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TB: not just a disease of the past

Tuberculosis is still a threat to public health in the UK - and it affects children as well as adults. Nurses need to know what to look for and where to go for advice.
TB_tile_iStock.jpg

Tuberculosis is still a threat to public health in the UK - and it affects children as well as adults. Nurses need to know what to look for and where to go for advice

According to Guy's and St Thomas' NHS Foundation Trust TB nurse manager Margaret Ogedengbe, getting the message across that tuberculosis (TB) is still a real and present danger in the UK is tough, because many people simply don't believe it.

'It's something that we come across all the time,' she says. 'Many people, from all walks of life, think it's a disease of the past, and that it can't happen to them. That includes health professionals as well as patients.

'Often their first response will be, "we

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Tuberculosis is still a threat to public health in the UK - and it affects children as well as adults.  Nurses need to know what to look for and where to go for advice


TB, caused by the bacterium Mycobacterium tuberculosis, is spread when a person with active TB
in their lungs coughs or sneezes. Picture: iStock

According to Guy's and St Thomas' NHS Foundation Trust TB nurse manager Margaret Ogedengbe, getting the message across that tuberculosis (TB) is still a real and present danger in the UK is tough, because many people simply don't believe it.

'It's something that we come across all the time,' she says. 'Many people, from all walks of life, think it's a disease of the past, and that it can't happen to them. That includes health professionals as well as patients.

'Often their first response will be, "we don't have that in our family", or "I’ve had my BCG vaccination", or "I'm eating well". It's difficult to have any conversation with them about it.'

Far from being a disease of the past, or one solely affecting developing countries, TB is still an issue, particularly in London (see box). It affects children as well as adults, and that's why the Guy's and St Thomas' service has recently appointed the first children's TB nurse for south east London.

'Think TB'

Christian Henderson is now part of the team that runs TB clinics at St Thomas' Hospital, Evelina London Children's Hospital, King's College Hospital, and University Hospital Lewisham, as well as visiting patients at home or close to home.

'We realised there was a gap in our service,' explains Ms Ogedengbe. 'We've always had adult nurses working with children, for example screening families, but they were trained to work with adults, not children. We needed someone to understand the needs of children, to talk to them and explain things, to understand where the child is coming from. It was about improving the skill mix.'

Ms Henderson, who has been a children's nurse for 11 years, most recently at the Evelina London Children's Hospital, says it's important to acknowledge that children's needs vary from those of adults. 'For one thing, the way they take their medication is different,' she says, adding that for young children, it will be in liquid form. 'It can be challenging to get toddlers to swallow medication, and I can help parents with that. And teenagers want someone they can speak to, someone they can text if they want advice. I'm also used to dealing with worried parents: they know that I'm around if they need help.'

She says an important part of the job is educating other health professionals to 'think TB' and to take action if they suspect a patient might be affected (see box). 'It's curable,' she adds. 'And the medications are free for people with TB. You don't have to pay for prescriptions.’

Empowered to act

Diagnosing the disease as early as possible is also important, she says, not just because individuals can be treated and cured, but to prevent the spread of infection. 'It depends on the type of TB, but it can be a real public health risk if someone is spreading it,' she adds.

The chief executive of the charity TB Alert, Mike Mandelbaum, welcomed Ms Henderson's appointment. He said treatment for TB, which often lasts for at least six months, was particularly challenging for children, and added that everyone had a role to play. 'For primary care nurses, this means not only being aware of the warning symptoms of TB, but recognising that they might be part of the extended treatment team,' he said.

Ms Henderson longs for the day when TB is eradicated, but is realistic enough to know that this might never happen. In the meantime, she is keen to make sure as many nurses as possible are aware of the signs and symptoms, and are empowered to take action.

'People still think it's a disease of Victorian times, they don't realise it's still prevalent today, especially in London,' she says. 'There's also a huge taboo about it, because people associate it with deprived communities. But TB can happen to anyone, and it's important to get that message out there.'

TB: the facts

  • TB is caused by the bacterium Mycobacterium tuberculosis. It is spread when a person with active TB in their lungs coughs or sneezes, expelling droplets containing the bacterium into the air. Anyone who breathes it in can become infected, although prolonged contact with the infected person is usually required.
  • The main symptoms of TB include: weight loss, night sweats, a cough that lasts for more than three weeks, loss of appetite, feeling 'under the weather', fever (particularly at night) and swollen lymph nodes.
  • If you suspect a patient has TB, you can either call the local TB service for advice, or refer to the local TB service.
  • Important questions to ask a patient when TB is suspected are whether they have been in contact with anyone with TB (be aware that most say no), whether they have travelled to countries where TB is prevalent, and whether they have symptoms.
  • There is still a stigma around TB that can make patients reluctant to talk about it. Ms Ogedengbe suggests asking open questions and suggesting blood tests and a chest X-ray to find out what is wrong so the patient can be treated.
  • In 2015, the TB rate in London was 26.2 cases per 100,000 people, compared with 10.5 cases per 100,000 people in England as a whole.
  • TB rates are higher in London because people come to the capital from countries that have high TB prevalence, such as Somalia and South Africa. Higher levels of poverty in London, as well as homelessness and cramped living conditions, may also contribute.
  • To understand more about the symptoms of TB and the challenges associated with diagnosis and treatment, nurses can take TB Alert's open access course developed with the Royal College of GPs and available at www.elearning.rcgp.org.uk/tb.

Jennifer Trueland is a freelance health writer

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