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Last updated at 10:08 02 May 2008

Challenge: TB is getting harder to treat
The rise in drug-resistant tuberculosis cases in the UK has been linked to immigration and inadequate attempts to
control the disease.
The Health Protection Agency (HPA) found more TB cases are now resistant to any of the drugs used for initial
treatment.
At the same time there has been a slight rise in TB infections with multidrug resistance, partly due to poor
treatment. This has led to fears that the disease will be harder to control in future.
Most multi-drug resistance cases occur due to problems with patient management, especially among drug users
and prisoners, the scientists claimed.
The incidence of TB in England, Wales and Northern Ireland is rising, with more than 8,000 cases reported in 2006.
Earlier this week there was an outbreak at a school in Birmingham where 30 girls tested positive for the disease.
Dr Michelle Kruijshaar and colleagues from the HPA monitored the latest trends in resistance to anti-TB drugs
between 1998 and 2005 using data on 28,620 confirmed cases.
Overall, the researchers found that the proportion of cases resistant to any "first line" drug had increased from 5.6

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per cent to 7.9 per cent.
They found an increasing proportion resistance to two other drugs, isoniazid (6.9 per cent) and rifampicin (1.2 per
cent), and multi-drug resistance (0.9 per cent).
Outside London there was a significant increase in resistance to isoniazid, says a report online for the British
Medical Journal.
The research team suggested this reflects the increasing number of patients with TB who are not born in the UK.
Further research showed an increase in the number of cases in people from Sub-Saharan Africa and the Indian
subcontinent, which scientists say could be related.
In London, the rise in isoniazid resistance has been linked to an ongoing outbreak from 1999 that has involved
more than 300 cases to date. The outbreak has been linked with imprisonment and drug abuse and includes mainly
the UK-born population.
The research team also found that the proportion of multi-drug resistance showed a small increase (from 0.8 per
cent to 0.9 per cent) with the levels seen in the UK similar to those in other Western European countries.
But the rising incidence of TB in the UK, combined with the rising proportion of resistant cases, increases the
potential for onward transmission, warned the report.
Lead researchers James Lewis and Violet Chihota called for strengthening of TB controls and improvements in
research into new diagnostics and drugs for multi-drug resistant strains.
They said: 'Drug-resistant tuberculosis in the UK cannot be controlled solely with local strategies - a global
perspective is needed.'
Doctor Mario Raviglione, director of Stop TB at the World Health Organisation, said: 'The study underlines once
again that TB care and control measures must be seriously implemented to cure people and prevent drug
resistance.
'Errors in diagnosis and treatment will not be forgiven by TB, and multi drug resistant (MDR) TB will emerge.
'The management of a MDR-TB case is 100 times higher in drug costs than that of a normal TB case.
'The study also proves that no country, no matter how rich and developed, will ever achieve elimination of TB until
TB is under control globally.
'In fact, TB, a classical airborne disease, does not respect, and cannot be stopped at, any border. Quality care by
all practitioners everywhere in the world is the key, since we do have tools and knowledge to do a better job.'

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Migrants are registering with family doctors at a rate of one a
minute, leaving GP surgeries "straining at the seams" as they try to
cope with the impact of rising immigration, new figures show.
By Tom Whitehead, Home Affairs Editor
Published: 10:00PM GMT 21 Dec 2009
More than 600,000 people signed up with a GP practice in England and Wales last year having arrived from
overseas – an increase of 50 per cent in just seven years.
The number of GPs only increased by a fraction of that over the same period fuelling concerns that Labour's
immigration policy has placed a huge strain on resources.
There is also concern that some of those who are registering may not even be eligible for free health care, such as
illegal immigrants.
Campaigners warned the sharp rise in numbers could result in delays for existing patients and impact on the
overall level of service.
Town halls have long warned that the sudden influx of migrants on local populations is piling pressure on resources
such as schools, public services and health care.
The British Medical Association, which represents GPs, said everyone in the UK legitimately is entitled to health
care but signalled that suitable resources should be in place for doctors.
But Dr Richard Fieldhouse, chief executive of the National Association of Sessional GPs (NASGP), which represents
locum doctors, said the influx of migrant patients has led to sharp rises in work to help "burnt out GPs".
He said in some practices a double booking is now automatically made if the patient does not speak English
because they take so long to explain treatment and deal with, often with the help of a translator over the phone.
"The workload at practices is straining at the seams," he said.
"Quite a lot of cover is for burnt out GPs because they cannot cope with this. People can only work so many hours
a week.
"Some locums have seen bookings increase by 30 per cent year on year."
A total of 605,000 people registered with a GP in England and Wales in 2007/08 having arrived from abroad,
figures from the Office for National Statistics show – the equivalent of one a minute.
Of those, only one in ten – 69,000 – were Britons returning home from a period overseas and it is a rise of half on
the 400,000 new migrant registrations in 2000/01
In comparison the number of GPs in England and Wales increased by 18 per cent over the period from 30,609 in
2001 to 36,041 last year.
The report, by think tank Migrationwatch, also raised concerns that the 605,000 was almost 100,000 higher than
the number of long-term migrants – those looking to stay for more than a year – who the ONS estimated arrived
during the year.
That suggests short-term migrants or illegal immigrants are also be registering although it may also include those

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long-term migrants who register some time after arriving.
The pressure comes at a time when the NHS is under huge financial pressure and has to find savings of £20 billion
over the next four years.
Earlier this month ministers announced plans to cancel parts of the NHS IT scheme in a move to save £600 million,
while the health service has also has been told to cut management costs by almost a third in coming years.
Sir Andrew Green, chairman of Migrationwatch, said: “This amounts to an open door to primary care which can
also lead to access to secondary care.
"The government has been dithering while the NHS has been struggling to cope with the extra numbers resulting
from mass immigration.
"In present financial circumstances it is surely obvious that we do not have the resources to cope with the extra
ten million people now officially projected over the next 25 years – seven million as a result of immigration.”
The net impact on GPs during 2007/08 was around a third of a million because some 333,000 people also left
during the year but Sir Andrew warned such a high "churn" can also add to the strain.
Matthew Elliott, chief executive of the Taxpayer's Alliance, said: "It is very important that our health care system
does not become a world health service offering free treatment to all and everyone who comes from overseas.
"Especially now the NHS is stretched in many areas it is very worrying that the numbers using it have gone up very
steeply without the necessary increase in support for GPs and hospital staff.
"Existing patients must always come first and it is clearly unacceptable that someone who has paid for the NHS
throughout their working life should face delays or queues as a result of recent immigration using the NHS ahead
of them."
A spokesman for the British Medical Association, said: "Doctors' primary concern is for patients' clinical need. If
people are in the UK legitimately then they have a right to health care and there should be adequate resources in
place to provide this. In reality many doctors find that a lot of migrants are young and healthy and so don't tend to
need to visit their GP very often."
Damian Green, the shadow immigration minister, said: "We have been arguing for years that the pressure on
public services is one of the key reasons for a limit on immigration."
Migrationwatch also criticised the Government for dropping plans to exempt overseas visitors from free NHS
primary care.
The proposal was first raised in 2004 but in July this year it emerged that GPs would continue to maintain their
discretion over who can register with them.
In August last year, midwives warned the quality of NHS care was falling because of a sharp rise in the birth rate
among immigrant mothers.
A Department of Health spokesman said it was often cheaper to treat a patient early on than face a more
complicated case if the problem develops.
He added that any change in the number of people registered at a GP practice is reflected in the funding that
practice receives.
He said: "GPs decide whether they register patients for NHS primary medical care. Access to a GP can have both
public health and cost benefits – it is better and cheaper for a GP to treat a patient at an early stage rather than
risk an emergency hospital admission when a condition becomes acute.
"GPs also play a key role in the provision of public health services such as inoculations and screening, which
protects the health of the British population at large. "

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By JAMES SLACK - More by this author » Last updated at 01:03am on 28th June 2007
Migrants from 130 countries with a high risk of TB are being cleared to live in Britain without any health checks, it
has emerged.
Once here, those with the disease are entitled to free treatment on the Health Service.
The Conservatives said last night that the loophole was fuelling 'health tourism' and any migrant found to have TB
should be placed immediately on a plane back home.
Cases of tuberculosis, which can be deadly if left untreated, are rising at 11 per cent a year, with immigrants
accounting for seven out of ten new cases.
Pre-screening of potential migrants - forcing them to undergo health tests before they are granted a visa to visit
Britain for six months or more - is taking place in only 11 countries.
These are Bangladesh, Cambodia, Eritrea, Ghana, Kenya, Laos, Pakistan, Somalia, Sudan, Tanzania and Thailand.
This is despite 131 other countries being described as officially 'high-risk' of TB, which means there are over 40
cases for every 100,000 residents. The first test migrants from these nations receive is when they arrive at a British
port.
Under Government guidelines, migrants found to have TB on arrival are sent to a GP or NHS hospital, where they
are treated at taxpayers' expense.
The cost of treatment can range from £1,000 for a patient with nonresistant TB to as much as £125,000 for those
with multi-drug resistant TB.
Tory immigration spokesman Damian Green said: 'People who are infected should not be let-out into the
community. There is also clearly a danger of health tourism there, so to some extent we would all feel more
comfortable if people could be told you have got to go home to be treated, you have got an infectious disease.
'They would not have come here without plans to return home if they are coming legally. It would clearly be better
all round if they went straight back home to be treated.'
He added: 'The Government knows this is a long-standing health problem which is getting worse but, despite
promising action, it has not delivered.
'They are screening applicants from very few countries, despite the number regarded as high risk standing at 142
around the world. There is not anything like enough action taking place.'
According to the Health Protection Agency, the majority of patients newly diagnosed with HIV, TB and malaria are
migrants.
Around 70 per cent of new cases of TB in 2004 were found among people born outside the UK. Latestfigures for
2005 show the disease is on the increase, with the biggest rise among people born abroad.
There were 8,113 cases in 2005 - up from 7,321 cases in 2004, a rise of 11 per cent.
Around 300 to 400 people die of TB in the UK each year, with the highest proportion from an Indian, Pakistani and
Bangladeshi ethnic background.
A Home Office spokesman said an expansion of TB pre-screening was being evaluated.
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©2007 Associated Newspapers Ltd · Terms & Conditions · Privacy

Wednesday March 23 2011
The number of people infected with HIV in the UK has almost doubled over the past decade, figures show.
New cases jumped from 1,950 in 2001 to 3,780 in 2010, according to data from the Health Protection Agency
(HPA).
All the cases involve people who acquired HIV in the UK.
Most new cases were among gay men, with a 70% rise in the past 10 years, from 1,810 in 2001 to 3,080 in 2010.
But black Africans are also at high risk, prompting the National Institute for Health and Clinical Excellence (Nice) to
publish new guidance on increasing HIV testing among black African communities.
Professor Mike Kelly, director of the centre for public health excellence at NICE, said: "For many people of black
African heritage there is a fear that being diagnosed HIV positive will result in social exclusion or racism and
prejudice from both inside and outside their community.
"As such there is often a reluctance to be tested which can significantly delay diagnosis."
The new guidance aims to ensure testing is routinely offered to all people who live in an area where there is a high
prevalence of HIV, when registering with a new GP, on admission to hospital, and when having a blood test.
Three out of five people who die from HIV each year received a late diagnosis.
Dr Valerie Delpech, head of HIV surveillance at the HPA, said: "HIV is an extremely serious infection. There are
excellent treatment options available nowadays but these are only at their most effective if the infection is
diagnosed early, before symptoms appear."

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By Joanna Skailes
Published: 04/12/2008
High immigration in Grampian has been partly blamed for the doubling in tuberculosis (TB) figures since 2000.
Figures released by Health Protection Scotland yesterday reveal that TB cases rose from 21 in 2000 to 41 in 2007
while other health board areas remained fairly stable.
The annual report for TB in Scotland stated that at-risk groups included those who misused alcohol, worked in
healthcare, suffered from immunosuppression or lived in a residential care home. People born outside the UK
numbered almost 43% of cases – rising from 24% in 2001.
The report states: “Surveillance data for Scotland shows that the number of cases and the incidence of tuberculosis
have remained relatively stable since 2000 with between 368 and 408 cases per year.”
However, it said that NHS Grampian’s figures had shown a continual rise.
An NHS Grampian spokesman referred to a report written earlier this year, which stated: “The number of cases in
Grampian has almost doubled in the last three years. This contrasts with the overall trend in Scotland which has
been stable over recent years.
“The majority of the increase in Grampian has occurred in people who were not born in the UK. Again, this
contrasts with Scotland overall. In 2006, 40% of cases in Scotland were in people not born in the UK, compared
with 58% in Grampian. In 2007, the proportion of cases in non-UK born people further increased in Grampian to
67%.”
The health board’s report continues: “The increasing number of cases being diagnosed locally in people who were
not born in the UK highlights the need to provide a comprehensive screening service for people coming to
Grampian from countries with high rates of TB. Currently, the screening we offer is very limited and take-up is
low.”

By Rhianna King

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Last updated at 2:19 PM on 20th March 2010

Baroness Ruth Deech has called for a campaign to warn migrants of the risks of marriages between cousins
A rise in the number of marriages between cousins in Britain has prompted calls for a crackdown on the practice
amid warnings it is putting children's health at risk.
Crossbench peer Baroness Deech has called for a 'vigorous' public campaign to deter marriages between family
members, which is common in Muslim and immigrant communities.
Her comments come as figures show up to 75 per cent of British Pakistanis in some areas are married to first
cousins.
In a speech to be made next week, obtained by The Times, the leading family lawyer will warn that such marriages
can be a barrier to the integration of minority communities and increases the risk of birth defects in children.
She is also expected to call for testing for genetic defects when marriages between family members are arranged
and for a register of people carrying genetic diseases to be set up in order for two carriers not to be introduced.
She said such a scheme could be possible in Bradford, which has the UK's highest population of Pakistanis.
Up to three-quarters of Pakistanis in Bradford are married to their first cousins.
The trend is also evident in Birmingham, where figures show that one in ten of all children born to first cousins
died in childhood or suffered from a serious genetic disorder.
More...
Traditional image of marriage being eroded by same-sex unions, warns top family lawyer
British Pakistanis, half of whom marry a first cousin, are 13 times more likely to produce children with genetic
disorders than the general population, according to Government-sponsored research.
Although British Pakistanis account for three per cent of the births in this country, they are responsible for 33 per
cent of the 15 to 20,000 children born each year with genetic defects.
Baroness Deech will also suggest that married first cousins use in-vitro fertilisation so that embryos can be tested

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for recessive diseases.
'Human right and religious and cultural practices are respected not by banning cousin marriage,' she will argue.
'But those involved must be made aware of the consequences.'
In next week's speech, she will say that marriages between cousins is on the rise and the practice is 'at odds with
freedom of choice, romantic love and integration.'
But she said the practice was continuing because of financial reasons - either to settle debts or provide financial
support for relatives abroad; helping relatives to migrate to Britain or wanting to provide a 'ready-made' family for
an immigrant spouse.
Lady Deech will also call for an education campaign to warn of the health risks of such marriages, but will stop
short of urging a ban.
'There is no reason, one could argue, why there should not be a campaign to highlight the risks and preventative
measures, every bit as vigorous as those centring on smoking, obesity and Aids.'

Immigration Minister Phil Woolas caused controversy in 2008 when he warned of birth defects resulting from
marriages between cousins
'Where marriages are arranged, it is possible to test for carrier status and record with results, without stigmatising
individuals.'
Her speech is set to reignite a debate from five years ago when Ann Cryer, the Labour MP for Keighley in
Yorkshire, said cousin marriages were medieval and called for them to be stopped.
Ms Cryer encouraged discussion the issue this week.
'We have been told to be careful, as discussing it could cause deep offence. Blow that, it does not matter. If people
wish to be offended, they will be offended.'
Two years ago Minister Phil Woolas provoked a furore by warning of the health risks of cousin marriages among
British Pakistanis.
He claimed the practice was sending the number of birth defects among children in these communities soaring.
His comments prompted Gordon Brown's spokesman to state that the issue was not one for ministers to comment
on.

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