Agenda item
Tuberculosis: Prevalence in Brent (verbal update)
Minutes:
OrderDr Melanie Smith (the Council’s Director of Public Health) delivered a presentation on the prevalence of Tuberculosis (TB) in Brent. She highlighted that despite the fact that Brent’s rates of TB infection per 100, 000 people were declining, they remained above the average for England and the rates used by the World Health Organisation (WHO) to identify areas of high prevalence. In relation to available data, Dr Smith noted that figures post-2014 were partially available, but there were not any aggregates. In terms of absolute numbers, there were approximately 200 cases registered a year in Brent. There had been a slight reduction in rates in recent years which could be due to improved detection rates, changes in healthcare and the requirement for nationals of certain countries to undergo an X-ray prior to applying for a visa. Referring to a slide showing TB cases by ethnicity, Dr Smith pointed out that the disease was most prevalent among the people of Indian origin. She reminded Members that as Brent was one of the most diverse boroughs in London, many residents came from or had spent long periods of time in countries experiencing high rates of TB.
The Committee heard that there were a number of cases of latent TB infection in Brent, which meant that people could live with the disease without experiencing any symptoms (such as cough) and without spreading it to others. While it was difficult to predict how many people infected with latent TB would develop the condition, deprivation, homelessness, drunkenness and alcohol abuse were listed as some of the factors that could increase the risk of re-activation. Showing a slide illustrating the demography of those at most risk of developing TB, Dr Smith pointed out that there was a strong correlation between ethnicity and deprivation, with people of Black, Asian and Minority Ethnic (BAME) being most affected. Members of the Committee challenged the relationship between deprivation and travelling abroad, which led to Dr Smith explaining that this was due to the fact that people might have lived in a high-risk area before moving to the UK and it was not necessary associated with travelling after they had settled in Brent.
Dr Ajit Shah (Co-Clinical Director at Brent Clinical Commissioning Group (CCG)) explained that a special screening service had been run since May 2016 by Public Health in collaboration with Brent CCG and Harrow CCG. It was part of a national programme and it focused on patients aged 16 to 35 who had arrived in the UK in the past five years and had lived in a high-risk country. Using a screening questionnaire and blood tests for latent TB, the programme identified patients who were at risk of developing TB and who had not been tested or treated. Over 1,000 individuals had been tested as part of the programme in the period April 2017 – February 2018 and 193 results were positive, with treatment offered to those infected. Dr Shah noted that Brent and Harrow had high rates of positive results, which had exceeded the initial expectations. However, the boroughs worked well together and Dr Shah emphasised the positive contribution to the reduction of TB made by practices, highlighting that Brent was one of the most successful boroughs taking part in the programme.
In response to a question about raising awareness of TB among residents, Dr Smith noted that the screening programme had been promoted at local General Practice (GP) surgeries and further promotion would take place on World Tuberculosis Day (24 March 2018) when a stall would be set up at the Civic Centre. In addition, funding from TB Alert had been secured and consideration would be given to running awareness sessions at community centres and places of worship. TB Alert produced materials in multiple languages, among which Gujarati and Hindi, which enhanced further the work that had already been done to target risk groups. Dr Smith said that she hoped that funding would continue as there had been a rise in the number of patients from the Indian subcontinent visiting GP practices which had contributed to the decrease in the prevalence of TB in the Borough.
Members asked if referrals were made on time and the Committee heard that there was a short period of time between presentation and diagnosis. As information about the age of those infected had not been included in the report, it was agreed that Dr Smith would email it to Members of the Committee.
RESOLVED that the contents of the Tuberculosis: Prevalence in Brent verbal update, be noted.