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Don't panic, it's only TB

Martin Whittaker reports on how schools have handled outbreaks of tuberculosis.

When a maths teacher contracted tuberculosis last term it threw Cheyne middle school into a crisis that few schools have experienced.

Over two days, 1,000 children and staff at the Kent school had to be screened for the disease, including those who had moved on and had to be tracked down. Public meetings were arranged and press releases issued to keep people informed. This term all pupils will be given a follow-up inoculation.

The teacher contracted TB while in South Africa for a family funeral. Although he has now recovered, he is still undergoing treatment and cannot return to his job until Easter. The Sheerness school had vital help in coping with the emergency from Kent and Medway strategic health authority and from Kent education authority. "They spelt out precisely what we had to do," said head Peter Woollacott.

Fear of tuberculosis has increased following claims that the disease is as prevalent in some parts of the UK as it is in the developing world. Rates in London have doubled in the past 15 years, according to the World Health Organisation. The borough of Brent is said to have the capital's highest rate of 116 cases per 100,000, followed by Newham with 104 cases.

But Dr John Hayward, director of health improvement with Newham primary care trust, says more should be done to nail the myths about tuberculosis, particularly in guidance to schools.

"The problem is that most people don't understand TB. They think of it as a sort of plague, where you're well in the morning and dead in the evening. That's not the case."

Tuberculosis is a curable infectious disease and anyone can catch it. It is easily treatable. Ten years ago WHO declared TB a global health emergency - but for most people in the UK the risk is extremely small. In 2000 there were fewer than 7,000 new cases in England and Wales, with most cases occurring in big cities. Around 40 per cent of these are in London.

Dr Hayward blames Newham's high rate of poverty, overcrowding, poor general health and a transient population. "TB is not new to east London," he says. "It's never gone away."

A Newham Council spokeswoman added that information on TB was posted on staff noticeboards in schools. It had raised awareness of symptoms, how the disease is transmitted, screening processes and the steps to be taken in the event of an outbreak.

When TB is first diagnosed in schools, health professionals move in to assess the risks to others. If there is a serious infection risk, contacts including friends, teachers and relatives are screened. This involves a skin test to see whether the immune system recognises TB. It may be followed by a chest X-ray.

The biggest outbreak at a British school occurred in March 2001, when 62 children, staff and relatives were diagnosed at Crown Hills community college in Leicester. For the LEA it was a baptism of fire. "It was the first time in a long time that an authority had to face an issue on this scale," said Trevor Pringle, an education officer with Leicester City Council.

One logistical headache was how to get 1,250 pupils and 170 staff to the nearest screening unit while keeping the school open. The LEA provided additional transport, met the costs and paid overtime.

Parents were contacted to ensure that concern did not turn to panic, while contractors' staff also had to be reassured. "We had to tackle the popular myth of sanatoria filled with TB cases," said Mr Pringle.

The outbreak attracted international press coverage. But when the satellite vans rolled up outside Crown Hills, the school, health authority and LEA used the media to get information out to the public quickly.

A key factor to emerge from the Leicester outbreak was the need for good communication, said Mr Pringle. "Be clear on what you're saying, be honest and give the factual account as quickly as you can."

For further tips for schools, see the Public Health Laboratory Service website:

Risk factors

Nearly every country in the world is affected by the resurgence of TB. Poverty, poor access to health services, migration and HIV are all factors in its spread. Although increasing in the UK, it is still rare. Those most at risk are:

* close contacts of an infectious case

* those who have lived where TB is common

* those with weakened immune systems

* those with chronic poor health

* young children and the very elderly Most people who contract TB have had prolonged exposure to an infectious person. It is extremely rare for children with TB to be infectious.

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