1. Tuberculosis in Ealing

2. What is TB Tuberculosis, or TB, is a disease caused by a germ (Mycobacterium tuberculosis). TB usually affects the lungs, but can affect other parts of the body, such as the lymph nodes (glands), the bones and (rarely) the brain. Infection with the TB germ may not develop into TB disease.

3. Symptoms Fever Night sweats Persistent cough Losing weight Losing appetite Blood in your sputum (phlegm or spit) at any time

4. Treatment Standard treatment for TB: –4 drugs for 2 months –2 drugs for 4 months Non standard treatment normally represents –either resistance to the bacteria or –reaction to the medication

5. Prevention and control of TB 1.Treatment of TB patients 2.Contact tracing (screening people who have been in contact with a known TB patient) 3.Providing treatment for people with TB infection but not disease 4.Education and Health Promotion 5.BCG vaccination

6. Epidemiology

7. Number of people notified with TB in Ealing Local Authority Notifications 2005 (rate/100,000) Notifications 2006 (rate/100,000) Notifications 2007 (rate/100,000) Percentage change betw. 2006-2007 Brent 287 (107.18)238 (88.88)274 (102.33)+15.13 Ealing242 (79.34)237 (77.70)246 (80.65)+3.80 Hammersmith & Fulham 90 (51.66)81 (46.50)69 (39.61)-14.81 Harrow 133 (63.11)124 (58.84)121 (57.42)-2.42 Hillingdon 143 (57.74)126 (50.88)127 (51.28)+0.79 Hounslow 169 (79.38)140 (65.76)139 (65.29)-0.71 Kensington & Chelsea 48 (27.53)53 (30.40)32 (18.35)-39.62 Westminster 98 (44.14)85 (38.29)88 (39.64)+3.53 Sector Total 1210 (66.68)1084 (59.74)1096 (60.40)+1.11

8. Ethnicity NW London (=Ealing)

9. Age and Gender

10. Year of Entry

13. Drug resistance in Ealing Year Isoniazid resistance (UK rate) Rifampicin Resistance (UK rate) MDR TB (UK rate) 20021.3% (6.9%)0.0% (1.2%)0.0% (1.0%) 20031.4% (6.9%)1.4% (1.8%)2.1% (1.3%) 20042.6% (6.8%)0.0% (1.5%)1.5% (1.1%) 20054.0% (7.0%)0.0% (1.4%)1.1% (1.0%) 20064.4% (7.0%)0.0% (??%)1.6% (1.1%)

14. Barriers to seeking treatment Culture Fear / Shame Stigma Knowledge Service (GP, EHT)

15. Chest Clinic no. referred less than 2 weeks (%) no. referred between 2 - 4 weeks (%) no. referred over 4 weeks (%) Chelsea & West.12(75)3(19)1(6) Charing Cross13(45)3(10)13(45) Ealing8(21)6(16)24(63) Hammersmith4(80)1(20)0(0) Hillingdon 0(0)2(50)2 Northwick Park64(80)3(4)13(16) St. Mary’s27(66)4(10)10(24) West Middlesex18(56)4(13)10(31) Willesden18(75)2(8)4(17) Total164(61)28(10)77(29) Delay between first contact with a health professional and referral to a TB clinic* * NWL HPU (2007) Patient delay audit report

16. Reasons Waiting for results from their investigations. (What the investigations were was not specified) TB not being suspected or being misdiagnosed by the GP.

17. Delay between referral to TB clinic and first appointment at the TB clinic Chest Clinicno. seen less than 2 weeks (%) no. seen between 2 - 4 weeks (%) no. seen over 4 weeks (%) Chelsea & West.12(71)2(12)3(18) Charing Cross24(73)4(12)5(15) Ealing33(70)6(13)8(17) Hammersmith3(60)1(20)1 Hillingdon20(91)2(9)0(0) Northwick Park92(97)1(1)2(2) St. Mary’s33(85)2(5)4(10) West Middlesex17(53)5(16)10(31) Willesden21(60)11(31)3(9) Total255(78)34(11)36(11) * NWL HPU (2007) Patient delay audit report

18. Reasons Waiting for investigation results Patient not being able to attend an earlier appointment

19. Other work Close working relationship with NW London Sector Performance management from SHA London Good communication with other TB clinics across London Find and Treat team Working with Crisis and other homeless / drug and alcohol agencies

20. Action taken Health promotion activities in the Somalian community (Community advocate worker) School assemblies Mobile X-ray Unit screening in Ealing (SHA London) Annual activities on World TB day (23 March yearly) – (TB team) ‘Advertising’ – TB alert (PCT) Streamlining the TB Service (TB Service, PCT) Increase of staff in 2008 (PCT) LAA targets (PCT)

21. Staffing 1 TB Associate Specialist – doctor (three sessions per week) 5 WTE TB Specialist Nurses 1 Administrator support worker (full time) 1 Somalian Outreach Worker