TB in Leicester: out of control, or just one of those things?

Recent increases in tuberculosis in the UK reflect a global problem

Last year in England and Wales 235 schoolchildren aged 5-14 were notified with tuberculosis. Most will not have been infectious—for example, those with tuberculous lymphadenitis—but some of the 148 children with pulmonary tuberculosis will have been smear positive and potential sources of infection. For each of these children local tuberculosis services will have searched for linked cases by screening household members and other close contacts, including those at school.1

Evidence of transmission of infection from a child index case in a school to other children is not often found1—but outbreaks in schools do occur. Although adults, usually staff, are often the source of infection, schoolchildren have also been reported.2^–6 The essential element in these outbreaks is an infectious patient whose illness may have been undiagnosed for a long period. Local environmental circumstances and the opportunity to expose many people also contribute to the scale of an outbreak.

What therefore should we be asking about the recent outbreak of tuberculosis in Leicester7 that has made headline news? Is it a one off event due to unusual circumstances or a sign of a growing problem in …