahead.
We had to take time out of school to attend an appointment a few weeks later at the hospital chest clinic. I had phoned to try to get to see someone out of school hours so that we didn't have a repeat of the "don't go near her" comments, but was told that it wasn't possible. Such is the stigma attached to TB that the clinic usually advises people to say they are going to the dentist.
At the hospital they repeated the Heaf test just in case it was a rogue result, maybe caused by her scratching the area. They also sent my daughter for a chest x-ray as this would show any evidence of TB on her lungs. When you're 13 and desperate to hide your developing body from everyone, stripping off in front of a total stranger is pretty daunting, but she did it.
We had to come back the following week for the results. By the time we got home, a surreptitious glance at my daughter's arm confirmed that the result of the Heaf test was going to be the same as the last one, but neither of us mentioned it. For the next week we just tried to get on with our lives although every so often my daughter would break down in tears. However much I told her that TB is a treatable disease, the prevailing image is of an emaciated patient coughing up blood, and it's frightening. When you are 13 you don't want to stand out from the crowd. She just wants her BCG like all her friends.
The stigma attached to the disease and the fact that we don't feel we can be more open about what is happening hasn't helped my daughter, but the fact is that anyone can catch TB and it is becoming increasingly common according to leading expert Dr John Moore-Gillon of the British Thoracic Society.
"There is a higher risk at the bottom of the socio-economic scale but absolutely anyone can catch TB. The Queen can catch TB, although the chances are higher if you are poorly nourished," he explains. This is the 15th consecutive year that the incidence of TB has risen in the UK and it is thought to be because of a combination of factors: an increase in poverty, an ageing population, more people travelling to areas where TB is common and immigration from such areas. The irony of the last two is that it was in Britain and the industrialised nations where TB developed in the first place. "It became common in industrial cities in the 19th century as people lived together in cramped conditions. We exported it and gave it to the world, and now it's winging its way back," says Dr Moore-Gillon.
Because it usually takes prolonged contact with someone with TB to catch it, large outbreaks of the disease are relatively rare, although they can happen. In Wandsworth, south London in March 2001, six children and five family and friends were found to have TB after a teacher at a nursery collapsed with the disease. At a college in Leicester in August 2000, 26 cases of active TB were diagnosed after a student had the disease. Health workers are constantly on the alert for outbreaks. When my daughter went to the chest clinic they were very keen to check what school she came from as there had been a rumour that there was a teacher at a school in the area with TB, but when they checked, all the cases they were seeing were from different schools.
Many experts in the field feel that they are fighting a losing battle. Earlier this month, the British Thoracic Society warned that there are inadequate numbers of specialist nurses in the UK's TB hotspots, which could contribute to a further rise in cases of the disease if they are not addressed. They have called for more than 100 extra nurses and 40 more specialist doctors. Dr Moore-Gillon says that investment is needed on the scale of New York 10 years ago when $1bn was pumped into the city to tackle the problem.
TB is preventable and treatable - if caught early enough, most people make a full recovery - but the tragedy is that it remains one of the biggest killers worldwide. Britain's 7,000 cases a year are just a small part of the 9 million cases and 2 million deaths that occur globally.
Thankfully, when we returned to the hospital we discovered that my daughter's chest x-ray was clear. The Heaf tests show that she has at some time in her life come into contact with TB but the likelihood is that she does not have it. The thing with TB is you can't be certain, it can lie dormant for weeks, months, even years, and the current tests only work when it is active. There is still a 5%-10% chance that she could develop TB in the future, so as a precaution she may now be put on a three-month course of antibiotics which should prevent this. We're now waiting to see a specialist paediatrician who will decide whether this is necessary after reviewing my daughter's test results and taking into consideration the area where we live. Given that we are from an inner-city area of London and the capital has 40% of the UK's cases of TB it seems pretty likely that a course of treatment will be recommended.
Initially I wasn't keen on the idea of my daughter taking medication for such a long time when she may not need it but having spoken to medical staff I believe it is necessary. I don't want to go through the rest of her life watching every cough and cold and worrying that it may develop into TB.
