Manual on meat inspection for developing countries

TB Is Back - So Could You Get It? And How Could You Tell?

Tuberculosis (TB), a potentially fatal disease, had been almost wiped out in Britain by the 1970s.

But there has been a dramatic rise in cases recently, especially in and around London, where 40 per cent of all TB cases are detected.

In a parliamentary briefing last week, doctors warned that London has a higher rate of TB than some Third World countries, including China and Brazil, with cases in the capital rising from 1,500 in 1987 to 3,000 last year.

Altogether, 7,300 cases were identified across Britain last year, which is an 80 per cent rise over the past decade.

There is fear that the disease may spread further, due to a combination of foreign immigrants infected with TB coming to the UK, increased travel abroad, and hospital staff who are not trained to spot the disease from early symptoms.

Tuberculosis is a communicable disease caused by infection with the tubercle bacillus (also known as Mycobacterium tuberculosis or M. Tuberculosis), most frequently affecting the lungs.

These tiny bacteria are usually passed on through mucus in the same way as colds are passed on, such as when people sneeze, talk or cough.

The bacillus can remain active in the air for several hours in confined warm spaces such as planes and the London Underground

A cure for TB was developed more than 50 years ago, but it is still one of the top three killer diseases in the world, along with malaria and HIV. An untreated person with TB can spread the disease to ten to 15 people each year.

WHO GETS IT?

Anyone can catch TB, although people who are at most risk are those in close contact with an infectious case, those who have lived in places where TB is still common, such as Third World countries with a high rate of poverty, those whose immune system is weakened by HIV or other medical conditions, young children and the elderly.

The TB bacilli have a thick, waxy coat, are slow growing and can survive in the body for many years in a dormant or inactive state. This means people can be infected but show no signs of the disease.

It is when the bacilli are dividing that people are said to have 'active TB'.

The disease can affect any part of the body, but is most common in the lungs and lymph glands. However, it is only TB in the lungs and respiratory system that is infectious.

Studies have demonstrated that only about 30 per cent of healthy people exposed to the disease will be infected, and, of those, only 5 per cent to 10 per cent will develop TB.

What happens to the TB bacilli once in the body is largely determined by the person's individual immune response. The immune systems of 70 per cent of healthy people will completely eradicate the bacilli; the remainder will become infected and have a positive reaction to a skin test.

For the 5 per cent to 10 per cent who go on to develop TB, the risk is greatest within the first five years following infection.

A small number of people who become infected develop what is called 'primary disease', usually within eight weeks of exposure. This can pass unnoticed and usually resolves without treatment, leaving a small scar on the lung and surrounding lymph nodes that can be seen by a chest X-ray.

Children are more likely to develop primary disease than adults. If the immune system cannot kill or contain the bacilli, they multiply, resulting in damage to the surrounding tissue of the lung.

WHAT ARE THE SYMPTOMS?

The most common symptoms include:

• Cough lasting for more than two weeks, and sometimes with blood-streaked sputum.

• shortness of breath.

• loss of appetite and weight loss.

• fever and sweating.

• extreme fatigue.

HOW IS THE INFECTION RISK ASSESSED?

When someone is diagnosed with TB, a team of specialist health professionals will first make an assessment of the infection risk posed to others.

If TB bacilli are found in the sputum of the sufferer, then their contacts will be investigated to identify others who may have been infected.

Contacts are defined as 'close' - meaning household and immediate family - and 'casual' - meaning friends, work colleagues, schoolmates, etc. Casual contacts are investigated only if the TB sufferer is assessed to be a serious infection risk.

If you are identified as a contact at risk from TB, then you will be routinely invited for screening. Screening will consist of a skin test to determine if your immune system recognises TB.

The skin test will be done in one of two ways. The most common method is the Heaf test, which will take a week to come back.

The other method is the Mantoux test, which can be interpreted after three days. Both types of test involve a small injection into the skin of the forearm.

You may also be asked to have a chest X-ray, especially if the skin test is strongly positive.

In the UK, the majority of people have had the BCG vaccine and so their skin tests will often be mildly positive. This does not mean that they have TB: it just means that their immune systems recognise the disease.

Because TB can develop some time after exposure, contacts are advised to look out for symptoms and may be followed for up to one year, with further appointments for screening.

WHAT IS THE TREATMENT?

People who have a strongly positive skin test and/or evidence of TB infection found on a chest X-ray, or who are unwell, will be investigated further by a specialist doctor and may be given a course of anti-TB medication.

TB is treated with antibiotics that must be taken for at least six months. Modern anti-TB drugs are extremely effective and, in nearly all cases, sufferers feel much better after the first two weeks of medication.

It is important to note that within two weeks of taking the antibiotics, TB sufferers are no longer infectious and can return to life as normal.

Anti-TB drugs are always prescribed in combination to reduce the risk of the TB bacilli becoming resistant to one or more strains of them. Patients will usually be started on three or four drugs.

It is vital, as with all antibiotics, that the medication is taken as prescribed. Taking anti-TB medication for too short a time can lead to the development of drugresistance TB, which is much harder to treat and significantly increases the sufferers' risk of longterm complications, or even death.

HOW IS IT PREVENTED?

The BCG vaccine increases a person's immunity to TB and protects against the most severe forms of disease, such as TB meningitis. However, people who have had the BCG vaccine can still develop TB.

BCG immunisation programmes vary across the UK according to the local risk of TB infection. It is particularly recommended for newborn babies in families where there has been a case of TB, or whose members may be at increased risk of TB infection, but it is not compulsory.

A new, more effective and longer lasting BCG vaccine, called the BCG SSI vaccine, was passed by the Medicines Control Agency in September and will be administered to schoolchildren throughout Britain this month.

Although there is no preventive treatment for TB, scientists are in the early stages of developing a new vaccine that would protect adults completely from the disease.

A team of U.S. Scientists at the Tuberculosis Research Unit has identified the particular molecules in the body's immune system - class II major histocompatibility complex (MHC-II) molecules - that the TB bacteria blocks from working, so disarming the body's natural immune response.

This has allowed scientists to begin development on an effective vaccine by making these molecules resistant to TB.

For more information, contact TB Alert, 020 8969 4830, or visit www.Tbalert.Org.Uk

CASE HISTORY

Lillian Snowdon, 55, is a retired secretary from Acton, West London. She

is divorced and has three children, aged 28, 27 and 23.

Lillian says: Last year, I began losing weight for no reason. I was vomiting and lost about a stone-and-a-half in six months. I thought I had cancer.

I knew about the symptoms of TB because my son had suffered from it in 1999, but I still didn't realise that I had contracted the disease.

The doctors didn't think that the two cases were connected and said it was likely I'd caught it on the Tube. However, my theory is that I had it lying dormant in me for years, and that my son caught it from me.

I was put into an isolation unit as I was extremely infectious. I had to stay there for eight weeks while I was treated with antibiotics. They should have worked within two weeks but I didn't respond to them because I was still being sick.

I was on antibiotics for a total of six months. Everyone who had been in close contact with me had to be screened for TB, and my daughter and other son were put on a precautionary course of antibiotics.

Now I feel back to normal and have no long-lasting symptoms from the infection, though I still have to go for chest X-rays every six months. Luckily, I don't have any scar tissue on my lungs.

I was shocked at how easy it is to catch TB. Now I'm very cautious about my health as the disease can lie dormant and re-emerge. Doctors should make people more aware of the disease and its symptoms. It is treatable - more so, if caught early.

Tuberculosis: What To Know About The Recent Outbreak, Symptoms And Treatment

Kansas has been at the center of an ongoing tuberculosis outbreak for the last year. Around 67 active cases have been confirmed since the start of 2025, and nearly 400 people are being monitored for exposure. Another case has been identified in a Michigan high school.

According to the US Centers for Disease Control and Prevention, there were 9,633 reported tuberculosis cases in the US in 2023, a 15.6% increase from 2022. To put that into perspective, that's an incidence rate of 2.9 cases per 100,000 people. Tuberculosis is prevalent in the US, but it's both preventable and curable.

Early detection and treatment plans have helped limit further disease transmission in the US. However, we've seen numbers creep back up over the last few years, possibly partly due to reduced access to medical care during the coronavirus pandemic.

The Kansas outbreak is more prominent than usual, though that doesn't mean it's a cause for panic. Despite being spread through the air, tuberculosis is not easily contracted, because it only spreads when a person has symptoms. Read on to learn everything you need to know about tuberculosis, including what it is, how it's spread and how to treat it.

For more on staying healthy, see which at-home COVID and flu tests you should use and our tips and tricks to tackle cold and flu season.

What is tuberculosis?

Tuberculosis, or TB, is a curable infectious disease that primarily affects the lungs. However, it can affect other tissues and organs, which is called extrapulmonary tuberculosis. It's a prevalent disease that's on the rise. The World Health Organization estimates that in 2023, around 1.25 million people died from the disease. 95% of TB-related deaths occur in developing countries.

Tuberculosis is caused by Mycobacterium tuberculosis, a bacterium that spreads through the air when an infected person talks, laughs, sneezes or coughs. It's an airborne disease, though it doesn't spread easily. You must be in close contact with someone with TB for an extended time. Most people get it from family members. 

The tricky thing about tuberculosis is that not everyone infected gets sick immediately. That's called inactive or latent tuberculosis. The inactive bacteria stay in the body, with the potential to become active later, especially during times of weakened immune systems.

You can't predict when or if it becomes active. Some live with latent tuberculosis for a lifetime without ever developing full-blown TB. Unlike other infectious diseases like COVID, you can't spread tuberculosis germs unless it is active in the body and you are experiencing symptoms.

That doesn't mean that latent TB isn't a big deal. In the US, approximately 80% of people who get active tuberculosis develop it from untreated latent TB. That's why it's essential to be aware of potential exposures and seek treatment even if you don't develop symptoms.

Visoot Uthairam/Getty ImagesSigns and symptoms

Anyone can get tuberculosis. However, only those with an active infection will exhibit symptoms. According to the CDC, conditions that increase your risk for TB include but are not limited to diabetes, weakened immune system, tobacco use and alcohol abuse. Additionally, tuberculosis is one of the leading causes of death for those with HIV.

The signs and symptoms include:

Fatigue

Chest pain

Fever, chills and night sweats

Coughing up blood or mucus

Cough lasting at least 3 weeks

Loss of appetite and weight loss

If you have any symptoms or were exposed to someone who does, talk to your doctor immediately to set up a treatment plan. There are two main tests for TB: a skin test and a blood test. Other tests can also be used, like chest x-rays or testing a sample of mucus you cough up.

I mentioned that active and latent TB is curable, though it's not as simple as taking some antibiotics for a couple of weeks, as with other bacterial infections. Depending on the treatment plan, the combinations of medications taken to treat TB will last four, six or nine months. If you don't see your treatment through, it can return.

What this means for you

Outbreak or not, your risk of getting tuberculosis is low unless you're in very close contact with a person with active symptoms. Even if you've breathed in TB germs, you cannot spread it to anyone else right away. Transmission is limited to those with active symptoms, not latent TB.

Conditions like a weakened immune system or diabetes can increase your risk. However, it's not something the average person needs to frequently worry about in daily life if they practice good hygiene and have a healthy immune system. It's something to simply be aware of.

Those who have the highest risk for TB:

People who frequently travel to locations where TB is common, like Asia, Africa and Latin America.

Those who live or work in places where it can be spread, like hospitals, homeless shelters, nursing homes or correctional facilities. 

Anyone who has spent time with someone with active TB.

I know what you may be thinking: It's flu season, and everyone is sick. Not to mention, COVID is still a constant presence and has many symptoms that overlap with TB. They also both attack the lungs. How can I be sure I don't have tuberculosis?

Dusan Petkovic/Getty Images

Differences between COVID and tuberculosis:

A symptom of COVID is the loss of taste or smell.

Tuberculosis has a longer incubation period, and the symptoms have a much slower onset.

With tuberculosis, a cough will last longer than three weeks and often contains mucus or blood.

If you're still unsure, think about if you've spent time around anyone experiencing symptoms. One of the most critical markers is the duration of your cough. Because it's a lung infection, one of the main warning signs of tuberculosis is a persistent cough lasting three or more weeks. It's always worth visiting your doctor, who can test you for the flu, COVID and tuberculosis.

Always get tested if you think you have been exposed. Latent tuberculosis may not actively spread symptoms, though if untreated, it can develop into active TB later.

Efective ways to stop the spread of tuberculosis:

Wash your hands regularly.

Allow in natural light. UV light can kill TB bacteria.

Cover your mouth and nose when coughing or sneezing.

Wear protective masks if you are in contact with someone who has TB.

Stay in ventilated areas. TB bacteria can stay in the air for hours without proper ventilation.

No 'confirmed Cases' Of Tuberculosis Among 176 ICE Detainees At Green County Jail

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