Tuberculosis: old reasons for a new increase?

Socioeconomic deprivation threatens tuberculosis control

Notifications of tuberculosis have increased in England and Wales over the past few years, as in other European countries and the United States.1 2 3 An estimated 8000 extra cases occurred between 1982 and 1993 in England and Wales, but the 95% confidence interval is wide (3000 to 12000).1 At least part of the increase may be an artefact—for example, the creation of consultants in communicable disease control in 1988, together with local initiatives (such as that described by Brown and colleagues (p 974),4 may have resulted in a substantial fall in the undernotification previously reported in several areas.5 The increase in notifications has been largely for non-respiratory tuberculosis,1 in which the new consultants may have had their biggest impact—undernotification is more likely in specialties other than respiratory medicine. On the other hand, evidence exists that undernotification of tuberculosis, particularly in association with HIV infection, is still common.6

Factors contributing to a real …