%0 Journal Article
%T Control of tuberculosis in large cities in developed countries: an organizational problem
%A Joan A Cayl¨¤
%A Angels Orcau
%J BMC Medicine
%D 2011
%I BioMed Central
%R 10.1186/1741-7015-9-127
%X See related article: http://www.biomedcentral.com/1471-2458/11/896 webciteTuberculosis (TB) is a contagious bacterial disease that can be fatal without treatment, and any delay in diagnosis of pulmonary and laryngeal cases increases the chances of transmission. The incidence of TB is greater in large cities than in non-urban areas or in the country as a whole, as Bothamley and colleagues describe in their article published this month in BMC Public Health [1]. The authors also found that cities that did not achieve the target of one nurse per forty TB notifications had worse TB control indicators than cities reaching this target. The authors concluded that control depends on adequate numbers of specialist TB nurses for early detection and case holding. They also observed strikingly high incidences in 2009 in cities such as Manchester (59.1/100, 000) and London (44.4/100, 000) in relation to other English cities. In other western European cities, in general, the incidences were also lower [2,3] (Figure 1). These data led to London appearing widely in the media as 'the European capital of TB' [4] following publication of a paper in The Lancet with the subtitle 'London has one of the highest rates of TB in Western Europe, and the city homeless population are most at risk and the hardest to treat' [5].TB affects the most vulnerable populations, including HIV-infected people, drug abusers, the homeless and immigrants, in a disproportionate way. These populations mostly live in urban settings and, as such, influence TB epidemiology in large developed cities [6,7]. TB control programs have to adapt to any new challenge, and new control strategies should be implemented when a new problem arises [8]. New York City, for instance, had to deal with a serious epidemiological situation when the AIDS epidemic broke out. From 1978 to 1992, the number of patients with TB nearly tripled due to HIV infection, drug resistances and the abandonment of TB programs, but fortunately they wer
%U http://www.biomedcentral.com/1741-7015/9/127