Drug resistant tuberculosis in England and Wales, 1993-1995

D. E. Bennett, A. R. Brady, J. Herbert, F. Drobniewski, M. Chadwick, I. Farrell, N. Lightfoot, B. Watt, R. Williams, A. Hayward, J. M. Watson

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    6 Citations (Scopus)

    Abstract

    Introduction: The Mycobacterial Resistance Network, a laboratory based reporting system for Mycobacterium tuberculosis complex isolates, was launched in 1993. All major mycobacterial laboratories in the country participate. The system was developed to detect changes in antibiotic resistance patterns and associated risks. Methods: Information reported on all initial Mycobacterium tuberculosis complex isolates in a calendar year is collated and deduplicated at the Public Health Laboratory Service Communicable Disease Surveillance Centre. Data held includes antibiotic resistance patterns and a minimum dataset including demographic, geographic, and other risk factors. Missing data items are sought by the CDSC co-ordinators from clinical and public health. Proportions of culture positive tuberculosis cases resistant to first line antituberculous drugs were calculated and analysed using chi-square test for trend. Population rates were calculated for 1993/1994 using denominators from the British Labour Force Survey and the Office of National Statistics. Results: From England and Wales, 3063 isolates were reported in 1993, 2929 in 1994, and 2452 for 1995 (preliminary). Multidrug resistance (MDR:resistance to isoniazid and rifampicin) was seen in 18 (0.6%) cases in 1993, 42 (1.4%) cases in 1994, and 55 (1.9%) cases in 1995; chi-square test for trend is significant at p < 0.001. Demographic information is incomplete for 1995. Over half the MDR cases in 1993/94 were seen in people belonging to the white ethnic group. MDR tuberculosis population rates were highest in the Black African ethnic group but rose most steeply in the white and Indian subcontinent (ISC) ethnic groups between 1993-1994. (See Table One). Table One: Rates of MDR Tuberculosis in ethnic subgroups, 1993-1994 1993 1994 RR** 95% CI* Cases Rate* Cases Rate* White 7 0.13 23 0.44 3.29 (1.4-7.7) African 4 13.76 6 20.63 1.50 (0.4-5.3) Caribbean 1 1.98 1 1.98 1.00 (0.1-16.0 ISC 4 2.52 14 8.84 3.50 (1.2-10.6 *per million, **Rate Ratio, ***Confidence Intervals Conclusions: Rates of multidrug resistant tuberculosis remain lower in England and Wales compared with high-prevalence areas in the United States, but rates are rising. Measures to ensure prompt and appropriate diagnosis and treatment, and to minimise transmission in health care settings, should be implemented.

    Original languageEnglish
    Pages (from-to)A8
    JournalThorax
    Volume51
    Issue numberSUPPL. 3
    Publication statusPublished - Dec 1996

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    Copyright 2006 Elsevier B.V., All rights reserved.

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