Editorials

Tuberculosis: old reasons for a new increase?

Notifications of tuberculosis have increased in England and Wales over the past few years, as in other European countries and the United States.^{1 2 3} An estimated 8000 extra cases occurred between 1982 and 1993 in England and Wales, but the 95% confidence interval is wide (3000 to 12000).¹ At least part of the increase may be an artefact--for example, the creation of consultants in communicable disease control in 1988, together with local initiatives (such as that described by Brown and colleagues (p 974),⁴ may have resulted in a substantial fall in the undernotification previously reported in several areas.⁵ The increase in notifications has been largely for non-respiratory tuberculosis,¹ in which the new consultants may have had their biggest impact--undernotification is more likely in specialties other than respiratory medicine. On the other hand, evidence exists that undernotification of tuberculosis, particularly in association with HIV infection, is still . . . [Full text of this article]

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